Determinants of admission to critical care following acute recreational drug toxicity

Noseda, Roberta; Franchi, Matteo; Pagnamenta, Alberto; Müller, Laura; Dines, Alison M.; Giraudon, Isabelle; Heyerdahl, Fridtjof; Eyer, Florian; Hovda, Knut Erik; Liechti, Matthias  E.; Miró, Òscar; Vallersnes, Odd Martin; Yates, Christopher; Dargan, Paul I; Wood, David M; Ceschi, Alessandro

doi:10.3390/jcm12185970

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Journal article

Determinants of admission to critical care following acute recreational drug toxicity : a Euro-DEN plus study

Noseda, Roberta Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
Franchi, Matteo Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Italy - National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Italy
Pagnamenta, Alberto Clinical Trial Unit, Ente Ospedaliero Cantonale, Lugano, Switzerland - Department of Intensive Care, Ente Ospedaliero Cantonale, Lugano, Switzerland - Division of Pneumology, University of Geneva, Switzerland
Müller, Laura Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
Dines, Alison M. Clinical Toxicology, Guy’s and St Thomas’ NHS Foundation Trust and King’s Health Partners, London, UK
Giraudon, Isabelle European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal
Heyerdahl, Fridtjof Prehospital Division, Oslo University Hospital, Norway -The Norwegian Air Ambulance Foundation, Oslo, Norway
Eyer, Florian Department of Clinical Toxicology, Klinikum Rechts der Isar, Technical University of Munich, Germany
Hovda, Knut Erik The Norwegian CBRNE Centre of Medicine, Oslo University Hospital, Norway
Liechti, Matthias E. Clinical Pharmacology and Toxicology, University Hospital and University of Basel, Switzerland
Miró, Òscar Emergency Department, Hospital Clínic, University of Barcelona, Catalonia, Spain
Vallersnes, Odd Martin Department of General Practice, University of Oslo, Norway - Oslo Accident and Emergency Outpatient Clinic, City of Oslo Health Agency, Norway
Yates, Christopher Emergency Department and Clinical Toxicology Unit, Hospital Universitario Son Espases, Mallorca, Spain
Dargan, Paul I Clinical Toxicology, Guy’s and St Thomas’ NHS Foundation Trust and King’s Health Partners, London, UK - Clinical Toxicology, Faculty of Life Sciences and Medicine, King’s College London, UK
Wood, David M Clinical Toxicology, Guy’s and St Thomas’ NHS Foundation Trust and King’s Health Partners, London, UK - Clinical Toxicology, Faculty of Life Sciences and Medicine, King’s College London, UK
Ceschi, Alessandro ORCID Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland - Clinical Trial Unit, Ente Ospedaliero Cantonale, Lugano, Switzerland - Faculty of Biomedical Sciences, Università della Svizzera italiana, Switzerland - Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, Switzerland

2023

Published in:

Journal of Clinical Medicine. - 2023, vol. 12, no. 18, p. 5970

Emergency department presentation

Determinants of critical care admission

English This study aimed to characterize patients admitted to critical care following Emergency Department (ED) presentation with acute recreational drug toxicity and to identify determinants of admission to critical care. A retrospective multicenter matched case-control study was conducted by the European Drug Emergency Network Plus (Euro-DEN Plus) over the period 2014–2021. The cases were ED presentations with acute recreational drug toxicity admitted to critical care, the controls consisted of ED presentations with acute recreational drug toxicity medically discharged directly from the ED. The potential determinants of admission to critical care were assessed through multivariable conditional stepwise logistic regression analysis and multiple imputation was used to account for the missing data. From 2014 to 2021, 3448 Euro-DEN Plus presentations involved patients admitted to critical care (76.9% males; mean age 33.2 years; SD 10.9 years). Patient age ≥35 years (as compared to ≤18 years) was a determinant of admission to critical care following acute recreational drug toxicity (adjusted odds ratio, aOR, 1.51, 95% confidence interval, CI, 1.15–1.99), along with polydrug use (aOR 1.39, 95% CI 1.22–1.59), ethanol co-ingestion (aOR 1.44, 95% CI 1.26–1.64), and the use of gamma-hydroxybutyrate/gamma-butyrolactone (GHB/GBL, aOR 3.08, 95% CI 2.66–3.57). Conversely, lower odds of admission to critical care were associated with the use of cocaine (aOR 0.85, 95% CI 0.74–0.99), cannabis (aOR 0.44, 95% CI 0.37–0.52), heroin (aOR 0.80, 95% CI 0.69–0.93), and amphetamine (aOR 0.65, 95% CI 0.54–0.78), as was the arrival to the ED during the night (8 p.m.–8 a.m., aOR 0.88, 95% CI 0.79–0.98). These findings, which deserve confirmation and further investigation, could contribute to a more complete understanding of the decision-making process underlying the admission to critical care of patients with acute recreational drug toxicity.

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