Risk factors for 48-hours mortality after prehospital treatment of opioid overdose

Wichmann, Sine; Nielsen, Søren R.K.; Siersma, Volkert; Rasmussen, Lars S.

doi:10.1136/emermed-2012-201124

Cited by 9 publications

(9 citation statements)

References 20 publications

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“…Hickman and colleagues showed that overdose during weekends was associated with an odds ratio of 1.48 for mortality in methadone overdose . In another study, it was shown by logistic regression analysis that age over 50 and overdose during weekends were associated with opioid overdose‐related 48‐hr mortality . We did not assess overdose during weekends, but by linear regression analysis, increased age was shown to be a predictor of hospital stay in our study.…”

Section: Discussioncontrasting

confidence: 48%

Risk Factors for Mortality and Endotracheal Intubation after Methadone Intoxication

Hassanian‐Moghaddam

Soltaninejad

Shadnia

et al. 2015

Basic Clin Pharma Tox

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This was a retrospective chart review to evaluate various risk factors associated with in-hospital mortality and intubation risk in acute methadone overdose. All patients admitted to an academic hospital in Tehran, Iran, during a 10-year period (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009) constituted the study sample. Exclusion criteria were significant comorbidities and age under 18 years. Outcome variables were in-hospital mortality and being intubated during admission. A total of 802 patients were enrolled in the study. There were 15 (1.8%) deaths due to methadone overdose or its complications. The number of yearly admissions was 15 patients in 2000, 16 in 2001, 16 in 2002, 18 in 2003, 23 in 2004, 38 in 2005, 59 in 2006, 110 in 2007, 206 in 2008 and 301 in 2009. Based on logistic regression analysis, the most important independent variable predicting mortality was length of admission in toxicology ward [OR (95% CI): 1.6 (1.1-2.3)]. For the prediction of intubation, independent variables were Glasgow Coma Scale (GCS) score of 5-9 [OR (95% CI): 356.5 (9.8-12907.4)] in the emergency department (ED), miosis in the ED [356.9 (1.4-87872.5)] and respiratory rate in the ED [1.5 (1.1-2.1)]. Linear regression model for length of hospitalization showed patient age as the most important variable for prediction of this outcome. Despite a relatively low mortality rate, the increasing number of methadone-poisoned patients requires special attention to this common intoxication. Careful disposition of patients from ED to ordinary wards or intensive care units and also from higher to lower levels of care should be considered in methadone overdose.Methadone, firstly introduced as an opiate substitution therapy agent in 1965, was described by Dole and Nyswander for methadone maintenance treatment (MMT) in rehabilitation programmes for heroin addicts [1,2]. Since that time, especially from the 1990s, methadone has been implicated in many overdose deaths and admissions to hospital emergency departments (EDs) because of its potential for abuse [3,4].Overdosing with methadone is a growing healthcare problem in many countries as a result of the widespread opioid abstinence programmes and increased availability of this drug. Death or any other adverse outcome from methadone poisoning are potentially preventable because of the long-term nature of clinical sequelae [5]. The majority of deaths due to illicit drug use were found to be related to accidental poisoning; methadone and heroin/morphine were responsible for about two-thirds of these deaths [6]. In heroin-addicted patients under MMT, one study found methadone overdose as the third cause of mortality following accidents and suicide [7].Studies have shown the correlation of some factors with mortality in methadone-prescribed patients; these include prescription of methadone for chronic pain, higher doses of methadone prescribed, sleep apnoea, psychiatric admission, history of benzodiazepines or barbiturates consumption, first 2 weeks of therapy and correct...

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Section: Discussioncontrasting

confidence: 48%

Risk Factors for Mortality and Endotracheal Intubation after Methadone Intoxication

Hassanian‐Moghaddam

Soltaninejad

Shadnia

et al. 2015

Basic Clin Pharma Tox

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“…These findings agree with previous studies evaluating outpatient opioid OD risk factors. Specifically, a study by Wichmann and colleagues found that patients who present to the emergency room with an opioid OD are more likely to die from the OD if they are older 14 . Other studies have found that patients with higher socioeconomic status (measured in education level), female gender, mood disorders and those taking sedating medications have an increased risk of opioid OD outside the hospital 15, 16 .…”

Section: Discussionmentioning

confidence: 99%

Predictors of In-hospital Postoperative Opioid Overdose After Major Elective Operations

et al. 2017

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Objective: To describe national trends and outcomes of in-hospital postoperative opioid overdose (OD) and identify predictors of postoperative OD. Summary Background Data: In 2000 the Joint Commission recommended making pain the 5th vital sign, increasing the focus on postoperative pain control. However, the benefits of pain management must be weighed against the potentially lethal risk of opioid OD. Methods: This is a retrospective multi-institutional cohort study of patients undergoing one of six major elective inpatient operation from 2002 to 2011 using the Nationwide Inpatient Sample, an approximately 20% representative sample of all United States hospital admissions. Patients with postoperative OD were identified using ICD-9 codes for poisoning from opioids or adverse effects from opioids. Multivariate logistic regression was used to identify independent predictors. Results: Among 11,317,958 patients, 9,458 (0.1%) had a postoperative OD; this frequency doubled over the study period from 0.6 to 1.1 overdoses per 1,000 cases. Patients with postoperative OD died more frequently during their hospitalization (1.7% vs. 0.4%, p-value < 0.001). Substance abuse history was the strongest predictor of OD (OR=14.8; 95% CI: 12.7–17.2). Gender, age, income, geographic location, operation type, and certain comorbid diseases also predicted OD (p<0.05). Hospital variables including teaching status, size, and urban/rural location did not predict postoperative OD. Conclusions: Postoperative OD is a rare, but potentially lethal complication, with increasing incidence. Postoperative monitoring and treatment safety interventions should be thoughtfully employed to target high risk patients and avoid this potentially fatal complication.

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“…The most common cause of death was overdose. Previous studies have found that rebound toxicity and death in the immediate days after an overdose attendance are rare among those who are left on the scene by ambulance services after naloxone treatment . This could suggest that an individual survives the first few days after an overdose attendance, but thereafter there is an increased risk of death, in particular from a new overdose.…”

Section: Discussionmentioning

confidence: 99%

“…One of these risk factors is injecting drug use, which not only increases the risk of death from overdose, but also increases the risk of death from cutaneous injection‐related infections, venous disease and blood‐borne infections such as hepatitis and HIV . Other factors that are well known to be associated with higher mortality rates include non‐fatal overdoses, older age, being male, having a long injecting career and combining opioid injections with alcohol and/or benzodiazepines . In addition, there is an increased risk of fatal overdoses among opioid users in the first month after prison release or discharge from abstinence‐orientated drug addiction treatment .…”

Section: Introductionmentioning

confidence: 99%

Are overdoses treated by ambulance services an opportunity for additional interventions? A prospective cohort study

Gjersing¹,

Bretteville-Jensen²

2015

Addiction

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AimsTo assess whether people who inject drugs (PWID) and who are treated for overdose by ambulance services have a greater mortality risk compared with other PWID, and to compare mortality risk within potentially critical time-periods (1 week, 1 month, 3 months, 6months, 1 year, 5 years) after an overdose attendance with the mortality risk within potentially non-critical time periods (time before and/or after critical periods).Design A prospective cohort study.Setting Oslo, Norway. Conclusions Mortality risk among PWID is significantly greater in time-periods after an overdose attendance than outside these time-periods.3

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Risk factors for 48-hours mortality after prehospital treatment of opioid overdose

Abstract: The author found a 48-hours mortality of 8.4%. Advanced age and opioid overdose in the weekends were significant risk factors. Release on scene after treatment was associated with a very small risk.

Cited by 9 publications

References 20 publications

Risk Factors for Mortality and Endotracheal Intubation after Methadone Intoxication

Risk Factors for Mortality and Endotracheal Intubation after Methadone Intoxication

Predictors of In-hospital Postoperative Opioid Overdose After Major Elective Operations

Are overdoses treated by ambulance services an opportunity for additional interventions? A prospective cohort study

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