Determinants of Admission to Critical Care Following Acute Recreational Drug Toxicity: A Euro-DEN Plus Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Euro-DEN Plus
2.2. Selection of Cases and Controls
2.3. Covariates
2.4. Outcomes
2.5. Statistical Analysis
3. Results
3.1. Baseline Characteristics
3.2. Determinants of Admission to Critical Care
4. Discussion
4.1. Characteristics of the Whole Euro-DEN Plus Cohort over the 8-Year Period 2014–2021
4.2. Characteristics of the Euro-DEN Plus Cohort Admitted to Critical Care
4.3. Determinants of Admission to Critical Care
4.4. Strengths and Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Sentinel Center | Total Number of ED Presentations (2014–2021) n (%), N = 61,274 | Cases with Admission to Critical Care n (%), N = 3448 | Controls Medically Discharged n (%), N = 37,306 |
---|---|---|---|
Oslo OAEOC (Norway) | 13,508 (22.1) | - | 9105 (24.4) |
London STH (United Kingdom) | 9255 (15.1) | 460 (13.3) | 4670 (12.5) |
Dublin (Ireland) | 4305 (7.0) | 89 (2.6) | 2042 (5.5) |
Amsterdam (Netherlands) | 3561 (5.8) | 99 (2.9) | 2893 (7.8) |
London KCH (United Kingdom) | 3111 (5.1) | 115 (3.3) | 2169 (5.8) |
Antwerp (Belgium) | 3007 (4.9) | 169 (4.9) | 2238 (6.0) |
Msida (Malta) | 2787 (4.6) | 59 (1.7) | 738 (2.0) |
Mallorca (Spain) | 2722 (4.4) | 30 (0.9) | 2387 (6.4) |
Paris (France) | 2281 (3.7) | 183 (5.3) | 1500 (4.0) |
Basel (Switzerland) | 1940 (3.2) | 134 (3.9) | 1365 (3.7) |
Barcelona (Spain) | 1529 (2.5) | 49 (1.4) | 1314 (3.5) |
Oslo OUH (Norway) | 1527 (2.5) | 1394 (40.4) | 15 (0.0) |
Munich (Germany) | 1055 (1.7) | 3 (0.1) | 212 (0.6) |
Bern (Switzerland) | 1055 (1.7) | 90 (2.6) | 639 (1.7) |
Gdansk (Poland) | 935 (1.5) | 2 (0.1) | 427 (1.1) |
Lugano (Switzerland) | 902 (1.5) | 103 (3.0) | 512 (1.4) |
Geneva (Switzerland) | 835 (1.4) | 53 (1.5) | 630 (1.7) |
York (United Kingdom) | 680 (1.1) | 7 (0.2) | 450 (1.2) |
Ljubljana (Slovenia) | 698 (1.1) | 119 (3.5) | 351 (0.9) |
Vilnius (Lithuania) | 686 (1.1) | 51 (1.5) | 453 (1.2) |
London SMH (United Kingdom) | 675 (1.1) | 10 (0.3) | 517 (1.4) |
Ghent (Belgium) | 636 (1.0) | 35 (1.0) | 343 (0.9) |
Tallin (Estonia) | 619 (1.0) | 43 (1.3) | 488 (1.3) |
Bratislava (Slovakia) | 408 (0.7) | 23 (0.7) | 196 (0.5) |
Sofia (Bulgaria) | 363 (0.6) | - | 357 (1.0) |
Drogheda (Ireland) | 322 (0.5) | 23 (0.7) | 96 (0.3) |
Riga (Latvia) | 272 (0.4) | - | 264 (0.7) |
Helsinki (Finland) | 253 (0.4) | - | 203 (0.5) |
Monza (Italy) | 208 (0.3) | 2 (0.1) | 147 (0.4) |
Copenhagen (Denmark) | 155 (0.3) | 14 (0.4) | 56 (0.2) |
Parnu (Estonia) | 171 (0.3) | 20 (0.6) | 104 (0.3) |
Kaunus (Lithuania) | 164 (0.3) | 1 (0.0) | 100 (0.3) |
Roskilde (Denmark) | 155 (0.3) | 18 (0.5) | 94 (0.3) |
Utrecht (Netherlands) | 135 (0.2) | 39 (1.1) | 71 (0.2) |
Bucharest (Romania) | 133 (0.2) | - | 18 (0.1) |
Prague (Czech Republic) | 70 (0.1) | 8 (0.2) | 17 (0.1) |
Tbilisi (Georgia) | 68 (0.1) | - | 68 (0.2) |
Izmir (Turkey) | 54 (0.1) | 2 (0.1) | 30 (0.1) |
Rozzano (Italy) | 26 (0.0) | 1 (0.0) | 20 (0.1) |
Nicosia (Italy) | 8 (0.0) | - | 7 (0.0) |
Cases n (%), N = 3448 | Matched Controls n (%), N = 3448 | Absolute Standardized Difference | |
---|---|---|---|
Patient demographics | |||
Patient sex | |||
Male | 2653 (76.9) | 2679 (77.7) | 0.02 |
Female | 795 (23.1) | 768 (22.3) | |
Missing | - | 1 (0.0) | |
Patient age, years | |||
Mean (SD) | 35.1 (10.9) | 33.0 (11.0) | 0.19 |
≤18 | 112 (3.3) | 191 (5.5) | 0.11 |
19–34 | 1685 (48.9) | 1865 (54.1) | 0.11 |
≥35 | 1633 (47.4) | 1369 (39.7) | 0.15 |
Missing | 18 (0.5) | 23 (0.7) | |
Calendar year of ED presentation occurrence | |||
2014 | 316 (9.2) | 275 (8.0) | 0.04 |
2015 | 308 (8.9) | 325 (9.4) | 0.02 |
2016 | 352 (10.2) | 271 (7.9) | 0.08 |
2017 | 458 (13.3) | 399 (11.6) | 0.05 |
2018 | 607 (17.6) | 532 (15.4) | 0.06 |
2019 | 527 (15.3) | 549 (15.9) | 0.02 |
2020 | 500 (14.5) | 594 (17.2) | 0.08 |
2021 | 380 (11.0) | 503 (14.6) | 0.11 |
Time of arrival at the ED | |||
During the night (from 8 p.m. to 8 a.m.) | 1870 (54.2) | 1994 (57.8) | 0.07 |
Missing | 9 (0.3) | 4 (0.1) | |
During the weekend (from Friday 5 p.m. to Monday 8 a.m.) | 1555 (45.1) | 1622 (47.0) | 0.04 |
Missing | 9 (0.3) | 4 (0.1) | |
Clinical observations on arrival at the ED | |||
Cardiac arrest | 142 (4.1) | 3 (0.1) | 0.28 |
Missing | 1 (0.0) | 7 (0.2) | |
Tachycardia (>100 beats per minute) | 986 (28.6) | 960 (27.8) | 0.01 |
Missing | 165 (4.8) | 199 (5.8) | |
Respiratory rate, breaths per minute | |||
Bradypnoea (<12) | 519 (15.1) | 245 (7.1) | 0.28 |
12–20 | 1695 (49.2) | 2192 (63.6) | 0.47 |
Tachypnoea (>20) | 590 (17.1) | 262 (7.6) | 0.32 |
Missing | 644 (18.7) | 149 (21.7) | |
Lactate, mmol | |||
<1.3 | 846 (24.5) | 210 (6.1) | 0.14 |
1.3–2 | 540 (15.7) | 262 (7.6) | 0.28 |
>2 | 1130 (32.8) | 300 (8.7) | 0.12 |
Missing | 932 (27.0) | 2676 (77.6) | |
Systolic blood pressure, mmHg | |||
Mean (SD) | 123.9 (25.8) | 127.2 (19.9) | 0.14 |
Hypotension (≤90) | 245 (7.1) | 66 (1.9) | 0.24 |
Hypertension (≥180) | 77 (2.2) | 41 (1.2) | 0.07 |
91–179 | 2918 (84.6) | 2660 (77.2) | 0.24 |
Missing | 208 (6.0) | 681 (19.8) | |
Diastolic blood pressure, mmHg | |||
Mean (SD) | 76.3 (19.2) | 77.1 (14.8) | 0.05 |
Missing | 214 (6.2) | 684 (19.8) | |
Hyperthermia (≥39 °C) | 107 (3.10) | 2 (0.06) | 0.27 |
Missing | 641 (18.59) | 654 (18.97) | |
Glasgow Coma Score | |||
Alert | 718 (20.8) | 1915 (55.5) | 0.78 |
Drowsy | 997 (28.9) | 1248 (36.2) | 0.16 |
Coma | 1653 (47.9) | 212 (6.2) | 1.09 |
Missing | 80 (2.3) | 73 (2.1) | |
Drugs used for recreational purposes | |||
Number of drugs used | |||
One | 2109 (61.2) | 2206 (64.0) | 0.06 |
>1 | 1339 (38.8) | 1242 (36.0) | |
Mean (SD) | 2.5 (0.8) | 2.4 (0.7) | 0.13 |
Drugs used in ≥ 5% of the ED presentations from the whole Euro-DEN Plus cohort over the 8-year period 2014–2021 | |||
Cocaine | 629 (18.2) | 658 (19.1) | 0.02 |
Cannabis | 376 (10.9) | 769 (22.3) | 0.31 |
Heroin | 585 (17.0) | 744 (21.6) | 0.12 |
GHB/GBL | 1143 (33.2) | 409 (11.9) | 0.53 |
Amphetamine | 353 (10.2) | 458 (13.3) | 0.10 |
MDMA | 244 (7.1) | 271 (7.9) | 0.03 |
Ethanol co-ingestion | 1496 (43.4) | 1391 (40.3) | 0.23 |
Missing | 1195 (34.7) | 926 (26.9) | |
Clinical features of acute recreational drug toxicity | |||
Agitation | 1298 (37.7) | 767 (22.2) | 0.34 |
Missing | 28 (0.8) | 24 (0.7) | |
Anxiety | 1152 (33.4) | 586 (17.0) | 0.39 |
Missing | 29 (0.8) | 28 (0.8) | |
Vomiting | 479 (13.9) | 336 (9.7) | 0.13 |
Missing | 28 (0.8) | 27 (0.8) | |
Seizures | 424 (12.3) | 74 (2.2) | 0.40 |
Missing | 27 (0.8) | 28 (0.8) | |
Hallucinations | 401 (11.6) | 191 (5.5) | 0.22 |
Missing | 27 (0.8) | 28 (0.8) | |
Arrhythmias | 386 (11.2) | 30 (0.9) | 0.45 |
Missing | 126 (3.7) | 124 (3.6) | |
Psychosis | 234 (6.8) | 131 (3.8) | 0.13 |
Missing | 28 (0.8) | 26 (0.8) | |
Headache | 187 (5.4) | 142 (4.1) | 0.06 |
Missing | 30 (0.9) | 27 (0.8) | |
Chest pain | 175 (5.1) | 227 (6.6) | 0.07 |
Missing | 29 (0.8) | 28 (0.8) | |
Palpitations | 129 (3.7) | 301 (8.7) | 0.21 |
Missing | 26 (0.8) | 27 (0.8) | |
Cerebellar features | 79 (2.3) | 57 (1.7) | 0.04 |
Missing | 1430 (41.5) | 1667 (48.4) |
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Noseda, R.; Franchi, M.; Pagnamenta, A.; Müller, L.; Dines, A.M.; Giraudon, I.; Heyerdahl, F.; Eyer, F.; Hovda, K.E.; Liechti, M.E.; et al. Determinants of Admission to Critical Care Following Acute Recreational Drug Toxicity: A Euro-DEN Plus Study. J. Clin. Med. 2023, 12, 5970. https://doi.org/10.3390/jcm12185970
Noseda R, Franchi M, Pagnamenta A, Müller L, Dines AM, Giraudon I, Heyerdahl F, Eyer F, Hovda KE, Liechti ME, et al. Determinants of Admission to Critical Care Following Acute Recreational Drug Toxicity: A Euro-DEN Plus Study. Journal of Clinical Medicine. 2023; 12(18):5970. https://doi.org/10.3390/jcm12185970
Chicago/Turabian StyleNoseda, Roberta, Matteo Franchi, Alberto Pagnamenta, Laura Müller, Alison M. Dines, Isabelle Giraudon, Fridtjof Heyerdahl, Florian Eyer, Knut Erik Hovda, Matthias E. Liechti, and et al. 2023. "Determinants of Admission to Critical Care Following Acute Recreational Drug Toxicity: A Euro-DEN Plus Study" Journal of Clinical Medicine 12, no. 18: 5970. https://doi.org/10.3390/jcm12185970
APA StyleNoseda, R., Franchi, M., Pagnamenta, A., Müller, L., Dines, A. M., Giraudon, I., Heyerdahl, F., Eyer, F., Hovda, K. E., Liechti, M. E., Miró, Ò., Vallersnes, O. M., Yates, C., Dargan, P. I., Wood, D. M., Ceschi, A., & on behalf of the Euro-DEN Plus Research Group. (2023). Determinants of Admission to Critical Care Following Acute Recreational Drug Toxicity: A Euro-DEN Plus Study. Journal of Clinical Medicine, 12(18), 5970. https://doi.org/10.3390/jcm12185970