Acute intoxication patients presenting to an emergency department in the Netherlands: admit or not? Prospective testing of two algorithms

Ambrosius, R G A; Vroegop, M.P.; Jansman, Frank G A; Hoedemaekers, Cornelia; Aarnoutse, Rob E.; Wilt, Gert Jan van der; Kramers, Cornelis

doi:10.1136/emj.2010.106500

Cited by 9 publications

(14 citation statements)

References 18 publications

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“…[20][21][22] Furthermore, there has been some modest development in creating new prediction models, of which the Dutch study performed by Ambrosius et al is most comparable to our study. [23] The authors tested a prediction model, based on literature research and expert opinion, and determined the general need for hospital admission for intoxicated patients …”

Section: Mechanical Venɵlaɵon N=1970 Cpr N=120mentioning

confidence: 99%

The need for ICU admission in intoxicated patients: a prediction model

Brandenburg¹,

Brinkman

Keizer

et al. 2016

Clinical Toxicology

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Context: Intoxicated patients are frequently admitted from the emergency room to the ICU for observational reasons. The question is whether these admissions are indeed necessary. Objective: The aim of this study was to develop a model that predicts the need of ICU treatment (receiving mechanical ventilation and/or vasopressors <24 h of the ICU admission and/or in-hospital mortality). Materials and methods: We performed a retrospective cohort study from a national ICU-registry, including 86 Dutch ICUs. We aimed to include only observational admissions and therefore excluded admissions with treatment, at the start of the admission that can only be applied on the ICU (mechanical ventilation or CPR before admission). First, a generalized linear mixed-effects model with binominal link function and a random intercept per hospital was developed, based on covariates available in the first hour of ICU admission. Second, the selected covariates were used to develop a prediction model based on a practical point system. To determine the performance of the prediction model, the sensitivity, specificity, positive, and negative predictive value of several cut-off points based on the assigned number of points were assessed. Results: 9679 admissions between January 2010 until January 2015 were included for analysis. In total, 632 (6.5%) of the patients admitted to the ICU eventually turned out to actually need ICU treatment. The strongest predictors for ICU treatment were respiratory insufficiency, age >55 and a GCS <6. Alcohol and "other poisonings" (e.g., carbonmonoxide, arsenic, cyanide) as intoxication type and a systolic blood pressure !130 mmHg were indicators that ICU treatment was likely unnecessary. The prediction model had high sensitivity (93.4%) and a high negative predictive value (98.7%). Discussion and conclusion: Clinical use of the prediction model, with a high negative predictive value (98.7%), would result in 34.3% less observational admissions. ARTICLE HISTORY

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Section: Mechanical Venɵlaɵon N=1970 Cpr N=120mentioning

confidence: 99%

The need for ICU admission in intoxicated patients: a prediction model

Brandenburg¹,

Brinkman

Keizer

et al. 2016

Clinical Toxicology

View full text Add to dashboard Cite

show abstract

“…In accordance to literature, alcohol was the most prevalent intoxication in our study. [2,4–9] In the current study, a co-intoxication was present in almost one third of all alcohol intoxicated patients. This is higher compared to other studies where alcohol is more often seen as a mono intoxication, although higher rates of combination intoxications are reported.…”

Section: Discussionmentioning

confidence: 47%

“…The occurrence of all intoxications treated in the ED found in this study is higher than those found in literature in the Netherlands. [1,4] Possible explanations could be a higher alcohol and/or drug use in the population over time, a higher use of alcohol and/or drugs in the population in Rotterdam, and/or the inner city hospital location of this study.…”

Section: Discussionmentioning

confidence: 97%

“…This is higher compared to other studies where alcohol is more often seen as a mono intoxication, although higher rates of combination intoxications are reported. [1,2,4,9] Nevertheless, alcohol was seen in the majority of all intoxications. In literature an increase in alcohol related visits to the ED is described.…”

Section: Discussionmentioning

confidence: 99%

“…[1–3] Globally, alcohol intoxication is the most prevalent intoxication among patients presenting to the ED. [2,4–9] Over time, changes in the number of specific types of intoxications are seen in other countries. [10–16] There is an increase in alcohol related visits to the ED in the United States (US).…”

Section: Introductionmentioning

confidence: 99%

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Emergency Department visits due to intoxications in a Dutch university hospital: Occurrence, characteristics and health care costs

et al. 2019

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BackgroundIntoxications with alcohol and drugs are common in the Emergency Department. This study aimed to describe the occurrence and characteristics of intoxications (alcohol, Drugs of Abuse (DOA), pharmaceutical and chemical) presented to the Emergency Department and the health care costs of these intoxications.MethodsThis was a retrospective medical record study of all patients (≥ 16 years) who presented to the Emergency Department of an inner-city academic hospital in the Netherlands due to single or multiple intoxication(s) as the primary or secondary reason in the year 2016. An intoxication was reported as present if the attending physician described the intoxication in the patient’s medical record.ResultsA total of 783 patients were included, accounting for 3.2% of the adult Emergency Department population (age ≥ 16 year). In 30% more than one substance was used. Intoxications with alcohol, Drugs of Abuse and pharmaceuticals was reported in respectively 62%, 29% and 21% of the intoxicated patients. The mean costs per patient presenting with an intoxication to the Emergency Department was € 1,490. The mean costs per patient were highest for pharmaceutical intoxications (€ 2,980), followed by Drugs of Abuse (€ 1,140) and alcohol (€ 1,070).ConclusionsIntoxications among patients aged 16 years and older are frequently seen at the Emergency Department and are frequently caused by multiple substances. Alcohol is the most common intoxication. Substantial healthcare costs are involved. Therefore, this study suggests that further research into hazardous alcohol consumption and DOA abuse is warranted.

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A quarter of admitted poisoned patients have a mild poisoning and require no treatment: An observational study

Hondebrink

Rietjens

Donker

et al. 2019

European Journal of Internal Medicine

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Acute intoxication patients presenting to an emergency department in the Netherlands: admit or not? Prospective testing of two algorithms

Abstract: The algorithms had good sensitivity and better specificity than current clinical practice in most hospitals. It is too early to advocate their implementation, but results indicate that it is possible to use clinical parameters objectively to reduce unnecessary admissions to the ward.

Cited by 9 publications

References 18 publications

The need for ICU admission in intoxicated patients: a prediction model

The need for ICU admission in intoxicated patients: a prediction model

Emergency Department visits due to intoxications in a Dutch university hospital: Occurrence, characteristics and health care costs

A quarter of admitted poisoned patients have a mild poisoning and require no treatment: An observational study

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