Lethality of suicidal organophosphorus poisoning in an Indian population: exploring preventability

BACKGROUND: Suicide by organophosphorus poisoning is common in India. Study of factors associated with lethality may suggest methods for prevention. METHODS: Severity of symptoms, biochemical manifestation of poisoning, degree of lethality and the outcome were studied with an aim to explore the modifiable factors associated with lethality and to discuss preventability. Clinical variables were collected; symptoms were rated by the physicians using global impression of severity; and the lethality was assessed by scale for assessment of lethality of suicide attempt (SALSA), in 100 consecutive patients with suicidal organophosphorus poisoning attending a medical college hospital in South India. RESULTS: Fatal outcome (n = 26) was significantly associated with higher mean age, lower mean pseudocholinesterase level, longer duration between organophosphorus compound ingestion and specific intervention. All those who died had respiratory failure. Physicians' assessment of symptom severity and lethality as assessed by the SALSA could differentiate those succumbed and survived in a significant proportion. CONCLUSION: Majority of cases of organophosphorus poisoning were associated with severe symptoms and higher lethality. Intervention facilities decreasing the period between the ingestion of poison and initiation of treatment might prevent many deaths. Measures like restricting availability and banning more toxic organophosphorus compounds may help.