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Safety of a Brief Emergency Department Observation Protocol for Patients With Presumed Fentanyl Overdose.
Scheuermeyer, Frank X; DeWitt, Christopher; Christenson, Jim; Grunau, Brian; Kestler, Andrew; Grafstein, Eric; Buxton, Jane; Barbic, David; Milanovic, Stefan; Torkjari, Reza; Sahota, Indy; Innes, Grant.
Afiliação
  • Scheuermeyer FX; Department of Emergency Medicine, St Paul's Hospital and the University of British Columbia, Vancouver, Canada. Electronic address: frank.scheuermeyer@gmail.com.
  • DeWitt C; Department of Emergency Medicine, St Paul's Hospital and the University of British Columbia, Vancouver, Canada.
  • Christenson J; Department of Emergency Medicine, St Paul's Hospital and the University of British Columbia, Vancouver, Canada.
  • Grunau B; Department of Emergency Medicine, St Paul's Hospital and the University of British Columbia, Vancouver, Canada.
  • Kestler A; Department of Emergency Medicine, St Paul's Hospital and the University of British Columbia, Vancouver, Canada.
  • Grafstein E; Department of Emergency Medicine, St Paul's Hospital and the University of British Columbia, Vancouver, Canada.
  • Buxton J; British Columbia Center for Disease Control, Vancouver, Canada.
  • Barbic D; Department of Emergency Medicine, St Paul's Hospital and the University of British Columbia, Vancouver, Canada.
  • Milanovic S; Department of Emergency Medicine, St Paul's Hospital and the University of British Columbia, Vancouver, Canada.
  • Torkjari R; Department of Emergency Medicine, St Paul's Hospital and the University of British Columbia, Vancouver, Canada.
  • Sahota I; Department of Emergency Medicine, St Paul's Hospital and the University of British Columbia, Vancouver, Canada.
  • Innes G; Department of Emergency Medicine, Rockyview Hospital and the University of Calgary, Calgary, Canada.
Ann Emerg Med ; 72(1): 1-8.e1, 2018 07.
Article em En | MEDLINE | ID: mdl-29530654
ABSTRACT
STUDY

OBJECTIVE:

Fentanyl overdoses are increasing and few data guide emergency department (ED) management. We evaluate the safety of an ED protocol for patients with presumed fentanyl overdose.

METHODS:

At an urban ED, we used administrative data and explicit chart review to identify and describe consecutive patients with uncomplicated presumed fentanyl overdose (no concurrent acute medical issues) from September to December 2016. We linked regional ED and provincial vital statistics databases to ascertain admissions, revisits, and mortality. Primary outcome was a composite of admission and death within 24 hours. Other outcomes included treatment with additional ED naloxone, development of a new medical issue while in the ED, and length of stay. A prespecified subgroup analysis assessed low-risk patients with normal triage vital signs.

RESULTS:

There were 1,009 uncomplicated presumed fentanyl overdose, mainly by injection. Median age was 34 years, 85% were men, and 82% received out-of-hospital naloxone. One patient was hospitalized and one discharged patient died within 24 hours (combined outcome 0.2%; 95% confidence interval [CI] 0.04% to 0.8%). Sixteen patients received additional ED naloxone (1.6%; 95% CI 1.0% to 2.6%), none developed a new medical issue (0%; 95% CI 0% to 0.5%), and median length of stay was 173 minutes (interquartile range 101 to 267). For 752 low-risk patients, no patients were admitted or developed a new issue, and one died postdischarge; 3 (0.4%; 95% CI 0.01% to 1.3%) received ED naloxone.

CONCLUSION:

In our cohort of ED patients with uncomplicated presumed fentanyl overdose-typically after injection-deterioration, admission, mortality, and postdischarge complications appear low; the majority can be discharged after brief observation. Patients with normal triage vital signs are unlikely to require ED naloxone.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Serviço Hospitalar de Emergência / Overdose de Drogas / Naloxona Tipo de estudo: Guideline / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Female / Humans / Male País/Região como assunto: America do norte Idioma: En Revista: Ann Emerg Med Ano de publicação: 2018 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Serviço Hospitalar de Emergência / Overdose de Drogas / Naloxona Tipo de estudo: Guideline / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Female / Humans / Male País/Região como assunto: America do norte Idioma: En Revista: Ann Emerg Med Ano de publicação: 2018 Tipo de documento: Article