Predictors of Overdose Death Among High-Risk Emergency Department Patients With Substance-Related Encounters: A Data Linkage Cohort Study
Predictors of Overdose Death Among High-Risk Emergency Department Patients With Substance-Related Encounters: A Data Linkage Cohort Study
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DOI：
10.1016/j.annemergmed.2019.07.014
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发表时间：
2020-01-01
影响因子：
6.2
通讯作者：
Saloner, Brendan
中科院分区：
文献类型：
--
作者：
Krawczyk, Noa;Eisenberg, Matthew;Saloner, Brendan
研究目的：患有药物使用障碍的人经常使用急诊室（艾德）服务，这为干预和转介到成瘾治疗和减少伤害服务创造了机会。然而，ED可能没有适当的工具来区分哪些患者具有最大的负面结果风险。我们将一个州的医院艾德和体检医师死亡率数据库联系起来，以确定与物质相关遭遇的艾德患者中与过量死亡相关的个体水平风险因素。这项回顾性队列研究将2014年至2015年马里兰州全州艾德医院非致命性过量或物质使用障碍患者的索赔记录与2015年至2016年的体检医师死亡记录联系起来。使用逻辑回归来识别医院记录中与阿片类药物过量死亡风险相关的因素。过量死亡的预测概率计算了不同组合的过量和物质使用诊断histors.Results的假设患者：共有139,252例患者有物质相关的艾德遭遇在2014年至2015年。在这些患者中，963例后来发生了阿片类药物过量死亡，表明病死率为69.2/10，000例患者，比因任何原因使用艾德的患者高6倍。与死亡最密切相关的因素包括同时患有阿片类药物和其他物质使用障碍（校正的比值比2.88; 95%置信区间2.04 - 4.07），既往非致死性用药过量≥ 3次（调整后的比值比为2.89; 95%置信区间为1.54至5.43），并且既往有涉及海洛因的非致命性过量（调整后的比值比2.24; 95%置信区间1.64至3.05）。结论：这些结果突出了在ED接受药物相关疾病治疗的患者中过量风险的重要差异。研究结果表明，将来自患者记录的常规数据纳入评估未来负面结果风险并确定启动和与救生护理联系的主要目标的潜在效用。
Study objective: Persons with substance use disorders frequently utilize emergency department (ED) services, creating an opportunity for intervention and referral to addiction treatment and harm-reduction services. However, EDs may not have the appropriate tools to distinguish which patients are at greatest risk for negative outcomes. We link hospital ED and medical examiner mortality databases in one state to identify individual-level risk factors associated with overdose death among ED patients with substance-related encounters.Methods: This retrospective cohort study linked Maryland statewide ED hospital claims records for adults with nonfatal overdose or substance use disorder encounters in 2014 to 2015 with medical examiner mortality records in 2015 to 2016. Logistic regression was used to identify factors in hospital records associated with risk of opioid overdose death. Predicted probabilities for overdose death were calculated for hypothetical patients with different combinations of overdose and substance use diagnostic histories.Results: A total of 139,252 patients had substance-related ED encounters in 2014 to 2015. Of these patients, 963 later experienced an opioid overdose death, indicating a case fatality rate of 69.2 per 10,000 patients, 6 times higher than that of patients who used the ED for any cause. Factors most strongly associated with death included having both an opioid and another substance use disorder (adjusted odds ratio 2.88; 95% confidence interval 2.04 to 4.07), having greater than or equal to 3 previous nonfatal overdoses (adjusted odds ratio 2.89; 95% confidence interval 1.54 to 5.43), and having a previous nonfatal overdose involving heroin (adjusted odds ratio 2.24; 95% confidence interval 1.64 to 3.05).Conclusion: These results highlight important differences in overdose risk among patients receiving care in EDs for substance-related conditions. The findings demonstrate the potential utility of incorporating routine data from patient records to assess risk of future negative outcomes and identify primary targets for initiation and linkage to lifesaving care.