METHODOLOGY

METHODOLOGY
 METHODOLOGY

METHODOLOGY

• Study setting: Tertiary rural health care centre.

• Study design: Cross sectional study.

• Study population: All cases of organophosphorus compound poisoning attended in casualty

at tertiary health care centre satisfying the inclusion criteria.

• Sample size: All patients of organophosphorus compound poisoning attended in casualty

from October 2022 to December 2023 at tertiary health care hospital.

• Study duration: From June 2022 to Nov 2024.

SELECTION CRITERIA

Inclusion Criteria:

1. All patients of organophosphorus compound poisoning brought to the casualty of tertiary

care hospital.
2. Patients showing Characteristic symptoms and signs of Organophosphorus compound
poisoning and characteristic odor of stomach wash or vomitus; and examination of the
container when available.
3. All patients of either sex and age group above 12 years are included.

Exclusion Criteria:

1. Patients with occupational exposure to organophosphorus compound poisons.

2. Patients with Non-organophosphorus compound poison consumption.

3. Patient with history of mixed poisoning consumption.

Ethical Clearance :

After approval from institutional ethics committee study was conducted.

Methodology And Material

• After obtaining approval from the institutional ethical committee, the study was conducted on
all patients admitted during the stipulated study duration who satisfied the inclusion criteria.
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• Their serum Cholinesterase levels in plasma values were estimated using the kinetic method,
and patients were classified based on severity, which was then correlated to assess severity and
outcome in patients of organophosphorus compound poisoning.
• Patients were also scored based on the Peradeniya organophosphorus poisoning scale (POP
scale), and then classified based on severity, which was used to assess the severity and outcome
in patients of organophosphorus poisoning.
• Detailed records of this were maintained and were used for statistical analysis.
• The end result was documented in the form of charts and tables.

Data Collection Method

• Patients attending the tertiary health care Centre emergency were included as subjects in the
study if they exhibited a history of contact or exposure and clinical features of
organophosphorus compound poisoning.
• Written and informed consent was taken as per proforma.
• The study of subjects was substantiated with proper history taking about the course of
poisoning and clinical status of the patient. Diagnosis was confirmed by assessing the patients
clinically and performing baseline investigations. An elaborate study of these patients with
regards to the date of admission, history given by the patient/attendant, type of poison
consumed, amount of poison consumed, duration since consumption of poison, various clinical
features in due course of poisoning, demographic variables, essential investigations, and
management was done.
• Peradeniya organophosphorus scale (POP Scale) was used in patients of organophosphorus
poisoning. According to the clinical components of the POP scale which include pupil size,
respiratory rate, heart rate, fasciculations, level of consciousness, seizures, patients were scored
0/1/2 points. Total points were calculated, and a score out of 11 was given to patients. Based
on this score, patients were classified into mild (0-3), moderate (4-7), severe (8-11) grade. After
the grading was done, this data was used to assess severity and outcome in patients of
organophosphorus compound poisoning. Outcome in terms of morbidity, mortality, and
survival was assessed.
• Serum cholinesterase levels were calculated in patients of organophosphorus compound
poisoning by testing blood. Plasma blood samples were utilized to calculate plasma
cholinesterase levels in the blood of patients with organophosphorus compound poisoning.
Depending on the levels, patients were classified into mild, moderate, and severe grades, and
 METHODOLOGY

this classification was used in assessing the severity and outcome in these patients of
organophosphorus compound poisoning. Outcome in terms of morbidity, mortality, and
survival was assessed.
• Along with Serum cholinesterase, CBC by cell counter analyzer HORIBA 5 parts (YUMIHEM
H550), RFT-by ion-selective electrode method (PROLYTE), LFT by fully automated EM 200,
Urine routine- by physical, chemical, and microscopy examination were done in patients with
Organophosphorus compound poisoning.

Assessment:

• Evaluation of patients was done in terms of risk factors, clinical features, basic clinical
examination, laboratory investigations including microbiological findings, treatment, and
outcome.
• It was assessed whether morbidity and mortality could be predicted using the POP scale and
serum cholinesterase levels in patients of Organophosphorus compound poisoning and if this
prediction could be used for better management of patients.

Peradeniya Organophosphorus Poisoning (POP) scale62,63

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SERUM CHOLINESTERASE ESTIMATION:

Principle:

Butyrylcholine iodide is hydrolysed by cholinesterase to produce thiocholine in the presence

of potassium hexacyanoferrate, the absorbance decrease at 405nm is directly proportional to
the cholinesterase activity in the sample.

Reagent:

RI-Buffer reagent

R II-Butyryl thiocholine iodide reagent

Sample:

Use non-hemolysin serum, Heparin or EDTA plasma

Reference Level: 4850-12000 U/L.

DATA ANALYSIS:

• Collected data was entered into Microsoft Excel. For categorical variables, data were presented
as numbers and percentages, and for continuous variables, data were presented as mean and
variable.
• Data analysis was done using SPSS version 20.0.
• The diagnostic accuracy of Peradeniya organophosphorus poisoning scale and serum
cholinesterase levels was identified based on sensitivity, specificity, positive predictive value,
and negative predictive value.
• A p-value <0.05 was considered significant. Based on the results, the better marker between
Peradeniya organophosphorus poisoning scale and serum cholinesterase was identified.