Department of Pharmacology and Toxicology, Radboud University Nijmegen Medical Centre, PO Box 9101, 6525 EZ Nijmegen, The Netherlands.
Emerg Med J. 2012 Jun;29(6):467-72. doi: 10.1136/emj.2010.106500. Epub 2011 May 5.
After acute intoxication, most patients presenting to the emergency department (ED)--76% of them in The Netherlands--are admitted to hospital. Many will not need medical treatment on the ward. The authors tested two algorithms in the ED, based on vital parameters, ECG findings, and ingested substances, to identify patients who will receive treatment in hospital.
This prospective inception study enrolled patients aged 14 years and older presenting with acute intoxication between January 2006 and April 2008 to a Dutch university hospital. An algorithm was developed based on a previous retrospective study and the medical literature. In a second algorithm the clinical course during the stay in the ED was also taken into account.
Of 313 patients presenting with acute intoxication to the ED, 134 (42.8%) were admitted to a ward for somatic care, but only 74 (23.6%) were treated on the ward. Algorithm 1 had 91.9% sensitivity (95% CI 82.6% to 96.7%) and 53.6% specificity (95% CI 47.0% to 60.0%). Algorithm 2 had 90.5% sensitivity (95% CI 80.9% to 95.8%) and 65.3% specificity (95% CI 58.8% to 71.2%). In line with hospital policy, several patients received N-acetylcysteine treatment for subtoxic paracetamol ingestion because they presented outside of office hours, when no measurements of blood paracetamol concentration are performed by the laboratory. When these patients are considered as untreated, both algorithms had 98.5% sensitivity (95% CI 90.6% to 99.9%).
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.
在急诊科（ED）急性中毒后，大多数患者——荷兰有 76%的患者——会被收入院。许多患者在病房中无需接受治疗。作者在 ED 基于生命体征、心电图结果和摄入物质，检验了两种算法，以识别将在医院接受治疗的患者。
这项前瞻性发病研究纳入了 2006 年 1 月至 2008 年 4 月期间在荷兰一家大学医院因急性中毒就诊的 14 岁及以上患者。算法是基于先前的回顾性研究和医学文献制定的。在第二个算法中，还考虑了在 ED 住院期间的临床病程。
313 名因急性中毒到 ED 就诊的患者中，有 134 名（42.8%）被收治到躯体护理病房，但只有 74 名（23.6%）在病房中接受了治疗。算法 1 的敏感性为 91.9%（95%置信区间 82.6%至 96.7%），特异性为 53.6%（95%置信区间 47.0%至 60.0%）。算法 2 的敏感性为 90.5%（95%置信区间 80.9%至 95.8%），特异性为 65.3%（95%置信区间 58.8%至 71.2%）。根据医院政策，一些因摄入低毒性扑热息痛而接受 N-乙酰半胱氨酸治疗的患者，因为他们在非办公时间就诊，此时实验室不进行血液扑热息痛浓度测量，因此接受了治疗。如果将这些患者视为未治疗患者，两种算法的敏感性均为 98.5%（95%置信区间 90.6%至 99.9%）。
在大多数医院，与当前临床实践相比，这些算法具有较好的敏感性和更高的特异性。现在提倡实施这些算法还为时过早，但结果表明，使用临床参数客观地减少病房不必要的入院是可行的。
