Illicit drugs in the emergency department: Can we determine on clinical grounds if patients are intoxicated? Results from the Western Australian Illicit Substance Evaluation (WISE) study.
emergency medical services
illicit drugs
methamphetamine
substance-related disorders
synthetic drugs
Journal
Drug and alcohol review
ISSN: 1465-3362
Titre abrégé: Drug Alcohol Rev
Pays: Australia
ID NLM: 9015440
Informations de publication
Date de publication:
11 2023
11 2023
Historique:
revised:
28
07
2023
received:
18
12
2022
accepted:
28
07
2023
medline:
13
11
2023
pubmed:
17
8
2023
entrez:
17
8
2023
Statut:
ppublish
Résumé
Presentations related to illicit drugs are a feature of emergency department practice. Clinicians may form a belief that a patient is intoxicated with illicit drugs based on patient self-report, clinical features on presentation and the local prevalence of illicit drug use. But evidence of the accuracy of this assessment is lacking. The Western Australian Illicit Substance Evaluation (WISE) study enrolled patients believed by their treating clinician to be intoxicated with illicit drugs, and this analysis aims to evaluate the validity of this belief. A blood sample was taken on patient arrival and details of patient history, examination and interventions were collected by clinical and research staff. Toxicological examination of biological samples used liquid chromatography-mass spectrometry techniques including Quadrupole Time of Flight screening and Triple Quadrupole targeted analyses. Of 632 study presentations, 518 had illicit drugs detected representing a positive predictive value of 0.82 (95% confidence interval 78.7, 84.9). Those with illicit drugs detected were significantly less likely to arrive by police transport (p = 0.010) or to have used alcohol (p < 0.001). They were significantly more likely to report illicit drug use (p < 0.001) and a much smaller proportion were admitted to a psychiatric ward (3.5% vs. 19.3%, p < 0.0001). Heart rate and systolic blood pressure were significantly higher in the illicit drug group (p = 0.004 and p = 0.003). In this study, the positive predictive value of clinicians determining if their patient had taken illicit drugs was 0.82. Contemporaneous biochemical analysis in the clinical setting would increase this accuracy and inform patient care.
Substances chimiques
Illicit Drugs
0
Ethanol
3K9958V90M
Banques de données
ANZCTR
['ACTRN12617000012370']
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1807-1815Informations de copyright
© 2023 The Authors. Drug and Alcohol Review published by John Wiley & Sons Australia, Ltd on behalf of Australasian Professional Society on Alcohol and other Drugs.
Références
Australian Institute of Health and Welfare. National Drug Strategy Household Survey 2019. Drug Statistics series no. 32. PHE 270. Canberra: AIHW; 2020.
Emergency Department Data Collection. Meth-related emergency department attendances report for July to December 2017. Perth, Australia: Government of Western Australia, Department of Health; 2018.
Australasian College for Emergency Medicine. 2018 alcohol and other drug harm snapshot survey. Melbourne: ACEM; 2019.
Smith J, McCutcheon D, Weber C, Soderstrom J, Burcham J, Fatovich D. ‘Trial by fire’: an online survey exploring confidence of junior doctors in managing toxicology presentations to the emergency department. Drug Alcohol Rev. 2022;41:1554-1564.
Tracy D, Wood D, Baumeister D. Novel psychoactive substances: types, mechanisms of action, and effects. BMJ. 2017;356:i6848.
Wood DM, Ceronie B, Dargan PI. Healthcare professionals are less confident in managing acute toxicity related to the use of new psychoactive substances (NPS) compared with classical recreational drugs. QJM. 2016;109:527-529.
McCutcheon D, Raghavan M, Soderstrom J, Oosthuizen F, Douglas B, MacDonald E, et al. An early warning system for emerging drugs of concern in the emergency department: protocol for the Western Australian illicit substance evaluation (WISE) study. Emerg Med Australas. 2019;31:411-416.
Hilbe J. Negative Binomial Regression. Cambridge, UK: Cambridge University Press; 2011.
Haukoos J, Lewis R. Advanced statistics: bootstrapping confidence intervals for statistics with “difficult” distributions. Acad Emerg Med. 2005;12:360-365.
FitzGerald G, Jelinek G, Scott D, Gerdtz M. Emergency department triage revisited. Emerg Med J. 2010;27:86-92.
van Boekel L, Brouwers E, van Weeghel J, Garretsen H. Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: systematic review. Drug Alcohol Depend. 2013;131:23-35.
Wilson C, Sherritt L, Gates E, Knight J. Are clinical impressions of adolescent substance use accurate? Pediatrics. 2004;114:e536-e540.
McGregor K, Makkai T. Self-reported drug use: how prevalent is under-reporting? Trends & Issues in crime and criminal justice. No. 260. Canberra, Australia: Australian Institute of Criminology; 2020.
Moeller KE, Kissack JC, Atayee RS, Lee KC. Clinical interpretation of urine drug tests: what clinicians need to know about urine drug screens. Mayo Clin Proc. 2017;92:774-796.
Liakoni E, Yates C, Dines A, et al. Acute recreational drug toxicity: comparison of self-reports and results of immunoassay and additional analytical methods in a multicenter European case series. Medicine (Baltimore). 2018;97:e9784.
Mandelli M, Tognoni G, Garattini S. Clinical pharmacokinetics of diazepam. Clin Pharmacokinet. 1978;3:72-91.