Early Discharge of Patients with Presumed Opioid Overdose: Development of a Clinical Prediction Rule

Abstract

Abstract. Objective: To develop a clinical prediction rule to identify patients who can be safely discharged one hour after the administration of naloxone for presumed opioid overdose. Methods: Patients who received naloxone for known or presumed opioid overdose were formally evaluated one hour later for multiple potential predictor variables. Patients were classified into two groups: those with adverse events within 24 hours and those without. Using classification and regression tree methodology, a decision rule was developed to predict safe discharge. Results: Clinical findings from 573 patients allowed us to develop a clinical prediction rule with a sensitivity of 99% (95% CI = 96% to 100%) and a specificity of 40% (95% CI = 36% to 45%). Patients with presumed opioid overdose can be safely discharged one hour after naloxone administration if they: 1) can mobilize as usual; 2) have oxygen saturation on room air of >92%; 3) have a respiratory rate >10 breaths/min and <20 breaths/min; 4) have a temperature of >35.0ЊC and <37.5ЊC; 5) have a heart rate >50 beats/min and <100 beats/min; and 6) have a Glasgow Coma Scale score of 15. Conclusions: This prediction rule for safe early discharge of patients with presumed opioid overdose performs well in this derivation set but requires validation followed by confirmation of safe implementation.

Risk Factors Associated with Prolonged Hospital Stay in Admitted Patients with Psychotropic Drug Overdose

“…Comatose or semicomatose states may increase the risk for developing systemic complications including aspiration pneumonia. A previous study in Canada also identified an altered consciousness level as one of the predictors for admission to hospitals in patients with opioid overdose [18]. Elevated WBC at admission was a risk factor for a prolonged LOS in this study.…”

“…Both the systemic complications and the cardiotoxic states may explain the delayed recovery in these patients. The prediction rules developed in previous studies for patients with opioid DO also identified abnormal HR including both tachycardia and bradycardia as an increased risk for admission [18].…”

Part 10: Special Circumstances of Resuscitation

“…Although abbreviated observation periods may be adequate for patients with fentanyl, morphine, or heroin overdose, 102,109,[120][121][122][123] longer periods of observation may be required to safely discharge a patient with life-threatening overdose of a long-acting or sustained-release opioid. 93,124,125 Naloxone administration in post-cardiac arrest care may be considered in order to achieve the specific therapeutic goals of reversing the effects of long-acting opioids (Class IIb, LOE C-EO).…”

Management of Opioid Analgesic Overdose

“…26,53,54 Published guidelines for the management of opioid intoxication were developed on the basis of data from patients with heroin overdose and should not be applied to patients with opioid analgesic overdose. 55,56 …”