| Summary: | 碩士 === 國立陽明大學 === 環境與職業衛生研究所 === 103 === Introduction: Drug abuse is a public health and medical problem worldwide. With the rapid growth of internet trafficking and easy availability of new recreational drugs, drug abuse related problems are likely to become more severe and complicated and may lead to more emergency department (ED) visits. Nevertheless, the lack of toxicologic screening facility in many EDs probably hinders the accurate and timely evaluation of the role of abused drugs, particularly novel psychoactive substances, in drug abuse related poisonings. Therefore, the aims of this study are to explore the association between drug abuse-related ED patients’ baseline demographic, clinical characteristics and clinical outcome, and to investigate the significance of toxicologic screening in clinical practice.
Methods: We conducted a retrospective study in a medical center from 2009 to 2013 in Taiwan. All patients who visited the ED of Taipei Veterans General Hospital and tested positive for any abused drugs were included in this study. Data on patients’ baseline demographic, clinical characteristics and clinical outcome were collected and tabulated. We further examined the association between patients’ baseline characteristics and their outcome (severe vs. non-severe)/ consistency of diagnosis (consistent vs inconsistent). Severe outcome was defined if the patient required endotracheal intubation or intensive care, or was dead during the hospitalization. Consistent diagnosis was defined if the primary clinical diagnosis was consistent with the result of toxicologic screening. All statistical analyses were performed using the SAS 9.4. The significance was set at P< 0.05.
Results: During the study period, 623 patients were identified and eligible for final analysis. Most patients were females (64.0%) and aged 20-49 years (67.1%). The majority of patients were classified as triage category 2 (50.1%). Benzodiazepines (n= 469) were the most frequent culprit of drug-abuse related ED visits, followed by “Z” drugs (e.g. zopiclone, zaleplon and zolpidem; n= 173), central nervous system (CNS) depressants (e.g. ketamine, barbiturates and heroin; n= 93), CNS stimulants (e.g. methamphetamine, ecstasy and mephedrone; n= 66) and CNS hallucinogens (e.g. phencyclidine and cannabinoids; n= 4). One hundred and sixty-three patients abused ≧2 drugs. Among the 623 patients, 121 patients, including 11 fatalities, had a severe outcome. In multiple logistic regression analysis adjusted for variables that were significant in bivariate analysis, ED triage, smoking, aspiration pneumonia, leukocytosis, hypernatremia, increased creatinine, elevated ALT, and hypocalcemia were associated with the risk of severe outcome. Besides, the primary clinical diagnosis was less likely to be consistent with the result of toxicologic screening among patients who developed severe outcome (OR= 0.589, 95% CI 0.358-0.969) and/or aspiration pneumonia (OR= 0.550, 95% CI 0.313-0.967).
Conclusion: Drug abuse-related ED visits were not uncommon and primarily involved younger patients and patients receiving psychotropic medications. Most patients were classified as ED triage 1 or 2 and 21.7% of them developed severe outcome, indicating the probable need of more medical resources in managing these patients. Toxicologic screening is also important in confirming the diagnosis and can provide important information to ED physicians in better managing patients with drug abuse related poisonings.
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