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Ogeil RP, Faulkner A, Beard N, Killian JJ, Arunogiri S, Phan V, Wilson J, Smith K, Lubman DI, Scott D. Adverse outcomes of GHB use: Analysis of ambulance attendances in metropolitan and regional Victoria. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 111:103932. [PMID: 36527909 DOI: 10.1016/j.drugpo.2022.103932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 11/23/2022] [Accepted: 12/05/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Gamma-hydroxybutyrate (GHB) use and attributable harms have been increasing in Australia, however changes over time, including the impact of COVID-19 lockdowns and restrictions on harms requiring an ambulance attendance, are unknown. This study utilised a novel population-based surveillance system to identify the types of GHB-related harms between January 2018 and 31 December 2021 in Victoria, Australia. METHODS A cross-sectional, retrospective analysis of all GHB-related ambulance attendances between January 2018 and 31 December 2021 in Victoria, Australia was undertaken. Paramedic clinical notes and Glasgow Coma Scale scores were used to assess conscious state. Event codes were classified using dispatch information available in the database. Crude rates (per 100,000 population) and descriptive analyses were calculated for metropolitan and regional settings. Adjusted Odds ratios (aOR) with 95% confidence intervals [95% CI] were used to assess the relationship between GCS severity and polysubstance combinations with GHB. RESULTS There were 6,836 ambulance attendances for GHB recorded during the study period. A statistically significant increase in GHB-related attendance numbers was observed State-wide in 2019 (n = 1,402, p<0.001) and 2020 (n = 2,622, p<0.001), when comparing year on year attendances. While both numbers and rates (per 100,000 population) of GHB-related attendances were significantly lower in regional areas, significant increases were evident in both metropolitan and regional areas in 2019 and 2020 (both p<0.001). Attendances involving GHB and alcohol had higher odds of a severe GCS score (aOR:1.25; 95%: 1.04-1.49; p<0.019). A high proportion of GHB-attendances involved harms of significant concern including: overdose (56%) and a loss of, or altered state of consciousness (45%). CONCLUSIONS We observed increases in GHB-related ambulance attendances over time in both metropolitan and regional areas, placing a significant burden on ambulance services. Our study demonstrates the value of using ambulance surveillance to obtain representative data on acute GHB-related harms.
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Affiliation(s)
- Rowan P Ogeil
- Turning Point, Eastern Health, Australia; Eastern Health Clinical School and Monash Addiction Research Centre, Monash University, Australia.
| | | | | | - Jessica J Killian
- Turning Point, Eastern Health, Australia; Eastern Health Clinical School and Monash Addiction Research Centre, Monash University, Australia
| | - Shalini Arunogiri
- Turning Point, Eastern Health, Australia; Eastern Health Clinical School and Monash Addiction Research Centre, Monash University, Australia
| | - Vicky Phan
- Turning Point, Eastern Health, Australia; Eastern Health Clinical School and Monash Addiction Research Centre, Monash University, Australia
| | | | - Karen Smith
- Department of Paramedicine and Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Australia; Research and Evaluation, Ambulance Victoria, Blackburn North, Australia
| | - Dan I Lubman
- Turning Point, Eastern Health, Australia; Eastern Health Clinical School and Monash Addiction Research Centre, Monash University, Australia
| | - Debbie Scott
- Turning Point, Eastern Health, Australia; Eastern Health Clinical School and Monash Addiction Research Centre, Monash University, Australia
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Sharif AF, Kasemy ZA, Alshabibi RA, Almufleh SJ, Abousamak FW, Alfrayan AA, Alshehri M, Alemies RA, Almuhsen AS, AlNasser SN, Al-Mulhim KA. Prognostic factors in acute poisoning with central nervous system xenobiotics: development of a nomogram predicting risk of intensive care unit admission. Toxicol Res (Camb) 2022; 12:62-75. [PMID: 36866212 PMCID: PMC9972822 DOI: 10.1093/toxres/tfac084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 11/01/2022] [Accepted: 12/05/2022] [Indexed: 12/27/2022] Open
Abstract
Background Acute intoxication with central nervous system (CNS) xenobiotics is an increasing global problem. Predicting the prognosis of acute toxic exposure among patients can significantly alter the morbidity and mortality. The present study outlined the early risk predictors among patients diagnosed with acute exposure to CNS xenobiotics and endorsed bedside nomograms for identifying patients requiring intensive care unit (ICU) admission and those at risk of poor prognosis or death. Methods This study is a 6-year retrospective cohort study conducted among patients presented with acute exposure to CNS xenobiotics. Results A total of 143 patients' records were included, where (36.4%) were admitted to the ICU, and a significant proportion of which was due to exposure to alcohols, sedative hypnotics, psychotropic, and antidepressants (P = 0.021). ICU admission was associated with significantly lower blood pressure, pH, and HCO3 levels and higher random blood glucose (RBG), serum urea, and creatinine levels (P < 0.05). The study findings indicate that the decision of ICU admission could be determined using a nomogram combining the initial HCO3 level, blood pH, modified PSS, and GCS. HCO3 level < 17.1 mEq/L, pH < 7.2, moderate-to-severe PSS, and GCS < 11 significantly predicted ICU admission. Moreover, high PSS and low HCO3 levels significantly predicted poor prognosis and mortality. Hyperglycemia was another significant predictor of mortality. Combining initial GCS, RBG level, and HCO3 is substantially helpful in predicting the need for ICU admission in acute alcohol intoxication. Conclusion The proposed nomograms yielded significant straightforward and reliable prognostic outcomes predictors in acute exposure to CNS xenobiotics.
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Affiliation(s)
- Asmaa F Sharif
- Corresponding author: Clinical Medical Sciences Department, College of Medicine, Dar AlUloom University, Riyadh, Al-Falah, 13314, Saudi Arabia.
| | - Zeinab A Kasemy
- Department of Public Health and Community Medicine, Faculty of Medicine, Menoufia University, Shebin ElKom, Egypt
| | | | - Salem J Almufleh
- College of Medicine, Dar Al-Uloom University, Riyadh, Saudi Arabia
| | | | | | - Muath Alshehri
- College of Medicine, Dar Al-Uloom University, Riyadh, Saudi Arabia
| | - Rakan A Alemies
- College of Medicine, Dar Al-Uloom University, Riyadh, Saudi Arabia
| | - Assim S Almuhsen
- College of Medicine, Dar Al-Uloom University, Riyadh, Saudi Arabia
| | - Shahd N AlNasser
- Poison Control Department, Emergency Medicine Administration, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Khalid A Al-Mulhim
- Emergency Medicine Department, King Fahad Medical City, Riyadh, 1125, Saudi Arabia
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Outpatient Mental Health Follow-up and Recurrent Self-harm and Suicide Among Patients Admitted to the ICU for Self-harm: A Population-based Cohort Study. Chest 2022; 163:815-825. [PMID: 36445799 DOI: 10.1016/j.chest.2022.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 10/16/2022] [Accepted: 10/23/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Patients surviving an ICU admission for deliberate self-harm are at high risk of recurrent self-harm or suicide after discharge. It is unknown whether mental health follow-up after discharge (with either a family physician or psychiatrist) reduces this risk. RESEARCH QUESTION What is the association between mental health follow-up after discharge and recurrent self-harm among patients admitted to the ICU for intentional self-harm? STUDY DESIGN AND METHODS Population-based cohort study of consecutive adults (≥ 18 years of age) from Ontario, Canada, who were admitted to ICU because of intentional self-harm between 2009 and 2017. We categorized patients according to follow-up, with 'early follow-up' indicating 1 to 21 days after discharge, 'late follow-up' indicating 22 to 60 days after discharge, and 'no follow-up' indicating no follow-up within 60 days of discharge. We conducted analyses using a cause-specific extended Cox regression model to account for varying time for mental health follow-up relative to the outcomes of interest. The primary outcome was recurrent ICU admission for self-harm within 1 year of discharge. RESULTS We included 9,569 consecutive adults admitted to the ICU for deliberate self-harm. Compared with receiving no mental health follow-up, both early follow-up (hazard ratio [HR], 1.37; 95% CI, 1.07-1.75) and late follow-up (HR, 1.69; 95% CI, 1.22-2.35) were associated with increased risk in recurrent ICU admission for self-harm. As compared with no follow-up, neither early follow-up (HR, 1.10; 95% CI, 0.70-1.73) nor late follow-up (HR, 1.54; 95% CI, 0.84-2.83) were associated with increased risk of death by suicide. INTERPREATION Among adults admitted to the ICU for deliberate self-harm, mental health follow-up after discharge was not associated with reduced risk of recurrent ICU admission for self-harm or death resulting from suicide, and patients seeking outpatient follow-up may be those at highest risk of these outcomes. Future research should focus on additional and novel methods of risk mitigation in this vulnerable population.
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Şen B, Öztürk İ. A Retrospective Evaluation of Suicidal and Accidental Drug Intoxication in Intensive Care Unit. CYPRUS JOURNAL OF MEDICAL SCIENCES 2022. [DOI: 10.4274/cjms.2020.1827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Vujaklija Brajković A, Grgat M, Bielen L, Brajković J, Zlopaša O, Vrdoljak NG, Radonić R. Self-poisoning as a cause of admission in a medical intensive care unit and a question of misuse of prescription medications. Heart Lung 2021; 51:17-21. [PMID: 34731692 DOI: 10.1016/j.hrtlng.2021.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 09/08/2021] [Accepted: 09/08/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Self-poisoning accounts for between 3 and 17% of intensive care unit (ICU) admissions. OBJECTIVES To display the misused substances, intention, and outcome of patients admitted to the ICU due to self-poisoning. METHODS A retrospective review of ICU admissions using an electronic patient database was performed. RESULTS A total of 149 patients were admitted, accounting for 4.6% of ICU admissions. Self-poisoning with self-harm was more frequent than without self-harm intent (62.4% vs. 37.6%). 64.4% of ingested substances were misused prescribed drugs. Females used antipsychotics (X2 = 15, p< 0.05) and benzodiazepines (X2 =11.52, p< 0.05), and males ingested antipsychotics (X2 = 12, p< 0.05) with a self-harm intent. Antipsychotics were always used with a self-harm intent. Illicit drugs (X2 =9.14, p< 0.05) and ethanol (X2 =7.34, p< 0.05) were mostly used without self-harm intent. 102 patients (68.5%) continued treatment in a psychiatric clinic, more often women (X2 (1,N = 145)=7.94, p< 0.005). The readmission rate was low. Mortality was 2.6%. CONCLUSION Self-poisoning is an infrequent cause of ICU admission. Prescribed psychotropic medications, including benzodiazepines, antipsychotics, and antidepressants were the most frequently misused substances. Psychiatric consultation before the ICU discharge and subsequent psychiatric treatment might lower the repetition and readmission rate.
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Affiliation(s)
- Ana Vujaklija Brajković
- School of Medicine, University of Zagreb, Šalata 3, Zagreb 10000, Croatia; Department of Internal Medicine, Division of Intensive Care Medicine, University Hospital Centre Zagreb, Kišpatićeva 12, Zagreb 10000, Croatia.
| | - Marta Grgat
- School of Medicine, University of Zagreb, Šalata 3, Zagreb 10000, Croatia
| | - Luka Bielen
- School of Medicine, University of Zagreb, Šalata 3, Zagreb 10000, Croatia; Department of Internal Medicine, Division of Intensive Care Medicine, University Hospital Centre Zagreb, Kišpatićeva 12, Zagreb 10000, Croatia
| | - Jurica Brajković
- Zagreb School of Economics and Management, Jordanovac 110, Zagreb 10000, Croatia
| | - Ozrenka Zlopaša
- Department of Internal Medicine, Division of Intensive Care Medicine, University Hospital Centre Zagreb, Kišpatićeva 12, Zagreb 10000, Croatia
| | - Nina Gubarev Vrdoljak
- Department of Internal Medicine, Division of Intensive Care Medicine, University Hospital Centre Zagreb, Kišpatićeva 12, Zagreb 10000, Croatia
| | - Radovan Radonić
- School of Medicine, University of Zagreb, Šalata 3, Zagreb 10000, Croatia; Department of Internal Medicine, Division of Intensive Care Medicine, University Hospital Centre Zagreb, Kišpatićeva 12, Zagreb 10000, Croatia
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Winstanley EL, Mahoney JJ, Castillo F, Comer SD. Neurocognitive impairments and brain abnormalities resulting from opioid-related overdoses: A systematic review. Drug Alcohol Depend 2021; 226:108838. [PMID: 34271512 PMCID: PMC8889511 DOI: 10.1016/j.drugalcdep.2021.108838] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/05/2021] [Accepted: 05/07/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Non-fatal opioid-related overdoses have increased significantly over the past two decades and there have been increasing reports of brain injuries and/or neurocognitive impairments following overdose events. Limited preclinical research suggests that opioid overdoses may cause brain injury; however, little is known about such injuries in humans. The purpose this systematic review is to summarize existing studies on neurocognitive impairments and/or brain abnormalities associated with an opioid-related overdose in humans. METHODS PubMed, Web of Science, Ovid MEDLINE and PsyINFO were searched, without year restrictions, and identified 3099 articles. An additional 24 articles were identified by reviewing references. Articles were included if they were published in English, reported study findings in humans, included individuals 18 years of age or older, and reported an objective measure of neurocognitive impairments and/or brain abnormalities resulting from an opioid-related overdose. Six domains of bias (selection, performance, attrition, detection (two dimensions) and reporting were evaluated and themes were summarized. RESULTS Seventy-nine journal articles, published between 1973-2020, were included in the review. More than half of the articles were case reports (n = 44) and there were 11 cohort studies, 18 case series, and 6 case-control studies. All of the studies were categorized as at-risk of bias, few controlled for confounding factors, and methodological differences made direct comparisons difficult. Less than half of the studies reported toxicology results confirming an opioid-related overdose; 64.6 % reported brain MRI results and 27.8 % reported results of neuropsychological testing. Only two studies had within subject comparative data to document changes in the brain possibly associated with an overdose. Despite these limitations, existing publications suggest that brain injuries and neurocognitive impairments are associated with opioid overdose. Additional research is needed to establish the incidence of overdose-related brain injuries and the potential impact on functioning, as well as engagement in treatment of substance use disorders. CONCLUSIONS Respiratory depression is a defining characteristic of opioid overdose and prolonged cerebral hypoxia may cause brain injuries and/or neurocognitive impairments. The onset, characteristics, and duration of such injuries is variable and additional research is needed to understand their clinical implications.
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Affiliation(s)
- Erin L. Winstanley
- Department of Behavioral Medicine and Psychiatry, School of Medicine and Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA,Department of Neuroscience, West Virginia University, Morgantown, WV, USA,Corresponding author at: West Virginia University, School of Medicine, Rockefeller Neuroscience Institute, Department of Behavioral Medicine and Psychiatry, 930 Chestnut Ridge Road, Morgantown, WV 26505, USA. (E.L. Winstanley)
| | - James J. Mahoney
- Department of Behavioral Medicine and Psychiatry, School of Medicine and Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA,Department of Neuroscience, West Virginia University, Morgantown, WV, USA
| | - Felipe Castillo
- Columbia University, Department of Psychiatry and New York State Psychiatric Institute, New York, NY, USA
| | - Sandra D. Comer
- Columbia University, Department of Psychiatry and New York State Psychiatric Institute, New York, NY, USA
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Savage M, Kung R, Green C, Thia B, Perera D, Tiruvoipati R. Predictors of ICU admission and long-term outcomes in overdose presentations to Emergency Department. Australas Psychiatry 2020; 28:75-79. [PMID: 31912753 DOI: 10.1177/1039856219889317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To describe the characteristics of patients presenting to an Emergency Department (ED) following overdoses; to identify risk factors for intensive care unit (ICU) admission among these patients; and to identify the rate of mortality and repeat overdose presentations over four years. METHODS Adult patients presenting to ED following drug overdose during 2014 were included. Data were collected from medical notes and hospital databases. RESULTS During the study period, 654 patients presented to ED 800 times following overdose. Seventy-eight (9.8%) resulted in ICU admission, and 59 (7.4%) required intubation; 57.2% had no history of overdose presentations, and 72.9% involved patients with known psychiatric illness. Overdose of atypical antipsychotics (AAP), age and history of prior overdose independently predicted ICU admission. A third of patients (n = 196, 30%) had subsequent presentations to ED following overdose, in the four years from their index presentation, with an all-cause four-year mortality of 3.4% (n = 22). CONCLUSION A history of overdose, use of AAP and older age were risk factors for ICU admission following ED presentations. Over a third of patients had repeat overdose presentation in the four-year follow-up with a mortality of 3.4%.
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Affiliation(s)
- Mark Savage
- Department of Intensive Care Medicine, Frankston Hospital (Peninsula Health), Australia
| | - Ross Kung
- Department of Intensive Care Medicine, Frankston Hospital (Peninsula Health), Australia
| | - Cameron Green
- Department of Intensive Care Medicine, Frankston Hospital (Peninsula Health), Australia; and Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
| | - Brandon Thia
- Department of Intensive Care Medicine, Frankston Hospital (Peninsula Health), Australia
| | - Dinushka Perera
- Department of Intensive Care Medicine, Frankston Hospital (Peninsula Health), Australia
| | - Ravindranath Tiruvoipati
- Department of Intensive Care Medicine, Frankston Hospital (Peninsula Health), Australia; and Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
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Leece P, Chen C, Manson H, Orkin AM, Schwartz B, Juurlink DN, Gomes T. One-Year Mortality After Emergency Department Visit for Nonfatal Opioid Poisoning: A Population-Based Analysis. Ann Emerg Med 2020; 75:20-28. [DOI: 10.1016/j.annemergmed.2019.07.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 07/10/2019] [Accepted: 07/15/2019] [Indexed: 10/26/2022]
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Abdelaziz K, Abdelrahim ME. Identification and categorisation of drug-related problems on admission to an adult intensive care unit. Eur J Hosp Pharm 2014. [DOI: 10.1136/ejhpharm-2014-000566] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Badreldin AMA, Doerr F, Putensen C, Bayer O, Noutsias M, Hekmat K. Glasgow Coma Scale for outcome prediction after cardiac surgery: is it applicable? J Cardiothorac Vasc Anesth 2014; 28:1257-63. [PMID: 25281043 DOI: 10.1053/j.jvca.2014.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The Glasgow Coma Scale (GCS) is used commonly for assessing patients' neurologic condition and outcome in intensive care units (ICUs); however, its reliability in cardiac surgical patients has been questioned. It has been claimed that active sedation is the cause of its unsuitability for these patients. This study aimed to compare the accuracy of GCS in cardiac surgical patients with and without active sedation to find out if the inapplicability of GCS in surgical patients is related to active sedation. DESIGN This was an observational cohort study. SETTING The study was conducted in a cardiac surgical intensive care unit between January 1, 2007 and December 31, 2009. PARTICIPANTS All consecutive adult cardiac surgical patients were included in this study. INTERVENTIONS All types of cardiac surgical procedures performed during the study period were included without any exceptions. The study population was divided into 2 groups: sedated and non-sedated. MEASUREMENTS AND MAIN RESULTS GCS was calculated daily for the first 7 postoperative days. The authors developed a new 4-point neurologic descriptor (ND): (1) neurologically free, (2) ICU psychosis, (3) actively sedated, and (4) documented focal neurologic deficits. The accuracy of both scales (GCS and ND) at predicting ICU mortality was compared by replacing the GCS in the Sequential Organ Failure Assessment (SOFA) score with the new ND, producing a modified SOFA. GCS was not an accurate outcome predictor in non-sedated or sedated patients. The ND was superior to GCS. Correspondingly, the modified SOFA showed a significantly higher accuracy of ICU-mortality prediction than the original SOFA. CONCLUSIONS Regardless of active sedation, GCS is not accurate at outcome prediction for cardiac surgical patients. The suggested ND is a simple and more accurate risk stratification variable in cardiac surgical ICUs.
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Affiliation(s)
- Akmal M A Badreldin
- Department of Anesthesia and Operative Intensive Care Medicine, Friedrich-Wilhelms-University of Bonn, Bonn, Germany.
| | - Fabian Doerr
- School of Medicine, University of Cologne, Cologne, Germany
| | - Christian Putensen
- Department of Anesthesia and Operative Intensive Care Medicine, Friedrich-Wilhelms-University of Bonn, Bonn, Germany
| | - Ole Bayer
- Department of Anaesthesia and Intensive Care Medicine, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Michel Noutsias
- Department of Cardiology, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Khosro Hekmat
- Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
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In-Hospital Mortality and Long-Term Survival of Patients With Acute Intoxication Admitted to the ICU*. Crit Care Med 2014; 42:1471-9. [DOI: 10.1097/ccm.0000000000000245] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Characteristics of patients admitted to the intensive care unit following self-poisoning and their impact on resource utilisation. Ir J Med Sci 2013; 183:391-5. [PMID: 24101144 DOI: 10.1007/s11845-013-1026-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 09/27/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Self-poisoning accounts for up to 10 % of hospital admissions, some of whom require admission to ICU. Few studies have looked at the epidemiology of these patients in an Irish setting. AIMS To quantify the proportion of ICU admissions attributable to self-poisoning, to examine the characteristics and outcome of these patients, and to assess their ICU resource utilisation. METHODS Retrospective review of ICU admissions from 2006 to 2010. Data were collected on patient age, sex, admission diagnosis, substances involved, APACHE II score, length of stay, organ support, and outcome. RESULTS There were 80 admissions to ICU following self-poisoning accounting for 3.8 % of ICU admissions and 13 % of all hospital admissions for self-poisoning. M:F ratio was 0.9:1. Mean age 35 (range 16-75), APACHE II score 14 (2-36). Commonest substances involved were benzodiazepines, opioids, tricycle antidepressants. Median ICU stay was 2 days (IQR 0.96-4.5). 84 % of patients were ventilated, 27.5 % required inotropic support, 14 % renal replacement therapy. When opioids were involved requirement for inotropes and CRRT were higher. ICU mortality was 6.3 %. These patients consumed 280 bed days. CONCLUSION Self-poisoning accounted for 3.8 % of ICU admissions. Patients tend to require a short period of ventilation, with a minority requiring additional organ support. The cost of ICU care is calculated based on previously published methodology to be <euro>7,717 per patient. Extrapolated nationally the annual cost for ICU care for self-poisoning is estimated to be in the order of <euro>5 m.
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Maignan M, Pommier P, Clot S, Saviuc P, Debaty G, Briot R, Carpentier F, Danel V. Deliberate drug poisoning with slight symptoms on admission: are there predictive factors for intensive care unit referral? A three-year retrospective study. Basic Clin Pharmacol Toxicol 2013; 114:281-7. [PMID: 23998644 DOI: 10.1111/bcpt.12132] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 08/19/2013] [Indexed: 11/26/2022]
Abstract
Deliberate drug poisoning leads to 1% of emergency department (ED) admissions. Even if most patients do not exhibit any significant complication, 5% need to be referred to an intensive care unit (ICU). Emergency physicians should distinguish between low- and high-acuity poisoned patients at an early stage to avoid excess morbidity. Our aim was to identify ICU transfer factors in deliberately self-poisoned patients without life-threatening symptoms on admission. We performed a 3-year retrospective observational study in a university hospital. Patients over 18 years of age with a diagnosis of deliberate drug poisoning were included. Clinical and toxicological data were analysed with univariate tests between groups (ED stay versus ICU transfer). Factors associated with ICU admission were then included in a logistic regression analysis. Two thousand five hundred and sixty-five patients were included. 63.2% were women, and median age was 40 (28-49). 142 patients (5.5%) were transferred to ICU. Cardiac drugs [adjusted OR (aOR) = 19.81; 95% confidence interval (95% CI): 7.93-49.50], neuroleptics (aOR = 2.78; 95% CI: 1.55-4.97) and meprobamate (aOR = 2.71; 95% CI: 1.27-5.81) ingestions were significantly linked to ICU admission. A presumed toxic dose ingestion (aOR = 2.27; 95% CI: 1.28-4.02), number of ingested tablets (aOR = 1.01; 95% CI: 1.01-1.02 for each tablet) and delay between ingestion and ED arrival <2 hr (aOR = 2.85; 95%CI: 1.62-5.03) were also factors for ICU referral. The Glasgow Coma Scale was the only clinical feature associated with ICU admission (aOR = 1.57; 95% CI: 1.44-1.70 for each point loss). These results suggest that emergency physicians should pay particular attention to toxicological data on ED admission to distinguish between low- and high-acuity self-poisoned patients.
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Affiliation(s)
- Maxime Maignan
- Emergency Department and Mobile Intensive Care Unit, CHU Michallon, Grenoble, France; UJFGrenoble1/CNRS/TIMC-IMAG UMR 5525/PRETA Team, Grenoble, France
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Eizadi Mood N, Sabzghabaee AM, Khalili-Dehkordi Z. Applicability of different scoring systems in outcome prediction of patients with mixed drug poisoning-induced coma. Indian J Anaesth 2013; 55:599-604. [PMID: 22223905 PMCID: PMC3249868 DOI: 10.4103/0019-5049.90616] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background: Mixed drugs poisoning (MDP) is common in the emergency departments. Because of the limited number of intensive care unit beds, recognition of risk factors to divide the patients into different survival groups is necessary. Poisoning due to ingestion of different medications may have additive or antagonistic effects on different parameters included in the scoring systems; therefore, the aim of the study was to compare applicability of the different scoring systems in outcomes prediction of patients admitted with MDP-induced coma. Methods: This prospective, observational study included 93 patients with MDP-induced coma. Clinical and laboratory data conforming to the Acute Physiology and Chronic Health Evaluation (APACHE II), Modified APACHE II Score (MAS), Mainz Emergency Evaluation Scores (MEES) and Glasgow Coma Scale (GCS) were recorded for all patients on admission (time0) and 24 h later (time24). The outcome was recorded in two categories: Survived with or without complication and non-survived. Discrimination was evaluated using receiver operating characteristic (ROC) curves and area under the ROC curve (AUC). Results: The mortality rate was 9.7%. Mean of each scoring system was statistically significant between time0 and time24 in the survivors. However, it was not significant in non-survivors. Discrimination was excellent for GCS24 (0.90±0.05), APACHE II24 (0.89±0.01), MAS24 (0.86±0.10), and APACHE II0 (0.83±0.11) AUC. Conclusion: The GCS24, APACHE II24, MAS24, and APACHE II0 scoring systems seem to predict the outcome in comatose patients due to MDP more accurately. GCS and MAS may have superiority over the others in being easy to perform and not requiring laboratory data.
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Affiliation(s)
- Nastaran Eizadi Mood
- Departments of Clinical Toxicology and Forensic Medicine, Noor and Ali Asghar (PBUH) Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
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Glasgow coma scale and its components on admission: are they valuable prognostic tools in acute mixed drug poisoning? Crit Care Res Pract 2011; 2011:952956. [PMID: 21559299 PMCID: PMC3087408 DOI: 10.1155/2011/952956] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Accepted: 01/26/2011] [Indexed: 12/02/2022] Open
Abstract
Introduction. The verbal, eye, and motor components of Glasgow coma scale (GCS) may be influenced by poisoned patients' behavior in an attempted suicide. So, the values of admission GCS and its components for outcomes prediction in mixed drugs poisoning were investigated. Materials and Methods. A followup study data was performed on patients with mixed drugs poisoning. Outcomes were recorded as without complications and with complications. Discrimination was evaluated by calculating the area under the receiver operating characteristic curves (AUC). Results. There was a significant difference between the mean value of each component of GCS as well as the total GCS between patients with and without complication. Discrimination was best for GCS (AUC: 0.933 ± 0.020) and verbal (0.932 ± 0.021), followed by motor (0.911 ± 0.025), then eye (0.89 ± 0.028). Conclusions. Admission GCS and its components seem to be valuable in outcome prediction of patients with mixed drug poisoning.
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Galvin S, Campbell M, Marsh B, O'Brien B. Cocaine-related admissions to an intensive care unit: a five-year study of incidence and outcomes. Anaesthesia 2009; 65:163-6. [PMID: 19930217 DOI: 10.1111/j.1365-2044.2009.06189.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Cocaine misuse is increasing and it is evidently considered a relatively safe drug of abuse in Ireland. To address this perception, we reviewed the database of an 18-bed Dublin intensive care unit, covering all admissions from 2003 to 2007. We identified cocaine-related cases, measuring hospital mortality and long-term survival in early 2009. Cocaine-related admissions increased from around one annually in 2003-05 to 10 in 2007. Their median (IQR [range]) age was 25 (21-35 [17-47]) years and 78% were male. The median (IQR [range]) APACHE II score was 16 (11-27 [5-36]) and length of intensive care stay was 5 (3-9 [1-16]) days. Ten patients died during their hospital stay. A further five had died by the time of follow-up, a median of 24 months later. One was untraceable. Cocaine toxicity necessitating intensive care is increasingly common in Dublin. Hospital mortality in this series was 52%. These findings may help to inform public attitudes to cocaine.
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Affiliation(s)
- S Galvin
- Department of Anaesthesia and Intensive Care Medicine, Mater Misericordiae University Hospital, Dublin, Ireland.
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