UMEM Educational Pearls

Title: Clinical severity score for acute poisoned patients ICU requirement score (IRS)

Keywords: ICU requirement score, physiologic score system (PubMed Search)

Posted: 8/19/2021 by Hong Kim, MD, MPH (Updated: 8/20/2021)
Click here to contact Hong Kim, MD, MPH

There are several clinical scoring systems (SAPS II, SAPS III, SOFA, etc.) to assess the severity and/or risk of mortality in critically ill patients. However, the routinely used physiologic scoring systems are not always suitable for poisoned patient.

ICU requirement score (IRS) has been recently developed by investigators from Europe and a validation study (retrospective cohort) has been performed.

ICU requirement score (IRS) components (see inserted table)

Age
Systolic blood pressure
Heart rate
GCS
Type of intoxication
Comorbidities (dysrhythmia, cirrhosis, and/or respiratory insufficiency, secondary diagnosis requiring ICU admission)

Retrospective cohort

Study duration: Jan 1, 2009 to Dec 31 ,2019
Positive IRS score: >= 6
Comparison to SAPS II, SAPS III, SOFA score, and PSS
End point: need for ICU treatment

Results

N=1503

Area under the curve for IRS ROC: 0.736 (95% CI: 0.702-0.770)

IRS <6

Negative predictive value: 95% (95% CI: 93-97)
Positive predictive value: 21% (95% CI: 18-24)
Sensitivity: 89% (95% CI: 85-93)
Specificity: 38% (95% CI:36-41)

Conclusion

IRS of < 6 demonstrated excellent negative predictive value for ICU admission.
A larger study of ICU requirement score will be needed to further assess its usefulness/limitation prior to clinical use.

References

Brandenburg R et al. The need for ICU admission in intoxicated patients: a predition model. Clin Toxicol (Phila) 2017. https://doi.org/10.1080/15563650.2016.1222616
El Gharbi F. et al. Does the ICU requirment score allow the poisoned patient to be safely managed without admission to the intensive care unit? - a validation cohort study. Clin Toxicol (Phila) 2021. https://doi.org/10.1080/15563650.2021.1961145

Attachments

2108191337_Untitled.pdf (252 Kb)