The Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON, K1S 5H4, Canada.
BMC Public Health. 2024 Sep 18;24(1):2546. doi: 10.1186/s12889-024-20016-8.
BACKGROUND: The opioid crisis is a serious public health issue in Canada. There have been many surveillance programs and research studies on opioid-related emergency department (ED) visits at a national, provincial, regional or municipal level. However, no published studies have investigated the in-depth contexts surrounding opioid-related ED visits. In addition, few studies have examined injuries other than poisonings in those visits. The objective of this study is to investigate the contextual factors and co-occurrence of poisonings and injuries among the opioid-related ED visits in a Canadian sentinel surveillance system on injuries and poisonings from 2011 to 2022. METHODS: This study used a mixed methods design. The data source was the Canadian Hospitals Injury Reporting and Prevention Program. We first selected all opioid-related ED visits during our study period and then identified the contextual factors through a content analysis of the combination of the narrative description and other variables in the patients' records. The contextual factors were organized into themes as opioid use context, social resource utilization, bystander involvement, and prior naloxone use. The opioid use context was used as a co-variable to examine the other themes and ED presentations (poisonings and other injuries). Quantitative descriptive approach was used to analyze all the contexts and ED presentations. RESULTS: The most common opioid use context was non-prescribed opioid use without intention to cause harm, followed by self-poisoning, children's exposure, and medication error. Various rare contexts occurred. Paramedics participated in 27.9% of visits. Police and security guards were involved in 5.1% and 2.3% of visits, respectively. Child welfare or social workers were involved in 0.4% of visits. Bystanders initiated 18.9% of the ED visits. Naloxone use before arriving at the ED occurred in 23.4% of the visits with a variety of administrators. The majority of patients presented with poisoning effects, either with poisoning effects only or with other injuries or conditions. CONCLUSIONS: Our study has provided an in-depth analysis of contextual factors and co-occurrence of poisonings and injuries among opioid-related ED visits in Canada. This information is important for ED programming and opioid-related poisoning and injury intervention and prevention.
背景：阿片类药物危机是加拿大严重的公共卫生问题。已经有许多关于全国、省、地区或市级阿片类药物相关急诊（ED）就诊的监测计划和研究。然而，尚无研究调查阿片类药物相关 ED 就诊的深入背景情况。此外，这些就诊中很少有研究检查除中毒以外的伤害。本研究的目的是在 2011 年至 2022 年期间，使用加拿大伤害和中毒监测系统调查与阿片类药物相关的 ED 就诊中毒和伤害的背景因素和共病情况。
方法：本研究采用混合方法设计。数据来源是加拿大医院伤害报告和预防计划。我们首先在研究期间选择所有与阿片类药物相关的 ED 就诊，然后通过对患者记录中的叙述描述和其他变量的组合进行内容分析来确定背景因素。背景因素被组织成主题，包括阿片类药物使用背景、社会资源利用、旁观者参与和之前使用纳洛酮。阿片类药物使用背景被用作协变量，以检查其他主题和 ED 表现（中毒和其他伤害）。采用定量描述性方法分析所有背景和 ED 表现。
结果：最常见的阿片类药物使用背景是非处方阿片类药物使用且无伤害意图，其次是自我中毒、儿童暴露和药物错误。各种罕见的背景情况也有发生。27.9%的就诊有急救人员参与，5.1%和 2.3%的就诊分别有警察和安保人员参与，0.4%的就诊有儿童福利或社会工作者参与。18.9%的 ED 就诊是由旁观者发起的。23.4%的就诊在到达 ED 之前使用过纳洛酮，且有各种管理员参与。大多数患者表现出中毒效应，要么只有中毒效应，要么伴有其他伤害或疾病。
结论：本研究深入分析了加拿大与阿片类药物相关的 ED 就诊中毒和伤害的背景因素和共病情况。这些信息对 ED 编程以及阿片类药物相关中毒和伤害干预和预防非常重要。
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