A clinical decision aid for triage of children younger than 5 years and with organophosphate or carbamate insecticide exposure in developing countries

Ann Emerg Med. 2008 Dec;52(6):617-22. doi: 10.1016/j.annemergmed.2008.03.026. Epub 2008 Jun 16.


Study objective: Unintentional pediatric exposure to insecticides is common in developing countries. A clinical decision aid could guide early triage decisionmaking.

Methods: Study design was prospective observational data collection in a specialty poisoning hospital in Cairo, Egypt. Patients were children 2 months to 59 months of age, without pretreatment, presenting within 2 hours of an exposure to an organophosphate or carbamate insecticide. A resource-requiring course was defined as any occurrence of hypoxia, use of atropine or obidoxime, use of ICU care, or death. The goal of analysis was derivation of a clinical decision aid to predict a resource-requiring course with 100% sensitivity.

Results: During the 21-month study, 197 children 2 months to 59 months of age exposed to an organophosphate or carbamate insecticide were treated at the center. One hundred two of these children met the study inclusion criteria: 95 had parental consent and completed the study observation period of which 65 used resources (4 died). All patients who ultimately met resource-requiring criteria initially did so at arrival. Pinpoint pupil alone identified 63 of 65 of these patients yet wrongly identified only 5 of 30 minimally ill patients. Pinpoint pupil or diarrhea identified 65 of 65 patients with a resource-requiring course while identifying 7 of 30 patients with a non-resource-requiring course (sensitivity 1.00; 95% confidence interval 0.95 to 1.00; specificity 0.77; 95% confidence interval 0.58 to 0.90).

Conclusion: Using 2 features, pinpoint pupils and diarrhea, we identified at presentation all patients who ultimately had a course using medications or advanced resources. According to this preliminary study, symptoms occur rapidly, so using an early triage aid may be feasible. A validation study is necessary.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Atropine / therapeutic use*
  • Carbamates / poisoning*
  • Child, Preschool
  • Cholinesterase Reactivators / therapeutic use*
  • Decision Making*
  • Developing Countries*
  • Egypt
  • Environmental Exposure / adverse effects*
  • Female
  • Humans
  • Infant
  • Insecticides / poisoning*
  • Male
  • Muscarinic Antagonists / therapeutic use*
  • Obidoxime Chloride / therapeutic use*
  • Organophosphate Poisoning*
  • Poison Control Centers / statistics & numerical data*
  • Poisoning / classification
  • Poisoning / diagnosis
  • Poisoning / drug therapy*
  • Prospective Studies
  • Triage


  • Carbamates
  • Cholinesterase Reactivators
  • Insecticides
  • Muscarinic Antagonists
  • Obidoxime Chloride
  • Atropine