Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Mayo Clin Proc. 2014 Apr;89(4):462-71. doi: 10.1016/j.mayocp.2013.12.008. Epub 2014 Mar 11.
To evaluate the rate of emergency department (ED) visits for opioid overdose and to examine whether frequent ED visits for opioid overdose are associated with more hospitalizations, near-fatal events, and health care spending.
Retrospective cohort study of adults with at least 1 ED visit for opioid overdose between January 1, 2010, and December 31, 2011, derived from population-based data of State Emergency Department Databases and State Inpatient Databases for 2 large and diverse states: California and Florida. Main outcome measures were hospitalizations for opioid overdose, near-fatal events (overdose involving mechanical ventilation), and hospital charges during the year after the first ED visit.
The analytic cohort comprised 19,831 unique patients with 21,609 ED visits for opioid overdose. During a 1-year period, 7% (95% CI, 7%-7%; n=1389 patients) of the patients had frequent (2 or more) ED visits, accounting for 15% (95% CI, 14%-15%; n=3167) of all opioid overdose ED visits. Middle age, male sex, public insurance, lower household income, and comorbidities (such as chronic pulmonary disease and neurological diseases) were associated with frequent ED visits (all P<.01). Overall, 53% (95% CI, 52%-54%; n=11,412) of the ED visits for opioid overdose resulted in hospitalizations; patients with frequent ED visits for opioid overdose had a higher likelihood of hospitalization (adjusted odds ratio, 3.98; 95% CI, 3.38-4.69). In addition, 10.0% (95% CI, 10%-10%; n=2161) of the ED visits led to near-fatal events; patients with frequent ED visits had a higher likelihood of a near-fatal event (adjusted odds ratio, 2.27; 95% CI, 1.96-2.66). Total charges in Florida were $208 million (95% CI, $200-$219 million).
In this population-based cohort, we found that frequent ED visits for opioid overdose were associated with a higher likelihood of future hospitalizations and near-fatal events.
评估因阿片类药物过量到急诊科（ED）就诊的比率，并考察是否频繁因阿片类药物过量到 ED 就诊与更多的住院、濒死事件和医疗保健支出相关。
这是一项回顾性队列研究，纳入了 2010 年 1 月 1 日至 2011 年 12 月 31 日期间至少有 1 次因阿片类药物过量到 ED 就诊的成年人，数据来自于加利福尼亚州和佛罗里达州两个大型且多样化的州的人群基础数据的州 ED 数据库和州住院患者数据库。主要结局指标为阿片类药物过量住院、濒死事件（涉及机械通气的药物过量）以及首次 ED 就诊后 1 年内的住院费用。
分析队列包括 19831 例独特的患者，共有 21609 次因阿片类药物过量到 ED 就诊。在 1 年期间，7%（95%CI，7%-7%；1389 例患者）的患者有频繁（2 次或更多次）ED 就诊，占所有阿片类药物过量 ED 就诊的 15%（95%CI，14%-15%；3167 例患者）。中年、男性、公共保险、较低的家庭收入以及合并症（如慢性肺部疾病和神经系统疾病）与频繁 ED 就诊相关（均 P<.01）。总体而言，53%（95%CI，52%-54%；11412 例患者）的因阿片类药物过量到 ED 就诊导致住院治疗；频繁因阿片类药物过量到 ED 就诊的患者更有可能住院治疗（校正优势比，3.98；95%CI，3.38-4.69）。此外，10.0%（95%CI，10%-10%；2161 例患者）的因阿片类药物过量到 ED 就诊导致濒死事件；频繁因阿片类药物过量到 ED 就诊的患者更有可能发生濒死事件（校正优势比，2.27；95%CI，1.96-2.66）。佛罗里达州的总费用为 2.08 亿美元（95%CI，2.00-2.19 亿美元）。
在这项基于人群的队列研究中，我们发现频繁因阿片类药物过量到 ED 就诊与未来住院和濒死事件的发生可能性更高相关。
