Death after emergency department visits for opioid overdose in British Columbia: a retrospective cohort analysis.
Death after emergency department visits for opioid overdose in British Columbia: a retrospective cohort analysis.
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DOI：
10.9778/cmajo.20200169
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发表时间：
2021-01
期刊：
影响因子：
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通讯作者：
Slaunwhite A
中科院分区：
文献类型：
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作者：
Moe J;Chong M;Zhao B;Scheuermeyer FX;Purssell R;Slaunwhite A
在服药过量后，去急诊科就诊是接触患者的重要机会。我们试图估计和比较因阿片类药物过量而去急诊科就诊的人和那些没有因阿片类药物过量而就诊的人之间的12个月死亡率。我们使用省过量队列进行了一项回溯性队列研究，该队列包含不列颠哥伦比亚省2015至2017年间与阿片类药物相关的过量服药患者的数据，以及20%的不列颠哥伦比亚省居民的随机样本进行比较。我们检查了2015年1月1日至2016年12月31日期间急诊科的所有非致命性就诊，年龄在14岁至74岁之间，并比较了与服药过量相关的就诊者和非服药相关就诊者的12个月死亡率。我们估计了死亡的风险比，并对年龄、性别、合并症和处置(出院或不按医生建议离开)进行了调整。我们包括3593名因服药过量而求诊的人士，以及216 453名与服药无关的急症室求诊人士。那些因服药过量而就诊的人更年轻，主要是男性，有更多的心理健康状况。本组12个月粗死亡率为5.4%(95%可信区间为4.7%-6.2%)，非服药相关就诊者为1.7%(95%可信区间1.6%-1.8%)。调整后，对于出院的患者，与服药过量相关的就诊者的12个月死亡风险是非服药相关就诊者的3.5倍(95%可信区间3.0-4.2)。对于违背医生建议而离开的人，阿片类药物过量者的死亡风险是7.1(95%可信区间4.0-12.5)倍。在因服药过量而去急诊科就诊的人中，12个月的死亡率高于那些没有服药过量相关就诊的人。与过量用药有关的就诊应促使采取紧急的循证干预措施(例如，带回家的纳洛酮试剂盒、丁丙诺啡-纳洛酮诱导)，以防止今后的死亡。
Visits to the emergency department are critical opportunities to engage individuals after an overdose. We sought to estimate and compare the 12-month mortality between persons with visits to the emergency department related to opioid overdose and those with non-overdose-related visits. We conducted a retrospective cohort study using the Provincial Overdose Cohort, which contains data for patients in British Columbia who had an opioid-related overdose between 2015 and 2017, along with a 20% random sample of BC residents for comparison. We examined all nonfatal visits to the emergency department between Jan. 1, 2015, and Dec. 31, 2016, among persons aged 14 to 74 years and compared the 12-month mortality between those with overdose-related visits and those with non-overdose-related visits. We estimated the hazard ratio for death, with adjustment for age, sex, comorbidity and disposition (discharged or left against medical advice). We included 3593 persons with overdose-related visits and 216 453 with non-overdose-related visits to the emergency department. Those with overdose-related visits were younger, were predominantly male and had more mental health conditions. The 12-month crude mortality probability was 5.4% (95% confidence interval [CI] 4.7%–6.2%) in this group and 1.7% (95% CI 1.6%–1.8%) among those with non-overdose-related visits. After adjustment, for persons who were discharged, the 12-month mortality hazard was 3.5 (95% CI 3.0–4.2) times higher among those with overdose-related visits than those with non-overdose-related visits. For persons who left against medical advice, the mortality hazard was 7.1 (95% CI 4.0–12.5) times higher among those with opioid overdose. Among persons with overdose-related visits to the emergency department, 12-month mortality was higher than among those with non-overdose-related visits. Overdose-related visits should prompt urgent evidence-based interventions (e.g., take-home naloxone kits, buprenorphine–naloxone induction) to prevent future deaths.