Comment on "Applicability of different scoring systems in outcome prediction of patients with mixed drug poisoning-induced coma".

Sir,

We read with interest the study performed by Eizadi Mood and colleagues entitled “Applicability of different scoring systems in outcome prediction of patients with mixed drug poisoning-induced coma” recently published in the Indian Journal of Anaesthesia.[1] The authors have compared the applicability of the different scoring systems in the prediction of outcome of the patients admitted with multidrug poisoning (MDP)-induced coma. Although an interesting and practical study, some concerns rise while reading it. The first one is about their inclusion and exclusion criteria. Excluding the intoxications due to acetaminophen, paraquat, organophosphates, etc. just because they have previously been evaluated does not seem correct to us. Efficacy of a scoring system is best determined when evaluated in every type of intoxication in the authors’ setting.

Secondly, as the authors have themselves mentioned, they have evaluated the sensitivity and specificity of each scoring system. We think, however, it would have been much better and more accurate if they had determined the positive and negative predictive values for each system as well, especially because they have not provided sensitivity and specificity for all systems.

Finally, a Mainz Emergency Evaluation Scores (MEES) score is obtained before and after pre-hospital intervention to assess patient improvement or deterioration. It does not allow outcome prediction, but provides an easy and reliable assessment of pre-hospital care.[2]

We would like to very much thank the authors for this interesting study.