Clinical predictors of severe outcomes in adult and pediatric poisoning patients presenting to emergency departments: a systematic review

Background: Poisoning is a common emergency department presentation and range from mild exposure to life-threatening intoxication. Early identification of patients at high risk for severe outcomes is important because some of the patients look stable at first and then deteriorate later. In this study we aimed to identify clinical predictors associated with severe outcomes in adult and pediatric poisoning patients presenting to emergency departments. Methods: This systematic review included original studies evaluated predictors of severe outcomes in acute poisoning patients. We conduct the literature search in PubMed, Web of Science, Scopus, and Embase from database inception until 2025. Screening was done in two stages, including title and abstract review followed by full-text assessment. Data extracted on study design, population, poisoning type, predictors, severe outcomes, and main findings. Results: A total of 10 studies were included. The studies involved adult, pediatric, and mixed-age populations with different poisoning types, including acute drug overdose, salicylate poisoning, amitriptyline poisoning, diphenhydramine toxicity, and general acute poisoning. Severe outcomes included mortality, intensive care unit admission, intubation, and adverse cardiovascular events. Predictors include clinical findings, lactate, electrocardiographic abnormalities, age-related factors, inflammatory biomarkers, and clinical prediction models. Conclusion: Severe outcomes in poisoning predicted by a combination of clinical, laboratory, ECG, and age-related factors rather than one single predictor.