CAA305 AT2 PTA - Organophosphate poisoning Assignment

CASP 1 - Effectiveness of Fresh Frozen Plasma in Management of Acute Organophosphate Intoxicated Patients: An Updated Systematic Review and Meta-Analysis.

This systematic review did address a clearly focused question because it had a specific population (organophosphate intoxicated patients), a specific outcome considered (possible improvement of the patient's condition), and a specific intervention given (fresh frozen plasma). The authors did look for the right type of papers as the majority of references used addressed the role of fresh frozen plasma relative to organophosphate intoxicated patients. Multiple references used by the authors were also randomized controlled trials, thus were appropriate for use in this systematic review. I do think all the important, relevant studies were included by the author because there is a wide variety of bibliographic databases. However, there seems to be no non-English language studies which may be restricting the quality of papers used for this study. The authors did do enough to assess the quality of the papers included in their review because all included studies were extremely thorough. However, there were 2 studies that had been published more than 10 years ago. Despite these 2 studies being older, they still held value and contributed to the review because they had similar findings to more recently published studies that were included. The results of the review have not been combined which was appropriate because there was notable variation between the results of included studies. The overall results of the review indicated that the use of fresh frozen plasma in acutely organophosphate poisoned patients did not provide any additional benefit compared to standard therapy. The results were expressed by the mean difference of changes in atropine, pralidoxime, length of hospital stay, and mortality when fresh frozen plasma was used. The results of this review were relatively precise, however, there was a limited number and sample size of the included trials. This was acknowledged in the limitations. The results can be applied to the local population as the population used was organophosphate intoxicate patients which although uncommon in Australia, is a possibility. All important outcomes were considered as it included the effect of fresh frozen plasma when used in conjunction with standard pharmacological agents and supportive care. This review also considered the degree of organophosphate intoxication in its results section. Based on this review, the benefits of fresh frozen plasma for the treatment of organophosphate intoxicated patients is not worth the costs and potential harms. 

CASP 2 - Utility of 2-Pyridine Aldoxime Methyl Chloride (2-PAM) for Acute Organophosphate Poisoning: A Systematic Review and Meta-Analysis. 

 The review did address a clearly focused question as there was a specific population (acutely organophosphate poisoned patients), a specific outcome considered (possible improvement of the patient's condition), and a specific intervention given (2-PAM). The authors did look for the right papers as all the included studies addressed organophosphate poisoned patients, the efficacy of atropine as a treatment, or the efficacy of 2-PAM for treatment. Additionally, all studies included were randomized controlled trials which is an appropriate study design for papers evaluating interventions. I do think all the important, relevant studies were included because the bibliographical databases used included PubMed, EMBASE, SCOPUS, and employed the assistance of a medical librarian. Additionally, the bibliographies of all included studies were reviewed in case there were some papers that were not found through the databases. However, all included articles were limited to the English language. The authors did do enough to assess the quality of the studies included by ensuring all papers were thorough and relevant. This was achieved by reaching a consensus and following the search criteria. The combining of results was appropriate for this review because the results of different studies are similar and contribute to the review question. Additionally, the results of all the included studies were clearly identifiable and any reasons for variations are discussed in the results. The overall results of the review are that the use of 2-PAM in addition to atropine when treating patients with acute organophosphate poisoning does not improve outcomes. The results were expressed by quantifying patient outcomes in several categories including mortality, rate of invasive ventilation, and other complications. The results are precise, however, the precise organophosphorus chemical agent that poisoned patients was unspecified. The results can be applied to the local population, however, there is variation. The population included in this study is developing countries, thus may differ from the population of developed countries. The majority of important outcomes were considered. The only other considerations are pediatrics and patients in developed countries. The benefits are not worth the costs and possible harms, although further study with different oxides may prove worthwhile.