EMERGENCY DEPARTMENT MANAGEMENT AND IN HOSPITAL OUTCOMES OF ORGANOPHOSPHATE POISONING IN YOUNG ADULTS AGED 18–35 YEARS PRESENTING TO THE EMERGENCY DEPARTMENT OF TERTIARY CARE HOSPITAL

Abstract

Objective: To describe the emergency department management and determine the in-hospital outcomes of young adults (18–35 years) with acute organophosphate poisoning presenting to the emergency department of the tertiary care hospital, and to assess the association of presentation delay and admission Peradeniya Organophosphorus Poisoning (POP) severity category with in-hospital mortality. Study Design: Prospective, observational cohort study. Setting: Accident & Emergency Department, Jinnah Postgraduate Medical Centre (JPMC), Karachi. Period: December 2025 to March 2026. Material & Methods: One hundred and sixty-three patients aged 18–35 years meeting the operational definition of acute organophosphate poisoning were enrolled by non-probability purposive sampling. A structured proforma recorded demographics, exposure and presentation-delay details, arrival vital signs and POP score, emergency management delivered, complications, and final disposition. Data were entered and analyzed in SPSS v26. Quantitative variables were summarized as mean ± SD or median (IQR) according to normality (Shapiro–Wilk) and compared between survivors and non-survivors using the independent-samples t-test or Mann–Whitney U test; categorical variables were compared using the Chi-square or Fisher's exact test. Associations of presentation delay and POP severity category with mortality were expressed as odds ratios (OR) with 95% confidence intervals (CI); because no deaths occurred in the ≤2-hour delay group (zero-cell/quasi-complete separation), Firth's penalized logistic regression was used for the adjusted analysis. Statistical significance was set at p≤0.05. Results: Mean age was 24.9±4.7 years; 96 (58.9%) were male, and 135 (82.8%) presentations followed intentional self-harm. All patients received atropine and 124 (76.1%) also received pralidoxime. Of 163 patients, 17 died, 2 left against medical advice and 2 were transferred (excluded from the mortality denominator per protocol); in hospital mortality among the remaining 159 was 10.69% (95% CI 6.78–16.46%). All 17 deaths occurred among patients presenting more than 2 hours after exposure (0/55 vs 17/104; Fisher's exact p=0.0007), and mortality rose from 1.3% (Mild) to 10.0% (Moderate) to 41.7% (Severe) across POP severity categories (trend p<0.001). On Firth-penalized logistic regression, Severe admission POP category remained an independent predictor of mortality (adjusted OR 18.26, 95% CI 3.05–109.50, p=0.0015). Conclusion: Presentation delay and admission POP severity category are strongly associated with in-hospital mortality in young adults with organophosphate poisoning; POP severity independently predicts death even after adjustment, supporting POP-based triage at arrival and renewed efforts to shorten pre-hospital delay.