Self-discharge during treatment for acute recreational drug toxicity: an observational study from emergency departments in seven European countries

Vallersnes, Odd Martin; Dines, Alison M.; Wood, David M.; Heyerdahl, Fridtjof; Hovda, Knut Erik; Yates, Christopher; Giraudon, Isabelle; Caganova, Blazena; Ceschi, Alessandro; Galicia, Miguel; Liakoni, Evangelia; Liechti, Matthias E.; Miró, Òscar; Noseda, Roberta; Persett, Per Sverre; Põld, Kristiina; Schmid, Yasmin; Scholz, Irene; Vigorita, Federico; Dargan, Paul I.

doi:10.1186/s12245-023-00566-1

International Journal of Emergency Medicine

Table 4 Clinical features and self-discharge from the emergency department during acute recreational drug toxicity

From: Self-discharge during treatment for acute recreational drug toxicity: an observational study from emergency departments in seven European countries

	Total n (%)	Self-discharge n (%)	Crude OR	95% CI	P value	Adjusted OR	95% CI	P value
Tachypnoea (RR > 20/min)^a	1581 (10.4)	134 (8.5)	0.66	0.55–0.79	< 0.001	0.79	0.63–1.00	0.046
Bradycardia (HR < 50/min)^a	278 (1.8)	19 (6.8)	0.54	0.34–0.86	0.009	0.62	0.34–1.13	0.12
Hypertension (SBP ≥ 180 mmHg)	432 (2.9)	31 (7.2)	0.56	0.39–0.81	0.002	1.00	0.66–1.51	0.98
Hypotension (SBP ≤ 90 mmHg)	708 (4.7)	48 (6.8)	0.52	0.39–0.71	< 0.001	0.60	0.42–0.86	0.005
Hyperthermia (temp ≥ 39.0 °C)	161 (1.1)	3 (1.9)	0.14	0.04–0.44	0.001	0.20	0.05–0.83	0.026
Arrhythmias	156 (1.0)	4 (2.6)	0.19	0.07–0.52	0.001	0.26	0.06–1.08	0.064
Palpitations	1029 (6.8)	64 (6.2)	0.47	0.36–0.61	< 0.001	0.57	0.41–0.77	< 0.001
Chest pain	969 (6.4)	67 (6.9)	0.53	0.41–0.68	< 0.001	0.70	0.52–0.94	0.016
Vomiting	1446 (9.6)	106 (7.3)	0.56	0.46–0.68	< 0.001	0.68	0.55–0.86	< 0.001
Headache	681 (4.5)	58 (8.5)	0.68	0.51–0.89	0.005	0.84	0.62–1.13	0.24
Psychosis	897 (5.9)	51 (5.7)	0.43	0.32–0.57	< 0.001	0.45	0.31–0.64	< 0.001
Hallucinations	1028 (6.8)	72 (7.0)	0.54	0.42–0.69	< 0.001	0.73	0.54–0.98	0.034
Agitation	3766 (24.9)	445 (11.8)	0.99	0.88–1.10	0.79	1.27	1.10–1.46	< 0.001
Anxiety	2722 (18.0)	181 (6.6)	0.47	0.40–0.55	< 0.001	0.64	0.52–0.77	< 0.001
Cerebellar features	196 (1.3)	14 (7.1)	0.56	0.33–0.97	0.040	0.68	0.37–1.24	0.21
Lowest level of consciousness
Alert (GCS 15)	4592 (39.5)	618 (13.5)	1			1
Drowsy (GCS 9–14)	4857 (41.8)	619 (12.7)	0.94	0.83–1.06	0.30	0.66	0.58–0.76	< 0.001
Coma (GCS 3–8)	2166 (18.6)	140 (6.5)	0.44	0.37–0.54	< 0.001	0.37	0.30–0.46	< 0.001
Treatment – sedation	2761 (18.2)	120 (4.3)	0.29	0.24–0.35	< 0.001	0.38	0.30–0.48	< 0.001
Treatment – naloxone	2452 (16.2)	295 (12.0)	1.01	0.89–1.15	0.88	1.27	1.07–1.51	0.005
Treatment – flumazenil	313 (2.1)	10 (3.2)	0.24	0.12–0.45	< 0.001	0.38	0.18–0.83	0.015
Female sex	3396 (22.4)	414 (12.2)	1.03	0.92–1.16	0.61	1.08	0.94–1.24	0.29
Age 20–39 years	982 (6.5)	64 (6.5)	1			1
≤ 19 years	9967 (66.4)	1171 (11.7)	0.52	0.40–0.68	< 0.001	0.55	0.40–0.74	< 0.001
≥ 40 years	4051 (27.0)	549 (13.6)	1.18	1.06–1.31	0.003	1.06	0.93–1.20	0.42
Total	15,135 (100)	1807 (11.9)

CI Confidence interval, GCS Glasgow coma scale score, HR Heart rate, OR Odds ratio, RR Respiratory rate, SBP Systolic blood pressure
Logistic regression analysis. Reference groups for categorical variables are cases without the specified clinical feature, specified treatment not given, or male sex
Odds ratios are adjusted for the variables in the table. Adjusted odds ratios for associations with p < 0.05 are given in bold types. Bradypnoea (RR < 12/min), tachycardia (HR ≥ 100/min), and seizures were not included in the multivariate model as both crude and adjusted ORs for these variables were not significantly associated with self-discharge (p < 0.05)
Missing: lowest level of consciousness not registered in 3520 cases (total n = 11,615, self-discharge n = 1377); age not registered in 135 cases
^aAt presentation

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ISSN: 1865-1380

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