Measuring a Crisis: Questioning the Use of Naloxone Administrations as a Marker for Opioid Overdoses in a Large US EMS System
Measuring a Crisis: Questioning the Use of Naloxone Administrations as a Marker for Opioid Overdoses in a Large US EMS System
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DOI：
10.1080/10903127.2017.1387628
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发表时间：
2018-01-01
影响因子：
2.4
通讯作者：
Williams, Jefferson G.
中科院分区：
文献类型：
--
作者：
Grover, Joseph M.;Alabdrabalnabi, Taibah;Williams, Jefferson G.
目的：美国目前正在经历阿片类药物过量的公共卫生危机。为了确定哪里可能最需要资源，许多公共卫生官员利用EMS的纳洛酮给药作为社区阿片类药物过量的容易测量的替代标志物。我们的目的是评估纳洛酮给药EMS是否准确地代表EMS要求阿片类药物过量。我们假设纳洛酮给药低估了阿片类药物过量。研究方法：我们对2013年1月至2015年12月期间北卡罗来纳州威克县疑似用药过量患者和任何服用纳洛酮的患者进行了图表审查。从电子患者护理记录中提取患者护理报告叙述和其他相关数据，并由两位EMS医生分析所得数据库。将病例分为以下类别：已知使用阿片类药物、推定使用阿片类药物、未知使用阿片类药物、精神状态改变、已知使用阿片类药物的心脏骤停、未知使用阿片类药物的心脏骤停或疑似酒精中毒，然后根据是否给予纳洛酮进一步分离。按患者人口统计学资料和事件年份比较患者类别。使用病历审查分类作为金标准，我们计算了纳洛酮给药对阿片类药物过量的敏感性和阳性预测值（PPV）。结果：2013- 2015年共确定了4，758例药物过量病例。在同一时期，1，351名患者接受了纳洛酮治疗。在已知或假定使用阿片类药物的1，431例患者中，57%（810例患者）接受了纳洛酮，43%（621例患者）未接受。纳洛酮给药识别已知或假定使用阿片类药物患者的灵敏度为57%（95% CI：54%-59%），PPV为60%（95% CI：57%-63%）。结论：在美国这个大型城市EMS系统中接受治疗的患者中，纳洛酮给药识别阿片类药物过量的总体敏感性和阳性预测值较低。需要更好的方法来确定类阿片过量趋势，以准确地描述社区内和社区之间类阿片过量的负担。
Objective: The United States is currently experiencing a public health crisis of opioid overdoses. To determine where resources may be most needed, many public health officials utilize naloxone administration by EMS as an easily-measured surrogate marker for opioid overdoses in a community. Our objective was to evaluate whether naloxone administration by EMS accurately represents EMS calls for opioid overdose. We hypothesize that naloxone administration underestimates opioid overdose. Methods: We conducted a chart review of suspected overdose patients and any patients administered naloxone in Wake County, North Carolina, from January 2013 to December 2015. Patient care report narratives and other relevant data were extracted from electronic patient care records and the resultant database was analyzed by two EMS physicians. Cases were divided into categories including known opioid use, presumed opioid use, no known opioid, altered mental status, cardiac arrest with known opioid use, cardiac arrest with no known opioid use, or suspected alcohol intoxication, and then further separated based on whether naloxone was administered. Patient categories were compared by patient demographics and incident year. Using the chart review classification as the gold standard, we calculated the sensitivity and positive predictive value (PPV) of naloxone administration for opioid overdose. Results: A total of 4,758 overdose cases from years 2013-15 were identified. During the same period, 1,351 patients were administered naloxone. Of the 1,431 patients with known or presumed opioid use, 57% (810 patients) received naloxone and 43% (621 patients) did not. The sensitivity of naloxone administration for the identification of patients with known or presumed opioid use was 57% (95% CI: 54%-59%) and the PPV was 60% (95% CI: 57%-63%). Conclusion: Among patients receiving care in this large urban EMS system in the United States, the overall sensitivity and positive predictive value for naloxone administration for identifying opioid overdoses was low. Better methods of identifying opioid overdose trends are needed to accurately characterize the burden of opioid overdose within and among communities.