Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC.
Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC.
Ann Emerg Med. 2020 May;75(5):559-567. doi: 10.1016/j.annemergmed.2019.11.022. Epub 2020 Jan 23.
Out-of-hospital naloxone has been championed as a lifesaving solution during the opioid epidemic. However, the long-term outcomes of out-of-hospital naloxone recipients are unknown. The objectives of this study are to describe the 1-year mortality of presumed opioid overdose victims identified by receiving out-of-hospital naloxone and to determine which patient factors are associated with subsequent mortality.
This was a regional retrospective cohort study of out-of-hospital records from 7 North Carolina counties from January 1, 2015 to February 28, 2017. Patients who received out-of-hospital naloxone were included. Out-of-hospital providers subjectively assessed patients for improvement after administering naloxone. Naloxone recipients were cross-referenced with the North Carolina death index to examine mortality at days 0, 1, 30, and 365. Naloxone recipient mortality was compared with the age-adjusted, at-large population's mortality rate in 2017. Generalized estimating equations and Cox proportional hazards models were used to assess for mortality-associated factors.
Of 3,085 out-of-hospital naloxone encounters, 72.7% of patients (n=2,244) improved, whereas 27.3% (n=841) had no improvement with naloxone. At day 365, 12.0% (n=269) of the improved subgroup, 22.6% (n=190) of the no improvement subgroup, and 14.9% (n=459) of the whole population were dead. Naloxone recipients who improved were 13.2 times (95% confidence interval 13.0 to 13.3) more likely to be dead at 1 year than a member of the general populace after age adjusting of the at-large population to match this study population. Older age and being black were associated with 1-year mortality, whereas sex and multiple overdoses were not.
Opioid overdose identified by receiving out-of-hospital naloxone with clinical improvement carries a 13-fold increase in mortality compared to the general population. This suggests that this is a high-risk population that deserves attention from public health officials, policymakers, and health care providers in regard to the development of long-term solutions.
在阿片类药物流行期间，院外纳洛酮被推崇为一种救命解决方案。然而，院外纳洛酮接受者的长期结局尚不清楚。本研究的目的是描述通过接受院外纳洛酮确定的疑似阿片类药物过量受害者的 1 年死亡率，并确定哪些患者因素与随后的死亡率相关。
这是一项对 2015 年 1 月 1 日至 2017 年 2 月 28 日来自北卡罗来纳州 7 个县的院外记录进行的区域性回顾性队列研究。纳入接受院外纳洛酮的患者。院外提供者在给予纳洛酮后主观评估患者的改善情况。将纳洛酮接受者与北卡罗来纳州死亡指数交叉引用，以检查 0、1、30 和 365 天时的死亡率。将纳洛酮接受者的死亡率与 2017 年年龄调整后的总人口死亡率进行比较。使用广义估计方程和 Cox 比例风险模型评估与死亡率相关的因素。
在 3085 例院外纳洛酮治疗中，72.7%（n=2244）的患者（n=2244）改善，而 27.3%（n=841）的患者纳洛酮无改善。在 365 天时，改善亚组中有 12.0%（n=269）、无改善亚组中有 22.6%（n=190）和整个人群中有 14.9%（n=459）死亡。在年龄调整后，与总人口匹配本研究人群后，改善的纳洛酮接受者在 1 年内死亡的可能性是一般人群的 13.2 倍（95%置信区间 13.0 至 13.3）。年龄较大和为黑人与 1 年死亡率相关，而性别和多次过量则无关。
通过接受院外纳洛酮并伴有临床改善而确定的阿片类药物过量患者与一般人群相比，死亡率增加了 13 倍。这表明这是一个高危人群，值得公共卫生官员、政策制定者和医疗保健提供者关注，以制定长期解决方案。
