Study objective: The assessment of patients with poisoning should include assessment of psychiatric details, the level of consciousness, and clinical features occurring in a number of toxidromes (toxicology syndromes). To ensure these aspects were routinely covered, we introduced a preformatted chart (PFC) to record our poisoning admissions. The aim of our study was to determine whether using a PFC improved the quality, accuracy, and completeness of the data obtained from admissions with poisoning.
Methods: Clinical details recorded on patients admitted with tricyclic antidepressant, neuroleptic, or carbamazepine poisoning between 1987 and 1994 were compared according to whether a PFC was used. A large number of items of history and examination of interest in poisonings were analyzed. The reproducibility of the findings recorded on the PFCs was measured in 20 patients. Findings initially recorded on the chart in the emergency department were compared with those recorded within the next 30 minutes by a second more experienced observer who did not have reference to the initial record.
Results: There were large and statistically significant differences in the completeness of recording of neurologic examination, such as pupil size (100% versus 68%), conjugate eye movements (97% versus 35%), deep tendon reflexes (97% versus 51%), and in the percentage that were reported as having abnormal signs, such as dilated pupils (26% versus 14%), nystagmus (12% versus 5%), and hyperreflexia (19% versus 8%). In all cases, more information was recorded when a PFC was used; however, the differences were small for items such as vital signs and drugs ingested. Agreement between 2 observers for history and examination was moderate to good, with items on history and level of consciousness generally recorded with greater agreement than other examination findings, perhaps reflecting fluctuations in these signs.
Conclusion: Data collected prospectively with a PFC collects more information than can be obtained retrospectively from case records. In particular, the validity of data on clinical signs on presentation gained from retrospective chart review is questionable. Centers that are interested in collecting data on series of poisonings would benefit from using a PFC or some other systematic prospective method of data collection.