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Is early discharge safe after naloxone reversal of presumed opioid overdose?

Published online by Cambridge University Press:  21 May 2015

Jeremy Etherington ,
James Christenson ,
Grant Innes ,
Eric Grafstein ,
Sarah Pennington ,
John J. Spinelli ,
Min Gao ,
Brian Lahiffe ,
Karen Wanger  and
Christopher Fernandes
Jeremy Etherington*
Affiliation:
Department of Emergency Medicine, St. Paul’s Hospital, Vancouver, BC, and the Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver
James Christenson
Affiliation:
Department of Emergency Medicine, St. Paul’s Hospital, Vancouver, BC, and the Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver
Grant Innes
Affiliation:
Department of Emergency Medicine, St. Paul’s Hospital, Vancouver, BC, and the Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver
Eric Grafstein
Affiliation:
Department of Emergency Medicine, St. Paul’s Hospital, Vancouver, BC, and the Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver
Sarah Pennington
Affiliation:
Department of Emergency Medicine, St. Paul’s Hospital, Vancouver, BC, and the Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver
John J. Spinelli
Affiliation:
Department of Emergency Medicine, St. Paul’s Hospital, Vancouver, BC, and the Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver
Min Gao
Affiliation:
Department of Emergency Medicine, St. Paul’s Hospital, Vancouver, BC, and the Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver
Brian Lahiffe
Affiliation:
Department of Emergency Medicine, St. Paul’s Hospital, Vancouver, BC, and the Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver
Karen Wanger
Affiliation:
Department of Emergency Medicine, St. Paul’s Hospital, Vancouver, BC, and the Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver
Christopher Fernandes
Affiliation:
Department of Emergency Medicine, St. Paul’s Hospital, Vancouver, BC, and the Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver
*
Department of Emergency Medicine, St. Paul’s Hospital, 1081 Burrard St., Vancouver BC V6Z 1Y6; 604 682-2344 x65480; ethering@interchange.ubc.ca

Abstract

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Introduction:

Patients with suspected opioid overdose frequently require naloxone treatment. Despite recommendations to observe such patients for 4 to 24 hours after naloxone, earlier discharge is becoming more common. This prospective, observational study of patients with presumed opioid overdose examines the safety of early disposition decisions and the accuracy of outcome prediction by physicians 1 hour after the administration of naloxone.

Methods:

The study was carried out at St. Paul’s Hospital, an inner city teaching centre that cares for most of the injection drug users in Vancouver, BC. Patients were formally assessed 1 hour after receiving naloxone for presumed opioid overdose. Demographics, medical history and physical examination were documented on specific data forms, and physicians recorded their comfort with early discharge. Patients were followed up, and those who required a critical intervention or suffered a pre-defined adverse event (AE) within 24 hours of their 1-hour assessment were identified.

Results:

Of 573 patients, 48% were discharged in less than 2 hours, 23% in 2–4 hours and 29% in >4 hours. 94 patients who were held in the emergency department (ED) or admitted required a critical intervention, including supplemental oxygen for hypoxia (74), repeat naloxone (52), antibiotics administered intravenously (IV) (14), assisted ventilations (13), fluid bolus for hypotension (12), charcoal for associated life-threatening overdose (6), IV inotropic agents (2), antiarrhythmics for sustained tachycardia >130 beats/min (1), and administration of bicarbonate for arterial [HCO3] <5 or venous CO2 <5 (1). Physicians predicted adverse events with 94% sensitivity and 59% specificity. No discharged patients suffered a serious AE within 24 hours of ED discharge.

Conclusions:

Emergency physicians can clinically identify patients at risk of deterioration after naloxone reversal of suspected opioid overdose. Prolonged observation or hospital admission is not usually required. Selective early discharge of patients with presumed opioid overdose is feasible and appears safe. A clinical prediction rule may be useful in identifying patients eligible for early discharge.

Keywords

naloxoneheroinopioid overdoseoutcome
Type
EM Advances • Progrès De La MU
Information
Canadian Journal of Emergency Medicine , Volume 2 , Issue 3 , July 2000 , pp. 156 - 162
Copyright
Copyright © Canadian Association of Emergency Physicians 2000

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