Predicting Adverse Cardiovascular Events in Emergencies Due to Drug Overdose

描述(申请人提供)：这项以患者为导向的指导研究职业发展奖(K23)的目的是帮助Alex Manini医学博士成为一名在药物过量紧急情况下的独立研究科学家。在David Vlahov博士(导师)的指导下，他将与经验丰富的研究人员合作，以令人兴奋的初步数据为基础，研究药物过量的不良心血管事件(ACVE)。培训活动包括哥伦比亚梅尔曼公共卫生学院的统计学和流行病学课程；西奈山医学院的成瘾培训计划；药物过量、流行病学和心脏病学方面的重点指导；以及在地区、国家和国际会议上展示中期结果。建议对急诊科用药过量患者进行预后指标研究，以评估院内ACVE的发生情况。根据初步数据，假设临床危险因素(例如，人口学、暴露意图、心电图)将独立预测住院ACVE。具体目的是：(1)确定药物过量患者ACVE的发生率；(2)确定药物过量患者院内ACVE的预后指标；(3)根据上述预后指标，建立简单的ACVE危险分层评分系统，并检验风险评分的诊断特征，为急性药物过量患者的临床决策提供帮助。为了达到这些目标，两家城市教学医院的急诊科用药过量患者将被前瞻性地纳入并纵向跟踪观察院内ACVE的发生。过量用药的严重程度将通过中毒严重程度评分、急性生理学和慢性健康评估以及判定的ACVE终点进行评估。入院的心电图将由盲人心脏病专家进行解释，血清将接受毒理学筛查和心脏生物标志物的评估。将得出ACVE的预后指标，并将其合并到简单的风险评分中，并选择一个切点以实现最佳的诊断测试特征。这一风险分层工具的实施有可能预防美国每年约150万次与药物有关的急诊科就诊的AGVE并发症。 公共卫生相关性：药物过量和处方药滥用影响不同的人口统计、种族/民族和经济阶层。在美国，中毒是与伤害相关的死亡的第二大原因，也是40岁以下受害者心脏骤停的主要原因。据报道，美国每年有240万起毒物暴露事件和约150万起与毒品有关的紧急事件。

DESCRIPTION (provided by applicant): The purpose of this mentored patient-oriented research career development award (K23) is to assist Alex Manini, MD to become an independent research scientist in drug overdose emergencies. Guided by Dr. David Vlahov (mentor), he will collaborate with accomplished investigators to study adverse cardiovascular events (ACVE) in drug overdose, building upon exciting preliminary data. Training activities include courses in statistics and epidemiology at the Columbia Mailman School of Public Health; the Addiction Training program at Mount Sinai School of Medicine; focused mentorship in drug overdose, epidemiology, and cardiology; and presentation of interim results at regional, national, and international conferences. Proposed is a prognostic indicator study of emergency department patients with drug overdose to evaluate occurrence of in-hospital ACVE. Based on preliminary data, the hypothesis is that clinical risk factors (e.g., demographics, exposure intent, electrocardiogram) will independently predict in-hospital ACVE. The specific aims are: (1) to determine the incidence of ACVE in patients with drug overdose; (2) to identify prognostic indicators for in-hospital ACVE in patients with drug overdose; and (3) to derive a simple risk stratification scoring system based on the above prognostic indicators for ACVE and to test the diagnostic characteristics of the risk score to aid clinical decision-making for patients with acute drug overdose. To meet these aims, emergency department patients with drug overdose at two urban teaching hospitals will be prospectively enrolled and followed longitudinally for occurrence of in-hospital ACVE. Overdose severity will be assessed with Poison Severity Scores, Acute Physiology and Chronic Health Evaluation, and adjudicated ACVE endpoints. Interpretation of the admission electrocardiogram will be performed by a blinded cardiologist, and serum will be evaluated for toxicology screens and cardiac biomarkers. Prognostic indicators for ACVE will be derived and incorporated into a simple risk score with a cutpoint chosen to achieve optimal diagnostic test characteristics. Implementation of this risk stratification tool has the potential to prevent AGVE complications for an estimated 1.5 million drug-related emergency department visits in the U.S. annually. PUBLIC HEALTH RELEVANCE: Drug overdose and prescription drug abuse affect diverse demographics, races/ethnicities, and economic classes. Poisoning is the second leading cause of injury-related fatality in the U.S., and the leading cause of cardiac arrest in victims under 40 years of age. There are 2.4 million reported poison exposures and approximately 1.5 million drug-related emergencies in the U.S. annually.