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Suekane A, Takayama W, Hashimoto R, Morishita K, Otomo Y. Risk factors for recurrence of suicide attempt via overdose: A prospective observational study. Am J Emerg Med 2024; 75:1-6. [PMID: 37890336 DOI: 10.1016/j.ajem.2023.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 09/19/2023] [Accepted: 10/06/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Although the prevalence of drug overdose has gradually increased worldwide, the risk factors associated with the recurrence of suicide attempts via drug overdose have not been well elucidated. In this study, we investigated the clinical course of patients with drug overdose and whether or not patients reattempted suicide via overdose, using telephone interviews, to evaluate the risk factors associated with overdose recurrence. METHODS This prospective observational study enrolled patients who attempted suicide by drug overdose and were transferred to a tertiary emergency hospital in Japan between January 1, 2015 and July 30, 2021. Recurrence of overdose within 1 year of admission for overdose was designated as the primary outcome. Multivariable logistic regression analysis was performed to assess the independent risk factors for the recurrence of overdose. Furthermore, we compared the difference in the recurrence interval between patients with and without cohabitants using the log-rank test. RESULTS A total of 94 patients were identified, and recurrence of overdose was observed in 28 patients (29.8%). The median recurrence interval was 6.0 months [IQR (interquartile range), 4.0-7.0 months]. The recurrence rate was significantly higher in patients with a history of schizophrenia than that in patients without a history of schizophrenia (58.3% vs 25.6%, p = 0.048), and significantly lower in patients with cohabitants than that in patients without cohabitants (22.6% vs 43.8%, p = 0.015). The presence of a cohabitant was significantly associated with a longer recurrence interval (p = 0.049). The effect of psychiatric intervention during hospitalization and psychiatric visits after discharge could not be found in this study. CONCLUSIONS A history of schizophrenia was an independent risk factor for the recurrence of overdose, and the presence of a cohabitant was significantly associated with a lower risk of recurrence. Large-scale, long-term studies are required to confirm the results of this study.
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Affiliation(s)
- Akira Suekane
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital, 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan
| | - Wataru Takayama
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital, 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan; Department of Acute Critical Care and Disaster Medicine, Graduate School of Tokyo Medical and Dental University, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan.
| | - Rio Hashimoto
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital, 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan
| | - Koji Morishita
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital, 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan
| | - Yasuhiro Otomo
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital, 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan; Department of Acute Critical Care and Disaster Medicine, Graduate School of Tokyo Medical and Dental University, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan
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Keenan M, Rice S, Frawley E, Jacques C, Wojcik S, Marraffa J. Rate of Adverse Outcomes During 6-Hour Observation for Asymptomatic Patients with Select Ingestions. J Med Toxicol 2023:10.1007/s13181-023-00954-2. [PMID: 37294525 DOI: 10.1007/s13181-023-00954-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/24/2023] [Accepted: 06/01/2023] [Indexed: 06/10/2023] Open
Affiliation(s)
- Michael Keenan
- Department of Emergency Medicine, SUNY Upstate Medical University, 750 East Adams St, Syracuse, NY, 13210, USA.
- Upstate New York Poison Control Center, 750 East Adams St, Syracuse, NY, 13210, USA.
| | - Stephen Rice
- Department of Emergency Medicine, SUNY Upstate Medical University, 750 East Adams St, Syracuse, NY, 13210, USA
| | - Emma Frawley
- Department of Emergency Medicine, SUNY Upstate Medical University, 750 East Adams St, Syracuse, NY, 13210, USA
| | - Chelsie Jacques
- Department of Surgery, New York Medical College at Metropolitan Hospital Center, 1901 1st Ave., New York, NY, 10029, USA
| | - Susan Wojcik
- Department of Emergency Medicine, SUNY Upstate Medical University, 750 East Adams St, Syracuse, NY, 13210, USA
| | - Jeanna Marraffa
- Department of Emergency Medicine, SUNY Upstate Medical University, 750 East Adams St, Syracuse, NY, 13210, USA
- Upstate New York Poison Control Center, 750 East Adams St, Syracuse, NY, 13210, USA
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Uzucek DM, Yildiz D, Urfalioglu AB, BugraYapici S, Sener K, Avci A, Yolcu S. Lactate for Predicting the Prognosis of Multi-Drug Poisoned Patients. Ethiop J Health Sci 2023; 33:107-114. [PMID: 36890943 PMCID: PMC9987290 DOI: 10.4314/ejhs.v33i1.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/08/2022] [Indexed: 03/10/2023] Open
Abstract
Background We aimed to compare serum lactate levels of multi-drug poisoned patients to determine whether knowing the level may help emergency clinicians in predicting the patients' prognoses. Methods The patients were divided into two groups according to the number of kinds of drugs taken (Group 1: patients took 2 kinds of drugs; Group 2: patients took 3 or more kinds of drugs). The groups' initial venous lactate levels, lactate levels before discharge, lengths of stay in the emergency department, hospitalisation units, clinics, and outcomes were recorded on the study form. These findings of the patient groups were then compared. Results When we evaluated the first lactate levels and lengths of stay in the emergency department, we found that 72% of the patients with initial lactate levels ≥13.5 mg/dL stayed more than 12 hours in the emergency department. Twenty-five (30.86%) patients in the second group stayed ≥12 hours in the emergency department, and their mean initial serum lactate level was significantly related (p=0.02, AUC=071). The mean initial serum lactate levels of both groups were positively related with their lengths of stay in the emergency department. The mean initial lactate levels of patients who stayed ≥12 hours and those who stayed <12 hours in the second group were statistically significant, and the mean lactate level of the patients who stayed ≥12 hours in the second group was lower. Conclusions Serum lactate levels may be helpful in determining a patient's length of stay in the emergency department in the case of multi-drug poisoning.
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Affiliation(s)
- Durdu Mehmet Uzucek
- Department of Anaesthesiology, Chettinad Hospital and Research Institute, Tamil Nadu, India
| | - Dervis Yildiz
- Department of Anaesthesiology, Chettinad Hospital and Research Institute, Tamil Nadu, India
| | - Ahmet Burak Urfalioglu
- Department of Anaesthesiology, Chettinad Hospital and Research Institute, Tamil Nadu, India
| | - Satuk BugraYapici
- Department of Anaesthesiology, Chettinad Hospital and Research Institute, Tamil Nadu, India
| | - Kemal Sener
- Department of Anaesthesiology, Chettinad Hospital and Research Institute, Tamil Nadu, India
| | - Akkan Avci
- Department of Anaesthesiology, Chettinad Hospital and Research Institute, Tamil Nadu, India
| | - Sadiye Yolcu
- Department of Anaesthesiology, Chettinad Hospital and Research Institute, Tamil Nadu, India
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Capua M, Amlicke M, Esposito E, Belfer J, Bellis M, Falkowitz D, Teng D. Time of Observation in Xenobiotic Ingestions in Children: Is 6 Hours Too Long? Pediatr Emerg Care 2023; 39:e24-e29. [PMID: 35439241 DOI: 10.1097/pec.0000000000002707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Children endure a prolonged observation after xenobiotic ingestions, despite low associated morbidity and mortality. The primary objective was to describe the management and outcomes of acute xenobiotic exposures in asymptomatic pediatric patients presenting to the emergency department (ED). A secondary objective was to explore the impact of vital signs on the patients' management and outcomes. METHODS We conducted a retrospective review of asymptomatic children (younger than 18 years) presenting to a pediatric ED after a toxic ingestion from 2014 to 2018. Ingestions of hydrocarbons, acetaminophen, salicylates, sulfonylureas, caustic, and/or extended release agents were excluded. Demographic and clinical data were abstracted. RESULTS Of 2817 charts, we identified 109 asymptomatic patients with a mean age of 4.7 years. The average observation from registration to disposition was 4.06 hours. Five patients were admitted and were subsequently discharged within 24 hours. Of the discharged patients, 2 returned within 72 hours and were subsequently discharged home. A total of 321 asymptomatic patients presented with ≥1 abnormal vital signs (mean age, 6.6 years) and were observed in the ED for an average of 4.54 hours. They had a higher percentage of ingestions related to suicide attempts (odds ratio, 6.8). Twenty-two were admitted. Of those discharged home, 11 returned to the ED within 72 hours; all were subsequently discharged home. CONCLUSIONS Prolonged observations may not be necessary after ingestions in asymptomatic children. Vital sign abnormalities at presentation did not impact disposition. Prospective studies are needed to determine the safety and efficacy of this shortened observation.
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Affiliation(s)
- Maya Capua
- From the Division of Pediatric Emergency Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Maire Amlicke
- Division of Pediatric Emergency Medicine, Cohen Children's Medical Center, New Hyde Park, NY
| | - Emily Esposito
- St. George's University Medical School, West Indies, Grenada
| | - Joshua Belfer
- Division of Pediatric Emergency Medicine, Cohen Children's Medical Center, New Hyde Park, NY
| | - Mitchell Bellis
- New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY
| | | | - David Teng
- Division of Pediatric Emergency Medicine, Cohen Children's Medical Center, New Hyde Park, NY
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Breed R, Mazer-Amirshahi M, Spiegel R. Delayed QT Prolongation: Derivation of a Novel Risk Factor for Adverse Cardiovascular Events From Acute Drug Overdose: January 2023 Annals of Emergency Medicine Journal Club. Ann Emerg Med 2023; 81:104-105. [PMID: 36543482 DOI: 10.1016/j.annemergmed.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Rebecca Breed
- Department of Emergency Medicine MedStar Washington Hospital Center and Georgetown University School of Medicine, Washington, DC
| | - Maryann Mazer-Amirshahi
- Department of Emergency Medicine MedStar Washington Hospital Center and Georgetown University School of Medicine, Washington, DC
| | - Rory Spiegel
- Department of Emergency Medicine MedStar Washington Hospital Center and Georgetown University School of Medicine, Washington, DC
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Wiersma T, van den Oever HLA, van Hout FJHA, Twijnstra MJ, Mauritz GJ, van 't Riet E, Jansman FGA. The performance of COBRA, a decision rule to predict the need for intensive care interventions in intentional drug overdose. Eur J Emerg Med 2022; 29:126-133. [PMID: 34560700 DOI: 10.1097/mej.0000000000000877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND COBRA was developed as a decision rule to predict which patients visiting the emergency department (ED) following intentional drug overdose will not require intensive care unit (ICU) interventions. COBRA uses parameters from five vital systems (cardiac conduction, oxygenation, blood pressure, respiration, and awareness) that are readily available in the ED. COBRA recommends against ICU admission when all these parameters are normal. OBJECTIVE The primary aim of this study was to determine the negative predictive value (NPV) of COBRA in predicting ICU interventions. Secondary outcomes were the sensitivity, specificity and positive predictive value (PPV), and the observation time required for a reliable prediction. DESIGN Observational cohort study. SETTINGS AND PARTICIPANTS Patients with a reported intentional overdose with drugs having potential acute effects on neurological, circulatory or ventilatory function were included, and data necessary to complete the decision rule was collected. The attending physician in the ED made the actual admission decision, on the basis of clinical judgement. COBRA was measured 0, 3 and 6 h after arrival at the ED. OUTCOME MEASURES Need for ICU interventions (treatment of convulsion; defibrillation; mechanical or noninvasive ventilation; intravenous administration of vasopressive agents, antiarrhythmics, atropine, calcium, magnesium or sedation; continuous hemofiltration or administration of antagonist/antidote and fluid resuscitation). MAIN RESULTS Of 230 new cases (144 unique patients), 59 were immediately referred to the psychiatric services and/or sent home by the attending physician, 27 went to a regular ward, and 144 were admitted to the ICU. Of these 144 cases, 40 required one or more ICU interventions. By the time the first parameters were collected, the NPV of COBRA was 95.6%. After 3 h of observation, NPV was 100%, while sensitivity, specificity and PPV were 100, 61.1 and 35.1%, respectively. None of these values improved by prolonging the observation time to 6 h. CONCLUSION In patients with a reported intentional overdose with drugs having potential acute effects on neurological, circulatory or ventilatory function, the COBRA decision rule showed good performances in predicting the need for intensive care interventions, with a NPV of 100% after 3 h of observation.
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Affiliation(s)
| | | | | | | | - Gert-Jan Mauritz
- Department of Emergency Medicine, Rijnstate Teaching Hospital, Arnhem
| | | | - Frank G A Jansman
- Department of Clinical Pharmacy, Deventer Hospital, Deventer
- Unit of PharmacoTherapy, Epidemiology & Economics, Groningen Research Institute of Pharmacy (GRIP), University of Groningen, Groningen, The Netherlands
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Shastry S, Aluise ER, Richardson LD, Vedanthan R, Manini AF. Delayed QT Prolongation: Derivation of a Novel Risk Factor for Adverse Cardiovascular Events from Acute Drug Overdose. J Med Toxicol 2021; 17:363-371. [PMID: 34449039 PMCID: PMC8455785 DOI: 10.1007/s13181-021-00855-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/18/2021] [Accepted: 07/19/2021] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION In ED patients with acute drug overdose involving prescription medication and/or substances of abuse, severe QTc prolongation (> 500 ms) is predictive of adverse cardiovascular events (ACVE), defined as myocardial injury, ventricular dysrhythmia, shock, or cardiac arrest. However, it is unclear whether delayed severe QTc prolongation (dsQTp) is a risk factor for ACVE and if specific clinical factors are associated with occurrence of dsQTp. METHODS A secondary analysis of a prospective cohort of consecutive adult ED patients with acute drug overdose was performed on patients with initial QTc < 500 ms. The predictor variable, dsQTp, was defined as initial QTc < 500 ms followed by repeat QTc ≥ 500 ms. The primary outcome was occurrence of ACVE. Multivariable logistic regression was performed to test whether dsQTp was an independent predictor of ACVE and to derive clinical factors associated with dsQTp. RESULTS Of 2311 patients screened, 1648 patients were included. The dsQTp group (N = 27) was older than the control group (N = 1621) (51.6 vs 40.2, p < 0.001) and had a higher number of drug exposures (2.92 vs 2.16, p = 0.003). Following adjustment for age, sex, race/ethnicity, number of exposures, serum potassium, and opioid exposure, dsQTp remained an independent predictor of ACVE (aOR: 12.44, p < 0.0001). Clinical factors associated with dsQTp were age > 45 years and polydrug (≥ 3) overdoses. CONCLUSION In this large secondary analysis of ED patients with acute drug overdose, dsQTp was an independent risk factor for in-hospital occurrence of ACVE.
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Affiliation(s)
- Siri Shastry
- grid.416167.3Department of Emergency Medicine, Icahn School of Medicine At Mount Sinai, Mount Sinai Hospital, 555 West 57th Street, 5th Floor, New York, NY 10019 USA
| | - Eleanor R. Aluise
- grid.416167.3Department of Emergency Medicine, Icahn School of Medicine At Mount Sinai, Mount Sinai Hospital, 555 West 57th Street, 5th Floor, New York, NY 10019 USA
| | - Lynne D. Richardson
- grid.416167.3Department of Emergency Medicine, Icahn School of Medicine At Mount Sinai, Mount Sinai Hospital, 555 West 57th Street, 5th Floor, New York, NY 10019 USA ,grid.59734.3c0000 0001 0670 2351Department of Population Health Science and Policy, Icahn School of Medicine At Mount Sinai, New York, NY USA
| | - Rajesh Vedanthan
- grid.240324.30000 0001 2109 4251Department of Population Health, New York University Grossman School of Medicine, New York, NY USA
| | - Alex F. Manini
- grid.414488.50000 0004 0453 0340Division of Medical Toxicology, Department of Emergency Medicine, Icahn School of Medicine At Mount Sinai, Elmhurst Hospital Center, New York, NY USA
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Elmoheen A, AlEssai G, Awad Salem W, Thomas SH. The establishment of a medical toxicology consulting service for advancing care of poisoning and overdose in Qatar. Qatar Med J 2021; 2020:44. [PMID: 33520686 PMCID: PMC7819277 DOI: 10.5339/qmj.2020.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 07/26/2020] [Indexed: 11/20/2022] Open
Abstract
Objectives: The State of Qatar, in recent decades, underwent rapid, and substantial population growth. The country's emergency medicine (EM) needs are met by government-operated facilities of the Hamad Medical Corporation (HMC), which see virtually all acute-care cases in adults and children. In 2017, emergency departments (ED) established the Medical Toxicology Consulting Service (MTCS). This report aims to outline the MTCS's initial 100 cases’ experience and report salient findings that can help ongoing national strategies in meeting Qatar's medical toxicology needs. Methods: The study setting is Qatar, and the clinical base for the MTCS was the country's sole level I center, Hamad General Hospital. The MTCS group is composed of six physicians, all with advanced training in medical toxicology. The study group is composed of the first 100 consecutive cases of the MTCS registry. Registry entry was triggered by in-person consultation, telephone consultation, or identification of cases by daily MTCS rounder surveillance of the ED's electronic tracking board. Results: The MTCS institution identified a significant number of medical toxicology cases within the national hospital system. The trends of poisoning in this study showed a median age of 30 years (range 1–81 years, IQR 22–36 years). Fourteen patients were < 18 years old. The median interval between exposure and ED presentation was 2 hours, with a range of 15 minutes to 24 hours (IQR 1–3 hours). Most patients (71%, 95% CI, 51%–80%) were symptomatic because they were exposed. The MTCS recommended therapeutic intervention in over a third of cases (36%, 95% CI, 27%–46%). Decontamination procedures were ordered in 8% of cases (95% CI, 4%–15%) and specific therapies recommended in 13 cases (13%, 95% CI, 7%–21%). Conclusions: The study highlighted that the availability of experts in medical toxicology, such as with a poison center or toxicology consultation service, results in significant resource conservation in the management of poisoned patients.
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Affiliation(s)
- Amr Elmoheen
- Department of Emergency Medicine, Hamad Medical Corporation, Qatar E-mail:
| | - Galal AlEssai
- Department of Emergency Medicine, Hamad Medical Corporation, Qatar E-mail:
| | - Waleed Awad Salem
- Department of Emergency Medicine, Hamad Medical Corporation, Qatar E-mail:
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Mong R, Arciaga GJ, Tan HH. Use of a 23-hour emergency department observation unit for the management of patients with toxic exposures. Emerg Med J 2017; 34:755-760. [PMID: 28768699 DOI: 10.1136/emermed-2016-206531] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 06/09/2017] [Accepted: 07/03/2017] [Indexed: 11/03/2022]
Abstract
BACKGROUND A significant proportion of patients with toxic exposures presenting to the ED require admission. However, most will improve within 24 hours, and so could potentially be managed in a short-stay observation unit. We describe the management and outcomes of these patients in a 23-hour ED observation unit (EDOU). METHODS A retrospective chart review of all patients with toxic exposures admitted to the EDOU in Singapore between 1 April 2013 and 31 March 2015 was performed. Patient demographics, exposure patterns, clinical presentation and interventions received were abstracted. The poisoning severity score (PSS) was retrospectively determined. Outcomes were length of stay and disposition. RESULTS A total of 286 patients were analysed, of which 78.0% had intentional self-poisoning, 12.2% had bites/stings and 9.8% had unintentional or occupational toxic exposures. Analgesics (29.4%), sedatives (12.3%) and antidepressants (6.8%) were the most common drugs encountered. The majority of patients had a mild (68.9%) or moderate (15.4%) PSS, but 4.2% were graded as severe. Most patients with deliberate self-poisoning were reviewed by psychiatry (88.8%) and social services (74.9%). Most patients (92.0%) were medically cleared during their stay in EDOU, including all 12 with a severe PSS. Of these, 200 (69.9%) were discharged and 63 (22.0%) were transferred directly to a psychiatric unit. The median length of stay in the EDOU was 18 hours (IQR 13-23). CONCLUSION Most patients admitted to the EDOU were successfully managed and medically cleared within 23 hours, including those with a severe PSS. The EDOU appears to be a suitable alternative to inpatient admission for selected patients.
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Affiliation(s)
- Rupeng Mong
- Emergency Department, Changi General Hospital, Singapore, Singapore
| | | | - Hock Heng Tan
- Emergency Department, Changi General Hospital, Singapore, Singapore
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Vallersnes OM, Jacobsen D, Ekeberg Ø, Brekke M. Outpatient treatment of acute poisoning by substances of abuse: a prospective observational cohort study. Scand J Trauma Resusc Emerg Med 2016; 24:76. [PMID: 27206472 PMCID: PMC4875697 DOI: 10.1186/s13049-016-0268-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 05/12/2016] [Indexed: 11/21/2022] Open
Abstract
Background Procedures for the clinical assessment of acute poisoning by substances of abuse should identify patients in need of hospital admission and avoid hazardous discharges, while keeping the observation time short. We assess the safety of a systematic procedure developed at the Oslo Accident and Emergency Outpatient Clinic (OAEOC). Methods All patients 12 years and older treated for acute poisoning by substances of abuse at the OAEOC were included consecutively from October 2011 to September 2012. Data were collected on pre-set registration forms. Information on re-presentations to health services nation-wide during the first week following discharge was retrieved from the Norwegian Patient Register and from local electronic medical records. Information on fatalities was obtained from the Norwegian Cause of Death Registry. Results There were 2343 cases of acute poisoning by substances of abuse. The main toxic agent was ethanol in 1291 (55 %) cases, opioids in 539 (23 %), benzodiazepines in 194 (8 %), central stimulants in 132 (6 %), and gamma-hydroxybutyrate (GHB) in 105 (4 %). Median observation time was four hours. The patient was hospitalised in 391 (17 %) cases. Two patients died during the first week following discharge, both from a new opioid poisoning. Among 1952 discharges, 375 (19 %) patients re-presented at the OAEOC or a hospital within a week; 13 (0.7 %) with a diagnosis missed at the index episode, 169 (9 %) with a new poisoning, 31 (2 %) for follow-up of concomitant conditions diagnosed at index, and 162 (8 %) for unrelated events. Among the patients with missed diagnoses, five needed further treatment for the same poisoning episode, two were admitted with psychosis, one had hemorrhagic gastritis, another had fractures in need of surgery and four had minor injuries. Conclusion The procedure in use at the OAEOC can be considered safe and could be implemented elsewhere. The high re-presentation rate calls for better follow-up.
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Affiliation(s)
- Odd Martin Vallersnes
- Department of General Practice, University of Oslo, Oslo, Norway. .,Department of Emergency General Practice, Oslo Accident and Emergency Outpatient Clinic, City of Oslo Health Agency, Oslo, Norway.
| | - Dag Jacobsen
- Department of Acute Medicine, Oslo University Hospital, Oslo, Norway
| | - Øivind Ekeberg
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Department of Behavioural Sciences in Medicine, University of Oslo, Oslo, Norway
| | - Mette Brekke
- Department of General Practice, University of Oslo, Oslo, Norway
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12
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Callahan ST, Fuchs DC, Shelton RC, Balmer LS, Dudley JA, Gideon PS, Deranieri MM, Stratton SM, Williams CL, Ray WA, Cooper WO. Identifying suicidal behavior among adolescents using administrative claims data. Pharmacoepidemiol Drug Saf 2013; 22:769-75. [PMID: 23412882 DOI: 10.1002/pds.3421] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Revised: 01/22/2013] [Accepted: 01/24/2013] [Indexed: 11/11/2022]
Abstract
PURPOSE To assess the safety of psychotropic medication use in children and adolescents, it is critical to be able to identify suicidal behaviors from medical claims data and distinguish them from other injuries. The purpose of this study was to develop an algorithm using administrative claims data to identify medically treated suicidal behavior in a cohort of children and adolescents. METHODS The cohort included 80,183 youth (6-18 years) enrolled in Tennessee's Medicaid program from 1995-2006 who were prescribed antidepressants. Potential episodes of suicidal behavior were identified using external cause-of-injury codes (E-codes) and ICD-9-CM codes corresponding to the potential mechanisms of or injuries resulting from suicidal behavior. For each identified episode, medical records were reviewed to determine if the injury was self-inflicted and if intent to die was explicitly stated or could be inferred. RESULTS Medical records were reviewed for 2676 episodes of potential self-harm identified through claims data. Among 1162 episodes that were classified as suicidal behavior, 1117 (96%) had a claim for suicide and self-inflicted injury, poisoning by drugs, or both. The positive predictive value of code groups to predict suicidal behavior ranged from 0-88% and improved when there was a concomitant hospitalization but with the limitation of excluding some episodes of confirmed suicidal behavior. CONCLUSIONS Nearly all episodes of confirmed suicidal behavior in this cohort of youth included an ICD-9-CM code for suicide or poisoning by drugs. An algorithm combining these ICD-9-CM codes and hospital stay greatly improved the positive predictive value for identifying medically treated suicidal behavior.
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Affiliation(s)
- S Todd Callahan
- Division of Adolescent and Young Adult Health, Department of Pediatrics, Vanderbilt School of Medicine, Nashville, Tennessee, USA.
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Okumura Y, Shimizu S, Ishikawa KB, Matsuda S, Fushimi K, Ito H. Comparison of emergency hospital admissions for drug poisoning and major diseases: a retrospective observational study using a nationwide administrative discharge database. BMJ Open 2012; 2:bmjopen-2012-001857. [PMID: 23220778 PMCID: PMC3533045 DOI: 10.1136/bmjopen-2012-001857] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To compare the clinical and procedural characteristics of emergency hospital admissions for drug poisoning and major diseases. DESIGN Retrospective observational study. SETTING Discharged patients from 855 acute care hospitals from 1 July to 31 December in 2008 in Japan. RESULTS There were a total of 1 157 893 emergency hospital admissions. Among the top 100 causes, drug poisoning was ranked higher in terms of the percentage of patients using ambulance services (74.1%; second) and tertiary emergency medical services (37.8%; first). Despite higher utilisation of emergency care resources, drug poisoning ranked lower in terms of the median length of stay (2 days; 100th), percentage of requirement for surgical procedures (1.7%; 91st) and inhospital mortality ratio (0.3%; 74th). CONCLUSIONS Drug poisoning is unique among the top 100 causes of emergency admissions. Our findings suggest that drug poisoning imposes a greater burden on emergency care resources but has a less severe clinical course than other causes of admissions. Future research should focus on strategies to reduce the burden of drug poisoning on emergency medical systems.
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Affiliation(s)
- Yasuyuki Okumura
- Department of Social Psychiatry, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Sayuri Shimizu
- Research Department, Institute for Health Economics and Policy, Minato-ku, Tokyo, Japan
| | - Koichi B Ishikawa
- Statistics and Cancer Control Division, National Cancer Center, Chuo-ku, Tokyo, Japan
| | - Shinya Matsuda
- Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Hiroto Ito
- Department of Social Psychiatry, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
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Abstract
BACKGROUND As more efficient and value-based care models are sought for the US healthcare system, geographically distinct observation units (OUs) may become an integral part of hospital-based care for children. PURPOSE To systematically review the literature and evaluate the structure and function of pediatric OUs in the United States. DATA SOURCES Searches were conducted in Medline, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Health Care Advisory Board (HCAB), Lexis-Nexis, National Guideline Clearinghouse, and Cochrane Reviews, through February 2009, with review of select bibliographies. STUDY SELECTION English language peer-reviewed publications on pediatric OU care in the United States. DATA EXTRACTION Two authors independently determined study eligibility. Studies were graded using a 5-level quality assessment tool. Data were extracted using a standardized form. DATA SYNTHESIS A total of 21 studies met inclusion criteria: 2 randomized trials, 2 prospective observational, 12 retrospective cohort, 2 before and after, and 3 descriptive studies. Studies present data on more than 22,000 children cared for in OUs, most at large academic centers. This systematic review provides a descriptive overview of the structure and function of pediatric OUs in the United States. Despite seemingly straightforward outcomes for OU care, significant heterogeneity in the reporting of length of stay, admission rates, return visit rates, and costs precluded our ability to conduct meta-analyses. We propose standard outcome measures and future directions for pediatric OU research. CONCLUSIONS Future research using consistent outcome measures will be critical to determining whether OUs can improve the quality and cost of providing care to children requiring observation-length stays.
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Affiliation(s)
- Michelle L Macy
- Division of General Pediatrics, Child Health Evaluation and Research Unit, University of Michigan, Ann Arbor, Michigan 48109-5456, USA.
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15
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Sachdeva DK, Stadnyk JM. Are one or two dangerous? Opioid exposure in toddlers. J Emerg Med 2005; 29:77-84. [PMID: 15961014 DOI: 10.1016/j.jemermed.2004.12.015] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2004] [Revised: 10/28/2004] [Accepted: 12/03/2004] [Indexed: 11/25/2022]
Abstract
Ingestions of opioid analgesics by children may lead to significant toxicity as a result of depression of the respiratory and central nervous systems. A review of the medical literature was performed to determine whether low doses of opioids are dangerous in the pediatric population under 6 years old. Methadone was found to be the most toxic of the opioids; doses as low as a single tablet can lead to death. All children who have ingested any amount of methadone need to be observed in an Emergency Department (ED) for at least 6 h and considered for hospital admission. Most other opioids are better tolerated in ingestions as small as one or two tablets. Based on the limited data available for these opioids, we conclude that equianalgesic doses of 5 mg/kg of codeine or greater require 4 to 6 h of observation in the ED. Data for propoxyphene and all extended-release preparations are limited; their prolonged half-lives would suggest the need for longer observation periods. All opioid ingestions leading to respiratory depression or significant central nervous system depression require admission to an intensive care unit.
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Affiliation(s)
- Deepak K Sachdeva
- Department of Emergency Medicine, Georgetown University, Washington, DC, USA
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16
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Abstract
Millions of children ingest household products and medications yearly. The continuous proliferation of new products and pharmaceutic agents makes it difficult for physicians to maintain a current command of toxicologic information. Multiple sources, including poison control centers, can provide information; however, EPs must be familiar with several agents that are either significant for their frequency or for their disproportionate potential for morbidity and mortality in pediatric patients. With this select group of intoxicants, physicians must anticipate cardiovascular and pulmonary instability and rapid changes in central nervous system functioning. Appropriate supportive care requires monitoring of the following: vital signs, level of consciousness, airway control, ventilation and circulatory support, body temperature, urine output, and acid base balance. Once these concerns are addressed, prevention of further absorption, enhancing a product's elimination, and treatment with specific antidotes may enhance supportive care. Care is also likely to be enhanced if the EP recognizes the inherent differences (medically and socially) between adults and children of various ages. Definitive emergency care is completed only after the provision of a developmentally oriented preventive strategy.
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Affiliation(s)
- Sean Bryant
- Section of Toxicology, Cork County Hospital, 1835 West Harrison Street, Chicago, IL 60612, USA
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17
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Hoffman RJ, Osterhoudt KC. Evaluation and management of pediatric poisonings. PEDIATRIC CASE REVIEWS (PRINT) 2002; 2:51-63. [PMID: 12865696 DOI: 10.1097/00132584-200201000-00007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Robert J Hoffman
- Division of Toxicology, Maimonides Medical Center, Brooklyn, NY; and the Division of Emergency Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA
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18
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