“你担心今天会出现戒断反应吗？” 以患者为中心的单问题物质使用及护理关联筛查的回顾性分析。

"Are you worried about going into withdrawal today?" Retrospective analysis of single-question, patient-centered screen for substance use and care linkage.

作者信息

London Kory S, Hurwitz Beth, Davis Jennifer, Warrick-Stone TaReva, Cherney Alan, Randolph Frederick, Bradley-O'Toole Bernice, Deis Kate, Alexander Karen

机构信息

Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut St #100, Philadelphia, PA 19107, United States of America; Department of Emergency Medicine, Thomas Jefferson University, 1020 Sansom Street, Suite 239, Philadelphia, PA 19107, United States of America; Jefferson Addiction Multidisciplinary Service, Thomas Jefferson University, 111 S 11th St, Philadelphia, PA 19107, United States of America.

Department of Emergency Medicine, Thomas Jefferson University, 1020 Sansom Street, Suite 239, Philadelphia, PA 19107, United States of America.

出版信息

Am J Emerg Med. 2025 Jun 16;96:69-74. doi: 10.1016/j.ajem.2025.06.017.

DOI:10.1016/j.ajem.2025.06.017

PMID:40540787

Abstract

BACKGROUND

Emergency Department (ED) screening for substance use disorder (SUD) is limited by a lack of standardization and challenging clinical environments. Existing tools may be focused on informing clinicians rather than supporting patients. This study assessed a novel single-question screening tool to identify patients at risk of withdrawal and link those with opioid use disorder (OUD) to standardized treatment.

METHODS

A cross-sectional, retrospective study was conducted at two urban EDs in Philadelphia, PA, using electronic health record data between November 8, 2022, and February 28, 2025. Patients were included in the study if they arrived ambulatory to the emergency department, were aged 18 years and older, and able to answer screening questions. Demographic, encounter, screening response, disposition, and withdrawal order set utilization data were obtained. Data analysis was primarily descriptive, and bivariate associations were examined using odds ratios to assess the strength of relationships between key variables.

RESULTS

106,212 patient encounters met the inclusion criteria during the study period. 70,603 (66.5 %) of those patients answered the screening question. 4686 (6.6 %) patients answered affirmatively to a concern over withdrawal. 1512 patients (2.1 %) received medications from the opioid withdrawal order set, including 186 patients who did not express a withdrawal concern. Screening positive for a withdrawal concern was associated with a 2.28-fold increase in the odds of patient-directed discharge from the ED (OR = 2.28, 95 % CI = 2.10-2.47, p < .001). Patients who received the withdrawal protocol had significantly lower rates of patient-directed discharge (9.1 %) compared to those who screened positive for withdrawal overall (17.8 %) (OR = 0.41, 95 % CI: 0.33-0.51, p < .001).

CONCLUSION

Use of a single-question ED screening tool to identify individuals in withdrawal and link them to withdrawal treatments may be an effective tool. Additional studies should assess barriers to screening and withdrawal treatment, and long-term outcomes of those who screen positive for withdrawal concern in the ED.

摘要

背景

急诊科（ED）对物质使用障碍（SUD）的筛查受到缺乏标准化和具有挑战性的临床环境的限制。现有工具可能侧重于为临床医生提供信息，而非支持患者。本研究评估了一种新型的单问题筛查工具，以识别有戒断风险的患者，并将那些患有阿片类物质使用障碍（OUD）的患者与标准化治疗联系起来。

方法

在宾夕法尼亚州费城的两家城市急诊科进行了一项横断面回顾性研究，使用2022年11月8日至2025年2月28日期间的电子健康记录数据。如果患者步行到达急诊科、年龄在18岁及以上且能够回答筛查问题，则纳入本研究。获取了人口统计学、就诊情况、筛查反应、处置情况和戒断医嘱集使用数据。数据分析主要为描述性分析，并使用比值比检验二元关联，以评估关键变量之间关系的强度。

结果

在研究期间，106,212例患者就诊符合纳入标准。其中70,603例（66.5%）患者回答了筛查问题。4686例（6.6%）患者对戒断担忧给出肯定回答。1512例患者（2.1%）接受了阿片类戒断医嘱集的药物治疗，其中包括186例未表达戒断担忧的患者。筛查出有戒断担忧呈阳性与患者自行要求从急诊科出院的几率增加2.28倍相关（比值比=2.28，95%置信区间=2.10 - 2.47，p <.001）。与总体筛查出戒断呈阳性的患者（17.8%）相比，接受戒断方案的患者自行要求出院的比例显著更低（9.1%）（比值比=0.41，95%置信区间：0.33 - 0.51，p <.001）。