Seven- and thirty-day mortality in digoxin poisoning: Results from the DIGITOX study.

BACKGROUND: Digoxin poisonings are relatively common and potentially fatal, requiring immediate therapeutic intervention, with special attention to the patient's hemodynamic status and the presence of electrocardiographic and electrolytic disturbances. OBJECTIVE: To identify factors associated with seven-day and thirty-day mortality in digoxin poisoning. DESIGN, SETTINGS AND PARTICIPANTS: A retrospective, observational, multicenter study was conducted across 15 Hospital Emergency Departments (HED) in Spain. All patients over 18 years of age who presented to participating HEDs from 2015 to 2021 were included. The inclusion criteria encompassed individuals meeting the criteria for digoxin poisoning, whether acute or chronic. OUTCOMES MEASURE AND ANALYSIS: To identify independent factors associated with 7-day and 30-day mortality, a multivariate analysis was conducted. This analysis included variables of clinical significance, as well as those exhibiting a trend (p < 0.1) or significance in the bivariate analysis. MAIN FINDINGS: A total of 658 cases of digoxin poisoning were identified. Mortality rates were 4.5% (30 patients) at seven days and 11.1% (73 patients) at thirty days. Regarding 7-day mortality, the mean age of deceased patients was comparable to survivors (84.7 (8.9) vs 83.9 (7.9) years; p = ns). The multivariate analysis revealed that factors independently associated with 7-day mortality encompassed the extent of dependence assessed by the Barthel Index (BI 60-89 OR 0.28; 95% CI 0.10-0.77; p = 0.014 and BI>90 OR 0.22; 95% CI 0.08-0.63; p = 0.005), the identification of ventricular arrhythmias (OR 1.34; 95% CI 1.34-25.21; p = 0.019), and the presence of circulatory (OR 2.84; 95% CI 1.19-6.27; p = 0.019) and neurological manifestations (OR 2.67; 95% CI 1.13-6.27; p = 0.025). Factors independently associated with 30-day mortality encompassed extent of dependence (BI 60-89 OR 0.37; 95% CI 0.20-0.71; p = 0.003 and BI>90 OR 0.18; 95% CI 0.09-0.39; p < 0.001) and the identification of circulatory (OR 2.13; 95% CI 1.10-4.15; p = 0.025) and neurological manifestations (OR 2.39; 95% CI 1.25-3.89; p = 0.006). CONCLUSIONS: The study identifies the degree of dependency assessed by the Barthel Index and the presence of cardiovascular and neurological symptoms as independent predictors of both 7-day and 30-day mortality. Additionally, the detection of ventricular arrhythmia is also an independent factor for 7-day mortality.

[Consultations to Emergency Departments for acute psychosis associated with illycit drugs use in Spain (REDUrHE Registry)]. / Consultas a Urgencias hospitalarias por psicosis aguda asociada al consumo de drogas ilegales en España (Registro REDUrHE).

OBJECTIVE: Mental health problems are increasing in Spain, and those related to drug use are a preventable aspect of public health. In Spain there are few studies on the incidence and characteristics of acute psychosis due to illegal drug use, especially at national and multicenter level, reason that motivated this paper. METHODS: A prospective multicentre study was carried out in eleven hospital Emergency Departments in Spain, lasting twenty-four months (REDUrHE Registry). Patients with acute psychosis were compared with those with organic pathology, analysing demographic aspects, drugs involved, associated clinical manifestations and evolution Quantitative variables were compared using Student's t-test and qualitative variables were compared using the chi-squared test (or Fisher's exact test as appropriate) and the magnitude of the association with the presence of psychosis using logistic regression. A p-value of less than 0.05 was considered statistically significant or if the 95%CI of the OR excluded the value 1. RESULTS: Of the 4,487 patients in the registry, 9.5% presented acute psychosis, with a median age of thirty-two years and 79% male. The main clinical features were agitation (53%, p=0.001), hallucinations (43.2%, p=0.001) and anxiety (40%, p=0.00). Psychosis was more frequent with cannabis (57.7%), cocaine (42%) and amphetamines and derivatives (26.4%), although in the analysis adjusted for co-drug use (39.5%), or in association with ethyl alcohol (57.7%), it was only statistically significant for cannabis (p=0.0). Patients with psychosis required more hospital admissions (38.1% vs. 10%, p=0.001), mainly in psychiatric units (34.1% vs. 4.2%, p=0.001), with hardly any intensive care unit admissions (0.4% vs. 2.1%, p=0.01). ED stay was high (29.3±73.8 hours vs 10.5±58.8 hours, p=0.001). CONCLUSIONS: In Spain, cannabis is the drug most associated with psychosis. This clinical condition produces more hospital admissions, although with a low risk at an organic level.

OBJETIVO: Los problemas de salud mental van en aumento en España, siendo los relacionados con el consumo de drogas una faceta prevenible en el ámbito de la Salud Pública. En España existen pocos estudios sobre la incidencia y características de la psicosis aguda por consumo de drogas ilegales, sobre todo de ámbito nacional y multicéntrico, razón que motivó este trabajo. METODOS: Se realizó un estudio multicéntrico prospectivo, de veinticuatro meses de duración, en once servicios de Urgencias hospitalarias de España (Registro REDUrHE). Se compararon los pacientes con psicosis aguda respecto a los que presentaban patología orgánica, analizando aspectos demográficos, drogas involucradas, clínica asociada y evolución. Las variables cuantitativas se compararon mediante la t de Student y cualitativas con la prueba ji al cuadrado (o el test exacto de Fisher según procediera) y la magnitud de la asociación con la presencia de psicosis mediante regresión logística. Se consideró estadísticamente significativo un valor de p menor de 0,05 o si el IC95% de la OR excluía el valor 1. RESULTADOS: De los 4.487 pacientes del registro, el 9,5% presentó psicosis aguda, con una mediana de edad de treinta y dos años y un 79% de varones. La clínica principal consistió en agitación (53%, p=0,001), alucinaciones (43,2%, p=0,001) y ansiedad (40%, p=0,00). La psicosis fue más frecuente con el consumo de cannabis (57,7%), de cocaína (42%) y de anfetaminas y derivados (26,4%), aunque en el análisis ajustado por coingesta de varias drogas (39,5%), o asociado a alcohol etílico (57,7%), sólo resultó estadísticamente significativo para el cannabis (p=0,0). Los pacientes con psicosis precisaron más ingreso hospitalario (38,1% frente a 10%, p=0,001), fundamentalmente en Unidades de psiquiatría (34,1% frente a 4,2%, p=0,001), sin apenas ingresar en unidades de cuidados intensivos (0,4% frente a 2,1%, p=0,01). La estancia en Urgencias fue más elevada (29,3±73,8 horas frente a 10,5±58,8 horas, p=0,001). CONCLUSIONES: En España, el cannabis es la droga que se relaciona en mayor medida con los casos de psicosis atendidas en Urgencias hospitalarias. Ésta clínica produce más ingresos hospitalarios, aunque con bajo riesgo a nivel orgánico.

Characteristics of digoxin toxicity attended in Spanish emergency departments according to type of poisoning and administration of digoxin antibodies: the DIGITOX study. / Características de las intoxicaciones por digoxina atendidas en diversos servicios de urgencias españoles en función del tipo de intoxicación y de la administración de anticuerpos antidigoxina: estudio DIGITOX.

OBJECTIVES: Digoxin toxicity accounts for a small percentage of poisonings attended by emergency departments. This study aimed to describe differences between acute and chronic digoxin toxicity and assess the use of digoxin-specific antibody fragments (digoxin-Fab) as an antidote. MATERIAL AND METHODS: Retrospective, observational, multicenter study in 15 hospital emergency departments in 8 Spanish autonomous communities in 7 years. We collected patient, clinical and treatment variables, and discharge destination. Patients were classified according to whether toxicity was acute or chronic and whether digoxin-Fab was administered or not. RESULTS: Twenty-seven acute and 631 chronic digoxin poisonings were attended. The mean (SD) patient age was 83.9 (7.9) years, and 76.9% were women. Patients with acute toxicity were younger (80.0 [12] years) than those with chronic toxicity (84.1 [7.7] years) (P .038), and accidental poisoning was less common (in 85.2% vs 100% in chronic toxicity; P .001). Cases of acute toxicity were also more serious (Poison Severity Score (29.6% vs 12.5% in chronic toxicity; P .001). Thirty-four patients were treated with digoxin-Fab (5.4%). These patients were younger (78.7 [11.5] years vs 84.2 (7.6) years), their toxicity was more often acute (in 20.6% vs 3.2% in chronic toxicity), more had attempted suicide (8.8% vs 0.2% with chronic toxicity), and more had severe symptoms (50% vs 11.2%) (P .001, all comparisons). Hospital admission was required for 76.1%. Overall, mortality was 11.4%. CONCLUSION: Chronic toxicity accounts for most digoxin poisoning cases, and most patients are women. Acute toxicity is more serious. Patients who required digoxin-Fab have more severe poisoning. Such patients usually have acute toxicity, and attempted suicide is more often the reason for the emergency.

OBJETIVO: Las intoxicaciones por digoxina representan un pequeño porcentaje de las intoxicaciones atendidas en urgencias. El objetivo de este estudio fue describir las diferencias entre intoxicaciones agudas y crónicas y evaluar la administración de su antídoto específico: los anticuerpos antidigoxina (AcAD). METODO: Estudio retrospectivo, observacional y multicéntrico en 15 servicios de urgencias hospitalarios de 8 comunidades autónomas durante 7 años. Se recogieron datos de filiación, clínica, tratamiento y destino al alta. Los pacientes se dividieron según era la intoxicación aguda o crónica y según recibían o no AcAD. RESULTADOS: Se recogieron 27 intoxicaciones agudas y 631 crónicas. La edad media fue de 83,9 (7,9) años, y el 76,9% eran mujeres. Los pacientes con intoxicación aguda tenían menor edad media (80,0 (12) vs 84,1 (7,7) años; p 0,038), y porcentaje de causa accidental (85,2% vs 100%; p 0,001) y mayor gravedad en la escala Poison Severity Score (29,6% vs 12,5%; p 0,001). Treinta y cuatro pacientes recibieron AcAD (5,4%) y constituyen un grupo de menor edad [78,7 (11,5) vs 84,2 (7,6); p 0,001], con mayor porcentaje de intoxicaciones agudas (20,6% vs 3,2%), intencionalidad suicida (8,8% vs 0,2%) y gravedad (50% vs 11,2%, p 0,001 en todas las comparaciones). El 76,1% precisó ingreso. La mortalidad fue del 11,4%. CONCLUSIONES: Las intoxicaciones por digoxina suelen ser crónicas y predominan en mujeres. Las intoxicaciones agudas son de mayor gravedad. Los pacientes que precisaron administración de AcAD tenían intoxicaciones más graves y mayor porcentaje de intoxicaciones agudas y con intencionalidad suicida.

Patients with drug-abuse poisoning with and without HIV infection: differential characteristics. / Intoxicaciones por drogas de abuso: características diferenciales en población VIH.

OBJECTIVES: Persons with HIV infection who use illicit drugs have higher morbidity and mortality rates than nonusers with or without HIV infection. The objetive were to detect differences between acute poisoning from illicit drugs in patients with and without HIV infection who are attended in hospital emergency departments, and to identify independent factors associated with a worse prognosis, defined by hospital admission or death. MATERIAL AND METHODS: Observational study in 2 hospitals between January 2017 and 31 December 2021. Included were patients with acute illicit drug poisoning with and without HIV infection. RESULTS: Information for 1132 patients was included. The mean (SD) ages of patients with and without HIV infection, respectively, were 38.9 (9.6) years and 32.6 (10.4) years. In patients with HIV, the main drugs used were opioids (279 [85.3%]), cocaine (226 [69.1%]), and amphetamines (153 [46.8%]. None in this group were on methadone substitution therapy for opioid addiction. In patients without HIV infection the main drugs were cocaine (372 [47.2%]) and cannabis (238 [33.8%]). Alcohol was used along with illicit drugs in 387 cases. Multivariate analysis showed that the only variables independently associated with a poor prognosis were HIV infection (odds ratio [OR], 2.19 [1.29-3.11], P .003), age (OR, 1.20 [1.01-1.05], P .003), and acute poisoning from benzodiazepines (OR, 3.48 [2.14-5.66], P .001). The area under the receiver operating characteristic curve of the model was 0.717. CONCLUSION: Certain characteristics distinguish the illicit drug use of patients with HIV infection. HIV infection, age, and the use of benzodiazepines are independently associated with a poor prognosis in acute poisonings.

OBJETIVO: La población VIH, consumidora de drogas de abuso (DA), tiene mayor morbimortalidad en relación con los no consumidores y no VIH. Se investiga si existen diferencias en las intoxicaciones agudas (IA) por DA, en pacientes VIH y no VIH atendidos en los servicios de urgencias hospitalarios (SUH), y se identifican factores independientes de mal pronóstico, definido por ingreso o fallecimiento. METODO: Estudio bicéntrico y observacional de 1 de enero de 2017 al 31 de diciembre de 2021. Se incluyeron pacientes VIH y no VIH atendido en dos SUH por intoxicación por DA. Se recogieron variables demográficas y la sustancia consumida. La variable de resultado principal fue mal pronóstico, definido como ingreso o muerte a los 30 días. RESULTADOS: Se recogieron 1.132 pacientes. La edad media de los pacientes VIH fue 39 ± 10 años, y 33 ± 10 años para los no VIH. En la población VIH predominaron los opiáceos 279 (85,3%) (ninguno de ellos estaba en tratamiento sustitutivo con metadona), la cocaína 226 (30,9%) y las anfetaminas 153 (69,1%), mientras que en la no VIH predominaron la cocaína 372 (47,2%) y el cannabis 238 (33,8%). El etanol se asoció con otras DA en 387 pacientes. El análisis multivariado mostró que las únicas variables independientes de mal pronóstico fueron el VIH [OR 2,19 (1,29-3,11), p 0,003], la edad [OR 1,20 (1,01-1,05), p 0,003], y la IA por benzodiacepinas (BDZ) [OR 3,48 (2,14-5,66), p 0,001], con un área bajo la curva de la característica operativa del receptor de este modelo de 0,717. CONCLUSIONES: Existen diferencias en las características de las IA en pacientes VIH. La infección VIH, la edad y el consumo de BZD son factores independientes de mal pronóstico en las IA.

Characteristics of drug poisonings treated in eleven Spanish emergency departments: Differentiated analysis by sex. / Características de las intoxicaciones por drogas atendidas en once servicios de urgencias españoles: Análisis diferenciado por sexo.

In order to identify the sociodemographic, clinical, emergency management and severity differences of drug poisoning treated in Emergency Departments (ED) from a gender perspective, data on patients from 11 Spanish EDs were recorded over 24 months (August 2017-July 2019). The severity of intoxication was compared by sex and was based on the combined adverse event (orotracheal intubation, cardiorespiratory arrest, intensive care hospitalization, and death). We included 4,526 patients (men 75.5%), with a mean age of 33 years. The most frequent drugs were: cocaine (47.8%), cannabis (44.4%) and amphetamines (25.5%). Men consumed more GHB (5.6% vs. 1.9%, p < .001) and less benzodiazepines (8.0% vs. 11.1%, p = .002) and alcohol (57.2% vs. 61.2%, p = .028) than women, with no differences in other types of drugs. Men presented significantly more severe bradycardia (OR = 4.39, 95%CI = 1.03-18.7), chest pain (OR = 1.72, 95%CI = 1.27-2.35) and symptomatic hypertension (OR = 1.56, 95%CI = 1.06-2.30) and less anxiety (OR = 0.74, 95%CI = 0.61-0.89) and vomiting (OR = 0.64, CI95% = 0.51-0.80). Men had more combined adverse events (3.1% vs. 2.0%, p = .047) and a greater intubations (1.9% vs. 1.0%, p = .044), with no significant differences in the adjusted model (OR = 1.349, 95%CI = 0.827-2.202 and OR = 1.371, 95%CI = 0.700-2.685, respectively). Twelve patients died (0.3%), with no differences according to sex. Drug intoxications attended in the ED differ according to sex. GHB, benzodiazepines and alcohol are more frequently involved in men than women. Cardiovascular symptomatology is more prevalent in men, while anxiety and vomiting are more frequent in women, which cannot be explained by differences in sociodemographic characteristics or the drugs used. There were no differences in the severity of the intoxication episodes.

Con el objetivo de identificar, con perspectiva de género, las diferencias sociodemográficas, clínicas, manejo en urgencias y gravedad de las intoxicaciones por drogas atendidas en Servicios de Urgencias Hospitalarias (SUH), se registraron todos los pacientes atendidos en 11 SUH españoles durante 24 meses (agosto 2017-julio 2019). La gravedad de la intoxicación se basó en el evento adverso combinado (intubación orotraqueal, parada cardiorrespiratoria, hospitalización en intensivos, y muerte), comparándose según el sexo. Cuando se encontraron diferencias significativas en sintomatología o gravedad, los resultados se ajustaron por características sociodemográficas y drogas consumidas. Se incluyeron 4.526 pacientes (hombres 75,5%), con edad media de 33 años. Las drogas más frecuentes fueron cocaína (47,8%), cánnabis (44,4%) y anfetaminas (25,5%). Hubo más GHB en hombres (5,6% vs 1,9%, p < ,001) y más benzodiacepinas (8,0% vs 11,1%, p = ,002) y alcohol (57,2% vs 61,2%, p = ,028) en mujeres, sin diferencias en otras de drogas. Los hombres tuvieron significativamente más bradicardia grave (OR = 4,39, IC95% = 1,03-18,7), dolor torácico (OR = 1,72, IC95% = 1,27-2,35) e hipertensión sintomática (OR = 1,56, IC95% = 1,06-2,30) y menos ansiedad (OR = 0,74, IC95% = 0,61-0,89) y vómitos (OR = 0,64, IC95% = 0,51-0,80). Tuvieron también más eventos adversos combinados (3,1% vs 2,0%, p = ,047) y más intubaciones (1,9% vs 1,0%, p = ,044), pero sin diferencias significativas en el modelo ajustado (OR = 1,349, IC95% = 0,827-2,202 y OR = 1,371, IC95% = 0,700-2,685, respectivamente). Fallecieron 12 pacientes (0,3%), sin diferencias según sexo. Concluimos que existen diferencias según el sexo en las drogas que originan intoxicaciones atendidas en los SUH. Las diferencias en sintomatología cardiovascular (más en hombres) y ansiosa o digestiva (más en mujeres) no se explican por diferencias sociodemográficas o de drogas utilizadas. La gravedad de la intoxicación no se ve influida por el sexo.

Amphetamine-related intoxications in people living with HIV: An observational study in an emergency department in Barcelona (Spain) from 2018 to 2020.

BACKGROUND: Stimulant drugs, particularly amphetamines, are more commonly implicated in drug-related deaths in people living with HIV; however, the clinical characteristics of amphetamine-related intoxication in people living with HIV are poorly described. MATERIAL AND METHODS: We conducted a retrospective study in people living with HIV who were admitted for amphetamine-related intoxication to an emergency department of a teaching hospital between 2018 and 2021. Severe intoxication (SI) was arbitrarily defined as requiring admission to the emergency medical support unit and receiving medical treatment for ≥6 h. RESULTS: In total, 170 male patients with a median age of 36.2 + 7.5 years were included in the study. A total of 77 (45.3%) individuals had mental disorders, and 120 (85.7%) had HIV-1 RNA suppression, with a median CD4 cell count of 696 (interquartile range 490-905). In total, 61 (37.9%) individuals were on ritonavir/cobicistat-based regimens. Presenting clinical syndromes included agitation in 60 (35.3%) subjects, anxiety in 37 (21.7%), psychosis in 27 (15.8%), chest pain in 26 (15.3%) and altered level of consciousness in 20 (11.7%). SI was observed in 48 (28.2%) individuals, 12 (7.1%) required admission to the intensive care unit, and two (1.2%) died. Altered level of consciousness (odds ratio [OR] 6.5; 95% confidence interval [CI] 2.2-18.9; p < 0.01), psychosis (OR 5.8; 95% CI 2.2-15.1; p < 0.01) and suicide attempt (OR 4.6; 95% CI 1.8-11.6; p 0.01) were associated with SI in the adjusted analysis. CONCLUSIONS: Amphetamine-related intoxication causes high morbidity in people living with HIV. Healthcare providers serving these patients should consider incorporating harm-reduction measures in the prevention of amphetamine-related intoxication.

Differences in clinical signs and severity of intoxication due to street drugs in adolescents and young adults treated in emergency departments. / Características diferenciales en las manifestaciones clínicas y la gravedad de las intoxicaciones por drogas de abuso en adolescentes atendidos en servicios de urgencias en comparación con adultos jóvenes.

OBJECTIVES: To determine whether symptoms and levels of severity of intoxication from street drugs differ between adolescents and young adults who come to hospital emergency departments for treatment. MATERIAL AND METHODS: We studied a consecutive cohort of adolescents (aged 12-17 years) and young adults (aged 18-30 years) who were treated in 11 hospital emergency departments belonging to the Drug Abuse Network of Spanish Hospital Emergency Departments (REDURHE). Sociodemographic and clinical characteristics and level of severity were recorded for comparison between between adolescents and young adults, adjusted for sex, alcohol co-ingestion, and type of drug used. An intoxication was recorded as severe if at least 1 of the following indicators was present: cardiac arrest, tracheal intubation, intensive care unit admission, and in-hospital death. RESULTS: We included a total of 2181 patients: 249 adolescents (11.4%) and 1932 young adults (88.6%). Alcohol coingestion and use of multiple drugs were less common in adolescents, who had significantly more events related to cannabis (in 81.1% vs 49.0% of young adults) and benzodiazepines (13.3% vs 5.5%). The adolescents had significantly fewer intoxications from the use of cocaine (10.8% vs 45.1%), amphetamines (17.3% vs 32.3%), ketamine (0.4% vs 6.0%) and gamma-hydroxybutyrate (0.4% vs 4.0%). A higher proportion of adolescents than young adults presented with diminished consciousness (23.0% vs 16.9%), but fewer manifested anxiety (15.9% vs 26.3%), palpitations (11.0% vs 19.5%), or chest pain (2.8% vs 9.2%). The pattern of associations was similar in the subgroup of intoxications due to cannabis. The adjusted model confirmed that the adolescents were more likely to have diminished consciousness, with an odds ratio (OR) of 1.851 (95% CI, 1.204-2.844) and less likely to have anxiety (OR, 0.529 (95% CI, 0.347-0.807). Intoxication was severe in 46 patients overall (2.1%); in adolescents and young adults the proportions were 0.8% and 2.3%, respectively (P = 0.129). In adolescents, the OR was 0.568 (95% CI, 0.131-2.468) for severity; for component indicators, the ORs were 0.494 (95% CI, 0.063-3.892) for intubation and 0.780 (95% CI, 0.175-3.475) for intensive care unit admission. No deaths occurred. CONCLUSION: Adolescents requiring emergency care for street drug intoxication had co-ingested alcohol or taken multiple drugs less often than young adults. Cannabis was the drug most often used by adolescents, who presented more often with diminished consciousness but less often with anxiety. We detected no differences related to event severity.

OBJETIVO: Investigar si existen diferencias en las drogas, sintomatología y gravedad entre adolescentes y jóvenes atendidos por intoxicación por drogas en servicios de urgencias hospitalarios (SUH). METODO: Entre los pacientes consecutivos atendidos por consumo de drogas en los 11 SUH de la REDURHE (Red de estudio de Drogas en Urgencias Hospitalarios en España), se seleccionaron los adolescentes (edad = 12-17 años) y los jóvenes (edad = 18-30 años). Se compararon las características sociodemográficas, clínicas y la gravedad (evento adverso combinado ­EAC­: parada cardiorrespiratoria, intubación endotraqueal, ingreso en cuidados intensivos o muerte intrahospitalaria) en adolescentes y jóvenes, ajustadas por sexo, coingesta de etanol y drogas involucradas. RESULTADOS: Se incluyeron 2.181 pacientes (adolescentes = 249, 11,4%; jóvenes = 1.932, 88,6%). En adolescentes, la coingesta de etanol y múltiples drogas fue menos frecuente. Hubo significativamente más asistencias por cannabis (81,1% vs 49,0%) y benzodiacepinas (13,3% vs 5,5%) y menos por cocaína (10,8% vs 45,1%), anfetamínicos (17,3% vs 32,3%), ketamina (0,4% vs 6,0%) y gamma-hidroxibutirato (0,4% vs 4,0%). Los adolescentes presentaron más disminución de consciencia (23,0% vs 16,9%) y menos ansiedad (15,9% vs 26,3%), palpitaciones (11,0% vs 19,5%) y dolor torácico (2,8% vs 9,2%). Estas asociaciones se mantuvieron al analizar el subgrupo de intoxicados por cannabis. En el modelo ajustado, los adolescentes presentan más disminución de consciencia con (OR = 1,851, IC 95%: 1,204-2,844) y menos ansiedad (OR = 0,529, IC 95%: 0,347-0,807). Se observó EAC en 46 pacientes (2,0%; 0,8% vs 2,3%, p = 0,129). La OR ajustada en adolescentes para EAC fue 0,568 (IC 95%: 0,131-2,468), y para intubación 0,494 (IC 95%: 0,063-3,892) y para ingreso en intensivos 0,780 (IC 95%: 0,175-3,475). No hubo fallecimientos. CONCLUSIONES: Los adolescentes intoxicados por drogas atendidos en SUH presentan con menor frecuencia coingesta de etanol o múltiples drogas. La droga más frecuentemente implicada es el cannabis, y presentan más disminución de consciencia y menos ansiedad. No detectamos diferencias en la gravedad entre adolescentes y jóvenes.

Clinical manifestations and serious adverse effects after cannabis use: role of age according to sex and coingestion of alcohol. / Manifestaciones clínicas y eventos adversos graves tras consumo de cannabis: efecto de la edad y análisis diferenciado en función del sexo y la coingesta de etanol.

OBJECTIVES: To study whether there are age-related differences in the clinical effects of cannabis poisoning and whether any age differences found are also related to sex or coingestion of alcohol. MATERIAL AND METHODS: Descriptive observational study of patients treated in 11 emergency departments for symptoms related to cannabis use. We collected data on 11 clinical manifestations and used a restricted cubic spline model to analyze their relative frequency according to age. We also looked for any interactions between the findings and patient sex or alcohol coingestion. RESULTS: A total of 949 patients were studied. The mean age was 29 years, 74% were males, and 39% had also consumed alcohol. We identified 3 symptom patterns related to age. One set of symptoms (vomiting, headache, convulsions, and hypotension) remained stable across all ages. Manifestations that increased in the middle of the age range studied were agitation and aggressivity, psychosis, palpitations and hallucinations. Chest pain and hypertension increased in older-aged patients. The frequencies of palpitations, vomiting, and headache differed according to sex. These manifestations held constant in males but were markedly higher in young-adult females. Coingestion of alcohol was associated with agitation and aggressivity (in 34.0% vs 23.4%, P .001), fewer reports of palpitations (in 9.8% vs 15.6%, P = .01), less anxiety (in 20.7% vs 27.8%, P = .01), less psychosis (in 10.3% vs 16.6%, P = .007), and less chest pain (in 3.8% vs 9.5%, P = .001). The only significant interaction between age and alcohol coingestion occurred with respect to vomiting and psychosis. CONCLUSION: There are age-related differences in the acute clinical manifestations of cannabis poisoning requiring emergency hospital care. Sex and coingestion of alcohol modify the relationship between age and frequency of some manifestations.

OBJETIVO: Investigar si existen diferencias en las manifestaciones clínicas por consumo de cannabis según la edad, y si estas se modifican en función del sexo o el consumo de etanol. METODO: Estudio observacional descriptivo de pacientes atendidos en 11 servicios de urgencias con consumo de cannabis como motivo de consulta. Se recogieron 11 manifestaciones clínicas y se analizó su frecuencia relativa en función de la edad mediante curvas spline cúbicas restringidas. Se analizó si existía interacción en el comportamiento etario de cada uno de los síntomas en función del sexo y del consumo de etanol. RESULTADOS: Se analizaron 949 pacientes, edad media 29 años, 74% varones y 39% con coingesta de etanol. Se identificaron tres patrones de síntomas según la edad: estable (vómitos, cefalea, convulsiones, hipotensión), incrementada en edades medias (agresividad-agitación, ansiedad, psicosis, palpitaciones, alucinaciones) y con aumento progresivo con la edad (dolor torácico e hipertensión). En la relación síntoma-edad, la frecuencia de palpitaciones, vómitos y cefalea tuvo un comportamiento significativamente diferente según el sexo, más constante en hombres y con un incremento marcado en edades medias en mujeres. La coingesta de etanol se asoció con más agitación-agresividad (34,0%/23,4%, p 0,001) y menos palpitaciones (9,8%/15,6%, p = 0,01), ansiedad (20,7%/27,8%, p = 0,01), psicosis (10,3%/16,6%, p = 0,007) y dolor torácico (3,8%/9,5%, p = 0,001). En cuanto a la relación síntoma-edad, el etanol solo modificó significativamente la frecuencia de vómitos y de psicosis. CONCLUSIONES: La edad condiciona efectos clínicos diferenciales en algunas manifestaciones agudas de la intoxicación por cannabis que precisa asistencia hospitalaria, y el sexo y el consumo simultáneo de alcohol modifican esta relación entre edad y frecuencia de algunos síntomas.

Comparative study of visits to Hospital Emergency Department for opioid overdose in two periods.

OBJECTIVE: The last few years have seen an increase in the use of opioid analgesics and in the incidence of opioid overdoses. The objective of this study was to evaluate the number of overdose-related visits to a  university hospital emergency department at two different periods of time  to analyze potential differences in terms of patient characteristics,  prescription profile, and treatment. METHOD: This is a retrospective observational study of opioid  verdoserelated visits in two periods of time: 2009-2014 and 2018-2020. RESULTS: The study included 47 cases of opioid overdoses: 20 during the first period (3.3 cases/year) and 27 during the second (9 cases/year).  A comparison between the two period showed a decrease in the patients' age (81.1 vs 74.0; p = 0.044) and an increase in the number of  acute trauma-derived pain treatments at the expense of chronic pain  treatments (p = 0.002). No differences were observed in the opioids  involved. As regards symptoms, there was a decrease in the incidence of  confusional syndromes (p = 0.026) and an increase in deaths. CONCLUSIONS: Emergency room visits for opioid overdoses have increased in recent years, as has the mortality associated to them. A  change has also been observed in the profile of affected patients, with a  higher number of cases where pain is derived from acute trauma.

Objetivo: El uso de fármacos opioides ha aumentado en las últimas  écadas, así como las intoxicaciones relacionadas con su uso. El objetivo de este estudio es evaluar el número de visitas a urgencias en un hospital  universitario por intoxicaciones por opiáceos entre dos periodos y analizar  las posibles diferencias de las características de los pacientes, perfil de  prescripción y el tratamiento de dicha intoxicación.Método: Estudio observacional, retrospectivo de las visitas debidas a intoxicaciones por fármacos opiáceos en dos periodos: 2009-2014 y 2018-2020.Resultados: Se incluyeron 47 casos de intoxicaciones, 20 en el primer periodo (3,3 casos/año) y 27 en el segundo (9 casos/año). Se observó una disminución en la edad de los pacientes (81,1 versus 74,0; p = 0,044) y un incremento de tratamientos debidos a dolor  raumatológico agudo a expensas de menos tratamientos de dolor crónico (p = 0,002). No hubo diferencias en el opiáceo implicado. Con  respecto a la clínica, se observó una disminución en los síndromes  confusionales (p = 0,026) y un incremento de fallecimientos.Conclusiones: Las visitas a urgencias por intoxicaciones a fármacos opiáceos han aumentado en los últimos años, así como la  mortalidad asociada. El perfil de los pacientes implicados ha variado,  incrementándose el tratamiento de dolor traumatológico agudo.

Spanish Research Network on Drugs in Hospital Emergency Departments - the REDUrHE registry: general analysis and comparisons between weekend and weekday poisonings. / Red de Estudio de Drogas en Urgencias Hospitalarias en España (Registro REDUrHE): análisis general y comparación según asistencia en día laborable o festivo.

OBJECTIVES: To describe the sociodemographic characteristics, drug use patterns, and the severity of drug overdoses treated in hospital emergency departments according to the registry of the Spanish Research Network on Drugs in Hospital Emergency Departments (REDUrHE project), and to identify differences between patterns on weekdays and weekends/national holidays. MATERIAL AND METHODS: Eleven hospitals participated in the REDUrHE project, studying consecutive patients with symptoms of drug overdose over a 24-month period. The drugs implicated were extracted from clinical records or toxicology reports. An overdose was considered severe if management required intubation, cardiopulmonary resuscitation, or admission to the intensive care unit, or if in-hospital death occurred (composite event). Each of these variables was also analyzed by itself. RESULTS: A total of 4526 patients were studied (2218 [49%] on weekends/holidays; 2308 [51%] on workdays). The mean (SD) age was 33 (11) years, and 75.5% were men. The most commonly used drugs were cocaine (47.8%), paciencannabis (44.4%), amphetamine derivatives (25.5%), benzodiazepines (8.8%), and opioids (7.3%). Patients treated on weekends/holidays were younger (32.1 vs 33.1 years on weekdays, P = .006), and they were more often taken to the hospital in an ambulance (60.5% vs 57.3%, P = .035). Hospitals in large cities (Barcelona and Madrid) saw more patients on weekends/holidays (55.8%). Major tourist destinations (the Balearic and Canary Islands) saw fewer patients on weekends/holidays (44.7%, P .001). Alcohol was ingested along with a drug by 58.2%; this combination was more common on weekends/holidays (in 63.3% vs 52.9% on weekdays, P .001), and 39.4% used more than 1 drug. Use of more than 1 drug was less common on weekends (in 37.6% vs 41.2%, P = .013). Opioid emergencies were also less frequent on weekends (6.0% vs 8.6%, P = .001), when gamma-hydroxybutyrate (GHB) overdoses were more common (5.8% vs 3.6%, P .001). Severity indicators were present (the composite event) more often on weekends (in 3.6% vs 2.2%, P = .006). Likewise, weekends saw more intubations (in 2.3% vs 1.0%, P = .001) and intensive care unit admissions (2.4% vs 1.6%, P = .047). Twelve patients (0.3%) died; mortality was similar on weekends (0.2%) and weekdays (0.3%) (P = .826). After adjusting for age, sex, combined use of alcohol, and type of drug, the risk of the severe-event composite was greater on weekends (odds ratio, 1.569; 95% CI, 1.088-2.263). CONCLUSION: Weekend and holiday emergencies due to drug overdoses are more frequent in large city hospitals. Weekend emergencies share certain distinctive characteristics: patients are younger, alcohol more often is ingested with drugs but multiple-drug combinations are less common, and GHB is used more often while opioids are used less often. Severe poisonings occur more often on weekends and holidays.

OBJETIVO: Conocer las características sociodemográficas, el patrón de consumo y la gravedad de los pacientes atendidos en servicios de urgencias hospitalarios (SUH) españoles por intoxicación por drogas (Proyecto REDUrHE) e investigar si existen diferencias entre los días festivos y los días laborables. METODO: Once SUH integrantes del proyecto REDUrHE incluyeron durante 24 meses de forma consecutiva a los pacientes atendidos por sintomatología derivada del consumo de drogas ilegales. Estas se determinaron por la historia clínica o la determinación toxicológica. El indicador primario de gravedad fue el evento adverso combinado formado por intubación, parada cardiorrespiratoria, ingreso en cuidados intensivos o muerte intrahospitalaria y los indicadores secundarios cada uno de estos eventos adversos considerado individualmente. RESULTADOS: Se incluyeron 4.526 pacientes (festivo: 2.218, 49%; laborables: 2.308, 51%), con edad media de 33 años (DE 11) y 75,5% hombres. Las drogas más frecuentemente involucradas fueron cocaína (47,8%), cannabis (44,4%), derivados anfetamínicos (25,5%), benzodiacepinas (8,8%) y opiáceos (7,3%). Los pacientes atendidos en festivos eran más jóvenes (32,1 vs 33,1 años, p = 0,006) y más frecuentemente traídos al SUH en ambulancia (60,5% vs 57,3%, p = 0,035). Los SUH de grandes ciudades (Barcelona, Madrid) tuvieron la mayor afluencia en festivo (55,8%) y los de zonas de alto turismo lúdico (Baleares, Canarias) los de menor afluencia (44,7%; p 0,001). El 58,2% ingirió simultáneamente etanol (más en festivos, 63,3% vs 52,9%, p 0,001) y el 39,4% más de una droga (menos en festivos, 37,6% vs 41,2%, p = 0,013). En festivo, los opiáceos fueron menos frecuentes (6,0% vs 8,6%, p = 0,001) y el gamma- hidroxibutirato más (5,8% vs 3,6%, p 0,001). También en festivo, hubo más eventos combinados adversos (3,6% vs 2,2%; p = 0,006), más intubaciones (2,3% vs 1,0%, p = 0,001) y más ingresos en cuidados intensivos (2,4% vs 1,6%, p = 0,047). Fallecieron 12 pacientes (0,3%), sin diferencias entre grupos (0,2% vs 0,3%, p = 0,826). Al ajustar por edad, sexo, ingesta combinada de etanol y tipos de drogas implicadas, los pacientes atendidos en festivos tuvieron más riesgo de evento adverso combinado, con OR = 1,569 (IC 95% = 1,088-2,263). CONCLUSIONES: Las intoxicaciones por drogas atendidas en SUH en día festivo suceden con mayor frecuencia en grandes ciudades y presentan ciertas características distintivas (pacientes más jóvenes, más ingesta conjunta con etanol, menos combinación de drogas, más frecuente gamma-hidroxibutirato y menos frecuente piáceos). Durante los festivos, las intoxicaciones atendidas son de mayor gravedad.

Impact of co-ingestion of ethanol on the clinical symptomatology and severity of patients attended in the emergency department for recreational drug toxicity.

OBJECTIVE: Investigate whether there are differences in the drugs involved, symptomatology and severity of drug intoxication in patients with co-ingestion of alcohol attended in hospital emergency departments (ED). METHOD: Patients attended in 11 Spanish EDs due to drug intoxication were included. Sociodemographic and clinical characteristics were collected. A combined adverse event of cardiorespiratory arrest, need for intubation, and admission to intensive care or death was considered as the primary indicator of severity. The symptomatology and severity were compared adjusted for age, sex and type of drug based on whether or not ethanol had been co-ingested. RESULTS: 3925 patients (alcohol co-ingestion: 2290, 58.3%) with a mean age of 33 (±11) years were included, and 25% were women. Co-ingestion of alcohol was observed in younger patients, in EDs in areas with high leisure tourism, on holidays and during the early morning hours. It was also more frequent in individuals intoxicated by amphetamine derivatives (66.2%) and cocaine (65.7%), and was more frequently associated with a reduction in consciousness (odds ratio [OR] = 2.13, 95% confidence interval [CI] 1.69-2.67) and agitation/aggressiveness (OR = 1.22, 95% = 1.04-1.43). A combined adverse event was observed in 114 patients (2.9%) with no differences between individuals co-ingesting or not ethanol (3.1% vs. 2.7%; OR = 1.11, 95% CI = 0.74-1.65). CONCLUSION: Co-ingestion of alcohol is more frequent in individuals intoxicated by cocaine and amphetamines and predisposes a greater reduction in the level of consciousness or agitation, although there are no differences in the severity of the episodes of drug intoxication.

Poisoning cases in Catalonia: characteristics according to age groups in the Intox.28 study. / Características de las intoxicaciones agudas atendidas en Cataluña y diferencias según grupos de edad: Estudio Intox-28.

OBJECTIVES: The Toxicology Working Group of the Catalan Society of Emergency Medicine (SoCMUETox) began the Intox-28 study in 2013. The aim was to identify differences in poisoning cases between 3 age groups. MATERIAL AND METHODS: Descriptive observational study of poisoning cases managed in 8 hospital emergency departments on the 28th day of each month from 2013 to 2019. We gathered information on patient particulars, type of poison, clinical data, and discharge destination. The patient sample was distributed into 3 groups for comparison: minors under the age of 17 years, adults aged 17 to 65 years, and adults over the age of 65 years. RESULTS: The hospitals registered 1088 cases: 132, 859, and 97 in each age group. In comparisons between the minors and the adults aged 65 years or younger, the minors had more females (58.3% vs 46.1%), fewer recreational poisonings (22% vs 46.1%) more poisonings inside the home (67.4% vs 51.1%), more medication poisonings (49.2% vs 31.1%), and less often received treatment (43.2% vs 73%) (P .001, all comparisons). The proportion of older adults receiving treatment (73.2%) was similar to that of the younger adults. CONCLUSION: The characteristics of poisonings vary according to age. Differences lie in gender, intentionality, and type of poison.

OBJETIVO: El Grupo de Trabajo de Toxicología de la Societat Catalana de Medicina d'Urgències i Emergències (SoCMUETox) inició en 2013 el estudio Intox-28. El objetivo de este trabajo es evaluar las diferencias existentes en las características de las intoxicaciones según la edad de los pacientes. METODO: Estudio descriptivo observacional de las intoxicaciones atendidas en 8 servicios de urgencias hospitalarios (SUH) el día 28 de cada mes durante el periodo 2013-19. Se recogieron datos demográficos, tipo de tóxico, datos clínicos y destino al alta. Los pacientes se dividieron en 3 grupos: menores de 17 años, adultos (entre 17 y 65 años) y mayores de 65 años. RESULTADOS: Se registraron 1.088 intoxicaciones: 132 (12,1%), 859 (78,9%) y 97 (8,9%) en cada grupo de edad respectivamente. En comparación a los pacientes adultos, en los menores de 17 años hubo más mujeres (58,3% vs 46,1%; p 0,001), menos intoxicaciones de tipo recreativo (22% vs 46,1%; p 0,001) y acontecieron más frecuentemente en el domicilio (67,4% vs 51,1%; p 0,001). El tipo de tóxico más implicado fueron los fármacos (49,2% vs 31,1%; p 0,001) y precisaron tratamiento con menor frecuencia (43,2% vs 73%; p 0,001). Los mayores de 65 años precisaron tratamiento en porcentaje similar a los pacientes de 17 a 65 años (73,2%). CONCLUSIONES: Existen diferencias entre los grupos de edad, entre las que destacan el sexo predominante, la intencionalidad de la intoxicación y el tipo de tóxico implicado.