Grover Joseph M, Alabdrabalnabi Taibah, Patel Mehul D, Bachman Michael W, Platts-Mills Timothy F, Cabanas Jose G, Williams Jefferson G
Prehosp Emerg Care. 2018 May-Jun;22(3):281-289. doi: 10.1080/10903127.2017.1387628. Epub 2018 Jan 3.
The United States is currently experiencing a public health crisis of opioid overdoses. To determine where resources may be most needed, many public health officials utilize naloxone administration by EMS as an easily-measured surrogate marker for opioid overdoses in a community. Our objective was to evaluate whether naloxone administration by EMS accurately represents EMS calls for opioid overdose. We hypothesize that naloxone administration underestimates opioid overdose.
We conducted a chart review of suspected overdose patients and any patients administered naloxone in Wake County, North Carolina, from January 2013 to December 2015. Patient care report narratives and other relevant data were extracted from electronic patient care records and the resultant database was analyzed by two EMS physicians. Cases were divided into categories including "known opioid use," "presumed opioid use," "no known opioid," "altered mental status," "cardiac arrest with known opioid use," "cardiac arrest with no known opioid use," or "suspected alcohol intoxication," and then further separated based on whether naloxone was administered. Patient categories were compared by patient demographics and incident year. Using the chart review classification as the gold standard, we calculated the sensitivity and positive predictive value (PPV) of naloxone administration for opioid overdose.
A total of 4,758 overdose cases from years 2013-15 were identified. During the same period, 1,351 patients were administered naloxone. Of the 1,431 patients with known or presumed opioid use, 57% (810 patients) received naloxone and 43% (621 patients) did not. The sensitivity of naloxone administration for the identification of patients with known or presumed opioid use was 57% (95% CI: 54%-59%) and the PPV was 60% (95% CI: 57%-63%).
Among patients receiving care in this large urban EMS system in the United States, the overall sensitivity and positive predictive value for naloxone administration for identifying opioid overdoses was low. Better methods of identifying opioid overdose trends are needed to accurately characterize the burden of opioid overdose within and among communities.
美国目前正经历阿片类药物过量使用的公共卫生危机。为了确定最需要资源的地方，许多公共卫生官员将急救医疗服务（EMS）人员给予纳洛酮作为社区阿片类药物过量使用的一个易于测量的替代指标。我们的目的是评估EMS人员给予纳洛酮是否准确反映了因阿片类药物过量而呼叫EMS的情况。我们假设给予纳洛酮会低估阿片类药物过量的情况。
我们对2013年1月至2015年12月在北卡罗来纳州韦克县疑似过量用药患者以及任何接受纳洛酮治疗的患者进行了病历审查。从电子患者护理记录中提取患者护理报告叙述及其他相关数据，由两名EMS医生对所得数据库进行分析。病例分为“已知使用阿片类药物”、“推定使用阿片类药物”、“未知使用阿片类药物”、“精神状态改变”、“已知使用阿片类药物的心脏骤停”、“未知使用阿片类药物的心脏骤停”或“疑似酒精中毒”等类别，然后根据是否给予纳洛酮进一步细分。通过患者人口统计学特征和事件年份对患者类别进行比较。以病历审查分类作为金标准，我们计算了给予纳洛酮用于识别阿片类药物过量的敏感性和阳性预测值（PPV）。
共识别出2013 - 15年的4758例过量用药病例。在同一时期，1351例患者接受了纳洛酮治疗。在1431例已知或推定使用阿片类药物的患者中，57%（810例患者）接受了纳洛酮治疗，43%（621例患者）未接受。给予纳洛酮用于识别已知或推定使用阿片类药物患者的敏感性为57%（95%置信区间：54% - 59%），PPV为60%（95%置信区间：57% - 63%）。
在美国这个大型城市EMS系统接受治疗的患者中，给予纳洛酮用于识别阿片类药物过量的总体敏感性和阳性预测值较低。需要更好的方法来识别阿片类药物过量趋势，以便准确描述社区内和社区间阿片类药物过量的负担。
