Clinical parameters that predict the need for medium or intensive care admission in intentional drug overdose patients: A retrospective cohort study

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• 作者：Huub L.A van den Oever ; MD^a ; ^{h.vandenoever@dz.nl} ; Mirja van Dam ; MD^a ; ^{mirjavandam@gmail.com} ; Esther van &rsquo ; t Riet ; PhD^b ; ^{e.vantriet@dz.nl} ; Frank G.A. Jansman ; PharmD ; PhD^c ; ^d ; ^{f.jansman@dz.nl}
• 关键词：CVVH ; Continuous venovenous haemofiltration ; ECG ; Electrocardiogram ; ER ; Emergency room ; GCS ; Glasgow Coma Score ; IC ; Intensive care ; IDO ; Intentional drug overdose ; MC ; Medium care ; NSAID ; Non-steroidal anti-inflammatory drug ; PO2 ; Partial pressure of oxygen in blood ; QRS ; Complex of Q- ; R- and S-waves in the electrocardiogram ; QTc ; QT-time on electrocardiogram corrected for heart rate ; RF ; Respiratory frequency ; SBP ; Systolic blood pressure ; SpO2 ; Peripheral oxygen saturation ; SSRI ; Selective
• 刊名：Journal of Critical Care
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：37
• 期：Complete
• 页码：156-161
• 全文大小：280 K
• 卷排序：37

文摘

Many patients with intentional drug overdose (IDO) are admitted to a medium (MC) or intensive care unit (IC) without ever requiring MC/IC related interventions. The objective of this study was to develop a decision tool, using parameters readily available in the emergency room (ER) for patients with an IDO, to identify patients requiring admission to a monitoring unit.MethodsRetrospective cohort study among cases of IDO with drugs having potentially acute effects on neurological, circulatory or ventilatory function, admitted to the MC/IC unit between 2007 and 2013. A decision tool was developed, using 6 criteria, representing intubation, breathing, oxygenation, cardiac conduction, blood pressure, and consciousness. Cases were labeled as ‘high acuity’ if one or more criteria were present.ResultsAmong 255 cases of IDO that met the inclusion criteria, 197 were identified as “high acuity”. Only 70 of 255 cases underwent one or more MC/IC related interventions, of which 67 were identified as ‘high acuity by the decision tool (sensitivity 95.7%).ConclusionIn a population of patients with intentional drug overdose with agents having potentially acute effect on vital functions, 95.7% of MC/IC interventions could be predicted by clinical assessment, supplemented with electrocardiogram and blood gas analysis, in the ER.