Dietze Paul, Horyniak Danielle, Agius Paul, Munir Venita, Smit de Villiers, Johnston Jennifer, Fry Craig L, Degenhardt Louisa
The Centre for Population Health, Burnet Institute, Melbourne; The School of Public Health and Preventive Medicine, Monash University, Melbourne.
Acad Emerg Med. 2014 Nov;21(11):1226-31. doi: 10.1111/acem.12516.
The objective was to examine the effect of endotracheal intubation on emergency department (ED) length of stay (LOS) and admission rates for patients with gamma-hydroxybutyrate (GHB) overdose.
A 3-year retrospective electronic and paper audit of recreational drug presentations was carried out at two major inner-city EDs in Melbourne, Australia. Different GHB overdose management strategies exist at the respective audit sites, namely: 1) all patients with a Glasgow Coma Scale (GCS) score of 8 or less are intubated or 2) uncomplicated patients with GCS scores of 8 or less are managed without intubation (conservative management), unless further complications arise. This difference allows for comparison of the effects of intubation. All suspected GHB-related cases (defined as cases where GHB or its analogs gamma-butyrolactone or 1,4-butanediol were recorded) in which altered consciousness state was noted as a presenting symptom at triage were selected from all recreational drug-related presentations occurring between January 2008 and December 2010. The relationship between intubation and the primary outcome, ED LOS, was examined using robust regression after adjustment for potential confounders. The relationship between intubation and admission status (admission to hospital versus discharge) was also examined using logistic regression.
After adjustment for potential confounders such as GCS score, intubation of GHB-related cases in the ED was associated with an increase in mean LOS of 41% (95% confidence interval [CI] = 19% to 65%) and an increase in the odds of admission to hospital of 9.95 (95% CI = 2.36 to 41.88) at one hospital site, compared to conservative airway management.
Conservative airway management (no intubation) is associated with shorter ED LOS in cases of uncomplicated GHB-related coma in the ED and may also be associated with lower admission rates for these patients.
本研究旨在探讨气管插管对γ-羟基丁酸（GHB）过量患者在急诊科（ED）的留观时间（LOS）及住院率的影响。
在澳大利亚墨尔本的两家主要市中心急诊科，对娱乐性药物就诊情况进行了为期3年的回顾性电子及纸质审核。在各自的审核地点存在不同的GHB过量管理策略，即：1）所有格拉斯哥昏迷量表（GCS）评分≤8分的患者均行气管插管，或2）GCS评分≤8分的非复杂性患者不行气管插管（保守治疗），除非出现进一步并发症。这种差异使得可以比较气管插管的效果。从2008年1月至2010年12月期间所有娱乐性药物相关就诊病例中，选取所有在分诊时以意识状态改变为主要症状的疑似GHB相关病例（定义为记录有GHB或其类似物γ-丁内酯或1,4-丁二醇的病例）。在对潜在混杂因素进行调整后，采用稳健回归分析气管插管与主要结局指标（ED留观时间）之间的关系。还采用逻辑回归分析气管插管与住院状态（住院与出院）之间的关系。
在对潜在混杂因素如GCS评分进行调整后，与保守气道管理相比，在一家医院急诊科对GHB相关病例进行气管插管与平均留观时间增加41%（95%置信区间[CI]=19%至65%）以及住院几率增加9.95（95%CI=2.36至41.88）相关。
在急诊科非复杂性GHB相关昏迷病例中，保守气道管理（不行气管插管）与较短的ED留观时间相关，并且可能也与这些患者较低的住院率相关。
