Horyniak Danielle, Degenhardt Louisa, Smit De Villiers, Munir Venita, Johnston Jennifer, Fry Craig, Dietze Paul
Centre for Population Health, Burnet Institute, , Melbourne, Victoria, Australia.
Emerg Med J. 2014 Apr;31(4):317-22. doi: 10.1136/emermed-2012-202174. Epub 2013 Feb 12.
To describe patterns and characteristics of emergency department (ED) presentations related to the use of ecstasy and related drugs (ERDs) in Melbourne, Australia.
Retrospective audit of ERD-related presentations from 1 January 2008 to 31 December 2010 at two tertiary hospital EDs. Variation in presentations across years was tested using a two-tailed test for proportions. Univariate and multivariate logistic regressions were used to compare sociodemographic and clinical characteristics across groups.
Most of the 1347 presentations occurred on weekends, 24:00-06:00. Most patients arrived by ambulance (69%) from public places (42%), private residences (26%) and licensed venues (21%). Ecstasy-related presentations decreased from 26% of presentations in 2008 to 14% in 2009 (p<0.05); γ-hydroxybutyrate (GHB) presentations were most common overall. GHB presentations were commonly related to altered conscious state (89%); other presentations were due to psychological concerns or nausea/vomiting. Compared with GHB presentations, patients in ecstasy-related presentations were significantly less likely to require intubation (OR 0.04, 95% CI 0.01 to 0.18), but more likely to result in hospital admission (OR 1.77, 95% CI 1.08 to 2.91). Patients in amphetamine-related cases were older than those in GHB-related cases (median 28.4 years vs 23.9 years; p<0.05), and more likely to have a history of substance use (OR 4.85, 95% CI 3.50 to 6.74) or psychiatric illness (OR 6.64, 95% CI 4.47 to 9.87). Overall, the median length of stay was 3.0 h (IQR 1.8-4.8), with most (81%) patients discharged directly home.
Although the majority of ERD-related presentations were effectively treated, with discharge within a short time frame, the number and timing of presentations places a significant burden on EDs. ERD harm reduction and improved management of minor harms at licensed venues could reduce this burden.
描述澳大利亚墨尔本与摇头丸及相关药物（ERDs）使用相关的急诊科（ED）就诊模式及特征。
对2008年1月1日至2010年12月31日期间两家三级医院急诊科与ERDs相关的就诊情况进行回顾性审计。使用双尾比例检验来检测各年份就诊情况的差异。采用单因素和多因素逻辑回归来比较不同组之间的社会人口统计学和临床特征。
1347例就诊中大多数发生在周末的24:00 - 06:00。大多数患者通过救护车抵达（69%），来自公共场所（42%）、私人住宅（26%）和持牌场所（21%）。与摇头丸相关的就诊比例从2008年的26%降至2009年的14%（p<0.05）；总体而言，γ-羟基丁酸（GHB）相关的就诊最为常见。GHB相关的就诊通常与意识状态改变有关（89%）；其他就诊原因是心理问题或恶心/呕吐。与GHB相关的就诊相比，与摇头丸相关的就诊患者插管需求显著更低（比值比0.04，95%置信区间0.01至0.18），但住院可能性更高（比值比1.77，95%置信区间1.08至2.91）。与苯丙胺相关病例的患者比与GHB相关病例的患者年龄更大（中位数28.4岁对23.9岁；p<0.05），且更有可能有药物使用史（比值比4.85，95%置信区间3.50至6.74）或精神疾病史（比值比6.64，95%置信区间4.47至9.87）。总体而言，中位住院时间为3.0小时（四分位间距1.8 - 4.8），大多数（81%）患者直接出院回家。
尽管大多数与ERDs相关的就诊得到了有效治疗，并在短时间内出院，但就诊的数量和时间给急诊科带来了巨大负担。减少ERD危害以及改善持牌场所轻微危害的管理可以减轻这一负担。
