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Acute Poisoning Readmissions to an Emergency Department of a Tertiary Hospital: Evaluation through an Active Toxicovigilance Program. J Clin Med 2022; 11:jcm11154508. [PMID: 35956123 PMCID: PMC9369450 DOI: 10.3390/jcm11154508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/10/2022] [Accepted: 07/21/2022] [Indexed: 02/05/2023] Open
Abstract
The aim of this study is to investigate hospital readmissions during 1 year after acute poisoning cases (APC), analyze the temporal behavior of early readmissions (ER) (in the month after the index episode) and predict possible ER. A descriptive analysis of the patients with APC assisted between 2011 and 2016 in the Emergency Department of Hospital La Paz is presented, and various methods of inferential statistics were applied and confirmed by Bayesian analysis in order to evaluate factors associated with total and early readmissions. Out of the 4693 cases of APC included, 968 (20.6%) presented, at least one readmission and 476 (10.1%) of them were ER. The mean age of APC with readmission was 41 years (12.7 SD), 78.9% had previous psychiatric pathology and 44.7% had a clinical history of alcohol addiction. Accidental poisoning has been a protective factor for readmission (OR 0.50; 0.26–0.96). Type of toxin (“drug of abuse” OR 8.88; 1.17–67.25), history of addiction (OR 1.93; 1.18–3.10) and psychiatric history (OR 3.30; 2.53–4.30) are risk factors for readmissions during the first year. Women showed three or more readmissions in a year. The results of the study allow for identification of the predictors for the different numbers of readmissions in the year after the index APC, as well as for ERs.
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Warfield S, Karras E, Lilly C, Brumage M, Bossarte RM. Causes of death among U.S. Veterans with a prior nonfatal opioid overdose. Drug Alcohol Depend 2021; 219:108484. [PMID: 33395597 PMCID: PMC8406624 DOI: 10.1016/j.drugalcdep.2020.108484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 11/25/2020] [Accepted: 11/27/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND For over a decade, there has been a surge in opioid-related morbidity and mortality among Veterans. To better understand the impact of the growing epidemic, it is important to identify the cause-specific mortality rates among Veterans with a prior nonfatal opioid overdose. METHODS We followed 8370 Veterans who received medical care for a nonfatal opioid overdose between 2011 through 2015.Mortality records were linked to clinical records from the Veterans Health Administration (VHA). We compared the mortality rates among those with a nonfatal opioid overdose to a 5 % stratified random sample of patients accessing services during the same time period. SMRs were calculated using age-adjusted cause-specific mortality rates for the l U.S. population obtained from the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER). RESULTS The crude mortality for Veterans with a history of a nonfatal overdose was 370.6 per 10,000 person years. Those with a prior nonfatal overdose had a higher risk of substance-related mortality (aHR [adjusted Hazard Ratio] 5.0), including a higher risk of death from drugs (aHR 6.9) and alcohol (aHR 2.7). Similarly, cause-specific mortalities assessed between Veterans and the U.S. population, SMRs were also highest for deaths associated with substances (114.0). CONCLUSION Veterans with a prior nonfatal overdose experienced substantially higher mortality rates compared to other Veterans or the general U.S. POPULATION Causes of death related to substance use and mental health were significantly higher than other causes of death, highlighting the importance of integrated treatment and substance use services.
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Affiliation(s)
- Sara Warfield
- Center of Excellence for Suicide Prevention, Department of Veterans Affairs, 400 Fort Hill Avenue, Canandaigua, NY, 14424, USA; Department of Epidemiology, School of Public Health, West Virginia University, 64 Medical Center Drive, P.O. Box 9190, Morgantown, WV, 26506, USA; Injury Control Research Center, West Virginia University, 3606 Collins Ferry Rd, Suites 201 & 202, Morgantown, WV 26505, USA.
| | - Elizabeth Karras
- Center of Excellence for Suicide Prevention, Department of Veterans Affairs, 400 Fort Hill Avenue, Canandaigua, NY, 14424, USA; Injury Control Research Center, West Virginia University, 3606 Collins Ferry Rd, Suites 201 & 202, Morgantown, WV 26505, USA; Department of Psychiatry, University of Rochester, 601 Elmwood Avenue, Rochester, NY, 14642, USA
| | - Christa Lilly
- Department of Biostatistics, West Virginia University, 64 Medical Center Drive, P.O. Box 9190, Morgantown, WV, 26506, USA
| | - Michael Brumage
- Injury Control Research Center, West Virginia University, 3606 Collins Ferry Rd, Suites 201 & 202, Morgantown, WV 26505, USA; Department of Occupational Medicine, West Virginia University, 64 Medical Center Drive, P.O. Box 9190, Morgantown, WV, 26506, USA
| | - Robert M Bossarte
- Center of Excellence for Suicide Prevention, Department of Veterans Affairs, 400 Fort Hill Avenue, Canandaigua, NY, 14424, USA; Department of Epidemiology, School of Public Health, West Virginia University, 64 Medical Center Drive, P.O. Box 9190, Morgantown, WV, 26506, USA; Injury Control Research Center, West Virginia University, 3606 Collins Ferry Rd, Suites 201 & 202, Morgantown, WV 26505, USA; Department of Behavioral Medicine and Psychiatry, West Virginia University, 64 Medical Center Drive, P.O. Box 9190, Morgantown, WV, 26506, USA
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Piccioni A, Cicchinelli S, Saviano L, Gilardi E, Zanza C, Brigida M, Tullo G, Volonnino G, Covino M, Franceschi F, La Russa R. Risk Management in First Aid for Acute Drug Intoxication. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17218021. [PMID: 33143348 PMCID: PMC7663746 DOI: 10.3390/ijerph17218021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 02/07/2023]
Abstract
Drug abuse (cannabis, cocaine, opiates, and synthetic drugs) is an increasing phenomenon, especially in the younger population, thus leading to more cases of intoxication requiring evaluation in the emergency department and subsequent hospitalization. In 2017, 34.2% of students reported having used an illegal psychoactive substance in their lifetime, while 26% reported having done so over the past year. We made a review about the effectiveness of the role of the temporary observation unit in the emergency department to improve management of acute drugs intoxication. We checked medical literature from the last 10 years (2009-2019). The following electronic databases were systematically searched: MEDLINE-PubMed, Web of Science, Scopus, and the Cochrane Central Register of Controlled Trials. Then, a systematic review was carried out according to the Preferred Reporting Items for Systematic Review standards. Intoxicated patients usually display a favorable medical course, few diagnostic and therapeutic interventions, a short stay in the hospital, and, when hospitalization is needed, semi-intensive therapy is a feasible solution; therefore, intoxicated patients are ideal candidates for a temporary observation unit. The emergency department is very important to manage intoxicated patients; however, the hospitalization of these patients is often not necessary.
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Affiliation(s)
- Andrea Piccioni
- Emergency Medicine Department, University Polyclinic Foundation A. Gemelli, IRCCS (Scientific Institute for Hospitalization and Treatment), 00168 Rome, Italy; (A.P.); (S.C.); (L.S.); (M.B.); (G.T.); (M.C.)
| | - Sara Cicchinelli
- Emergency Medicine Department, University Polyclinic Foundation A. Gemelli, IRCCS (Scientific Institute for Hospitalization and Treatment), 00168 Rome, Italy; (A.P.); (S.C.); (L.S.); (M.B.); (G.T.); (M.C.)
| | - Luisa Saviano
- Emergency Medicine Department, University Polyclinic Foundation A. Gemelli, IRCCS (Scientific Institute for Hospitalization and Treatment), 00168 Rome, Italy; (A.P.); (S.C.); (L.S.); (M.B.); (G.T.); (M.C.)
| | - Emanuele Gilardi
- Emergency-Admission Department, Biomedical Campus, 00128 Rome, Italy;
| | - Christian Zanza
- Department of Anesthesia, Critical Care and Emergency Medicine, Pietro and Michele Ferrero Hospital, 12051 Verduno, Italy;
| | - Mattia Brigida
- Emergency Medicine Department, University Polyclinic Foundation A. Gemelli, IRCCS (Scientific Institute for Hospitalization and Treatment), 00168 Rome, Italy; (A.P.); (S.C.); (L.S.); (M.B.); (G.T.); (M.C.)
| | - Gianluca Tullo
- Emergency Medicine Department, University Polyclinic Foundation A. Gemelli, IRCCS (Scientific Institute for Hospitalization and Treatment), 00168 Rome, Italy; (A.P.); (S.C.); (L.S.); (M.B.); (G.T.); (M.C.)
| | - Gianpietro Volonnino
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University, 00161 Rome, Italy;
| | - Marcello Covino
- Emergency Medicine Department, University Polyclinic Foundation A. Gemelli, IRCCS (Scientific Institute for Hospitalization and Treatment), 00168 Rome, Italy; (A.P.); (S.C.); (L.S.); (M.B.); (G.T.); (M.C.)
| | | | - Raffaele La Russa
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University, 00161 Rome, Italy;
- Correspondence:
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