Division of Clinical Pharmacology and Toxicology, University Hospital Basel and University of Basel, Basel, Switzerland.
Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain.
Clin Toxicol (Phila). 2022 Aug;60(8):912-919. doi: 10.1080/15563650.2022.2060116. Epub 2022 Apr 11.
To investigate if clinical features associated with acute cannabis intoxication in patients presenting to Emergency Departments for medical assistance differ according to patient age and sex.
We analysed presentations in the Euro-DEN Plus dataset from 2014 to 2019 in which cannabis was the only drug involved (except for alcohol), and age, sex and alcohol co-ingestion had been recorded. Age was considered as categorical (five groups; <20, 20-29, 30-39, 40-49 and ≥50 years), and sex as binary variable (male/female). We evaluated 12 key clinical features recorded during emergency department (ED) care. Risks of presenting with each of these clinical features according to patient age and sex were calculated by logistic regression models, and adjusted for sex, age and alcohol co-ingestion.
4,268 of 43,633 Euro-DEN presentations (9.8%) fulfilled the inclusion criteria (median age: 26 years (IQR = 20-34), 70% male, 52% co-ingested alcohol). The frequency of clinical features was: anxiety 28%, vomiting 24%, agitation 23%, palpitations 14%, reduced consciousness 13%, acute psychosis 9%, hallucinations 9%, chest pain 7%, headache 6%, hypotension 4%, hypertension 3% and seizures 2%. Patients younger than 20 years more frequently had vomiting (34.7% of cases), reduced consciousness (21.5%), and headache (10.8%); and less frequently acute psychosis (5.5%). Patients older than 49 years more often had hypotension (6.5%) and less frequently vomiting (20%), anxiety (14%), agitation (14%) and reduced consciousness (10%). Males more frequently presented with hypertension (3.7 vs. 1.5%; OR = 2.311, 95%CI = 1.299-3.816), psychosis (10.4 vs 6.3%; 1.948, 1.432-2.430), chest pain (8.1 vs 4.5%; 1.838, 1.390-2.430) and seizures (2.5 vs 1.4%; 1.805, 1.065-3.060), and less frequently with vomiting (21.8 vs 28.2%; 0.793, 0.677-0.930), anxiety (25.4 vs 32.3%; 0.655, 0.561-0.766) and hypotension (2.9 vs 5.8%; 0.485, 0.350-0.671).
The prevalence of some clinical features typically associated with acute cannabis intoxication differed according to age and sex. The causes for these differences should be further investigated in order to better understand the pathophysiology of cannabis-related acute toxicity, and they may be relevant particularly for developing prevention campaigns and for treatment in specific sex and/or age groups.
调查因急性大麻中毒到急诊就诊的患者的临床特征是否因年龄和性别而异。
我们分析了 2014 年至 2019 年期间 Euro-DEN Plus 数据集中的就诊情况，其中大麻是唯一涉及的药物（除了酒精），并记录了年龄、性别和酒精共摄入情况。年龄被视为分类变量（<20、20-29、30-39、40-49 和≥50 岁），性别为二分类变量（男/女）。我们评估了急诊护理期间记录的 12 个关键临床特征。根据患者年龄和性别，使用逻辑回归模型计算出现这些临床特征的风险，并根据性别、年龄和酒精共摄入进行调整。
在 43633 例 Euro-DEN 就诊中，有 4268 例（9.8%）符合纳入标准（中位年龄：26 岁（IQR=20-34），70%为男性，52%共摄入酒精）。临床特征的频率为：焦虑 28%、呕吐 24%、激越 23%、心悸 14%、意识减退 13%、急性精神病 9%、幻觉 9%、胸痛 7%、头痛 6%、低血压 4%、高血压 3%和癫痫发作 2%。年龄小于 20 岁的患者更常出现呕吐（34.7%的病例）、意识减退（21.5%）和头痛（10.8%）；较少出现急性精神病（5.5%）。年龄大于 49 岁的患者更常出现低血压（6.5%）和较少出现呕吐（20%）、焦虑（14%）、激越（14%）和意识减退（10%）。男性更常出现高血压（3.7%比 1.5%；OR=2.311，95%CI=1.299-3.816）、精神病（10.4%比 6.3%；1.948，1.432-2.430）、胸痛（8.1%比 4.5%；1.838，1.390-2.430）和癫痫发作（2.5%比 1.4%；1.805，1.065-3.060），较少出现呕吐（21.8%比 28.2%；0.793，0.677-0.930）、焦虑（25.4%比 32.3%；0.655，0.561-0.766）和低血压（2.9%比 5.8%；0.485，0.350-0.671）。
一些与急性大麻中毒相关的典型临床特征的患病率因年龄和性别而异。应进一步调查这些差异的原因，以便更好地了解大麻相关急性毒性的病理生理学，并且它们可能与特定性别和/或年龄组的预防运动和治疗特别相关。
