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Poisoning is the most common mode of unnatural death in South East Asia, causing hundreds of thousand deaths per year. Organophosphorus (OP) compounds are commonly used as pesticides. Easy availability and widespread use has increased the likelihood of poisoning with these compounds. The present study was done to predict severity in acute organophosphate poisoning with clinical scoring and serum pseudocholinesterase levels. Total 60 patients of acute organophosphorus poisoning patients are enrolled in the study after fulfilling inclusion and exclusion criteria. The study was done at IGMC Shimla, Himachal Pradesh in the period of June 2018 to July 2019. POP score was applied and serum pseudocholine esterase levels are estimated. Suitable statistical methods applied to assess correlation and variables. Majority of patients were aged between 21 to 40 years, with M:F ratio of 2:1. Most common consumed compound was chlorpyriphos and mainly for suicidal intent. Bradycardia was the most common clinical feature. There was significant correlation between the severity of poisoning categorized by the POP scale and the serum cholinesterase at the time of initial presentation of the patients, requirements of atropine on the first day of admission, the total amount of dose of atropine, atropine needed and the average duration of hospital stay(<0.01) . We concluded that POP score scale is useful for determining the severity of the poisoning. POP scale can be used to treat OP poisoning patients in terms of need of ventilator, hospital stay and atropine dose; at the same time being important indicator of mortality. POP scale can be used readily in all level of health care from primary to tertiary level health care. [ABSTRACT FROM AUTHOR]