Self-discharge during treatment for acute recreational drug toxicity: an observational study from emergency departments in seven European countries
Abstract Background Self-discharge is a risk factor for readmission and excess mortality. We assess the rate of self-discharge from the emergency department (ED) among presentations for acute recreational drug toxicity and identify factors associated with self-discharge. Methods From the Euro-DEN Pl...
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| Format: | Article |
| Language: | English |
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BMC
2023-11-01
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| Series: | International Journal of Emergency Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12245-023-00566-1 |
| _version_ | 1827604468949057536 |
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| author | Odd Martin Vallersnes Alison M. Dines David M. Wood Fridtjof Heyerdahl Knut Erik Hovda Christopher Yates Isabelle Giraudon Blazena Caganova Alessandro Ceschi Miguel Galicia Evangelia Liakoni Matthias E. Liechti Òscar Miró Roberta Noseda Per Sverre Persett Kristiina Põld Yasmin Schmid Irene Scholz Federico Vigorita Paul I. Dargan |
| author_facet | Odd Martin Vallersnes Alison M. Dines David M. Wood Fridtjof Heyerdahl Knut Erik Hovda Christopher Yates Isabelle Giraudon Blazena Caganova Alessandro Ceschi Miguel Galicia Evangelia Liakoni Matthias E. Liechti Òscar Miró Roberta Noseda Per Sverre Persett Kristiina Põld Yasmin Schmid Irene Scholz Federico Vigorita Paul I. Dargan |
| author_sort | Odd Martin Vallersnes |
| collection | DOAJ |
| description | Abstract Background Self-discharge is a risk factor for readmission and excess mortality. We assess the rate of self-discharge from the emergency department (ED) among presentations for acute recreational drug toxicity and identify factors associated with self-discharge. Methods From the Euro-DEN Plus database of presentations to the ED with acute recreational drug toxicity, we extracted data from 11 centres in seven European countries from 2014 to 2017. Self-discharge was defined as taking one’s own discharge or escaping from the ED before being medically cleared. We used multiple logistic regression analyses to look for factors associated with self-discharge. Results Among 15,135 included presentations, 1807 (11.9%) self-discharged. Self-discharge rates varied from 1.7 to 17.1% between centres. Synthetic cannabinoids were associated with self-discharge, adjusted odds ratio 1.44 (95% confidence interval 1.10–1.89), as were heroin, 1.44 (1.26–1.64), agitation, 1.27 (1.10–1.46), and naloxone treatment, 1.27 (1.07–1.51), while sedation protected from self-discharge, 0.38 (0.30–0.48). Conclusion One in eight presentations self-discharged. There was a large variation in self-discharge rates across the participating centres, possibly partly reflecting different discharge procedures and practices. Measures to improve the management of agitation and cautious administration of naloxone to avoid opioid withdrawal symptoms may be approaches worth exploring to reduce self-discharge. |
| first_indexed | 2024-03-09T06:00:27Z |
| format | Article |
| id | doaj.art-b1b7455f0e2146eea6f92b4713109baa |
| institution | Directory Open Access Journal |
| issn | 1865-1380 |
| language | English |
| last_indexed | 2024-03-09T06:00:27Z |
| publishDate | 2023-11-01 |
| publisher | BMC |
| record_format | Article |
| series | International Journal of Emergency Medicine |
| spelling | doaj.art-b1b7455f0e2146eea6f92b4713109baa2023-12-03T12:09:31ZengBMCInternational Journal of Emergency Medicine1865-13802023-11-0116111010.1186/s12245-023-00566-1Self-discharge during treatment for acute recreational drug toxicity: an observational study from emergency departments in seven European countriesOdd Martin Vallersnes0Alison M. Dines1David M. Wood2Fridtjof Heyerdahl3Knut Erik Hovda4Christopher Yates5Isabelle Giraudon6Blazena Caganova7Alessandro Ceschi8Miguel Galicia9Evangelia Liakoni10Matthias E. Liechti11Òscar Miró12Roberta Noseda13Per Sverre Persett14Kristiina Põld15Yasmin Schmid16Irene Scholz17Federico Vigorita18Paul I. Dargan19Department of General Practice, University of OsloClinical Toxicology, Guy’s and St Thomas’ NHS Foundation Trust and King’s Health PartnersClinical Toxicology, Guy’s and St Thomas’ NHS Foundation Trust and King’s Health PartnersPrehospital Division, Oslo University HospitalInstitute of Clinical Medicine, University of OsloEmergency Department and Clinical Toxicology Unit, Hospital Universitari Son EspasesEuropean Monitoring Centre for Drugs and Drug Addiction (EMCDDA)National Toxicological Information Centre, University HospitalDivision of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero CantonaleEmergency Department, Hospital Clinic, University of BarcelonaClinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, University of BernClinical Pharmacology and Toxicology, University Hospital and University of BaselEmergency Department, Hospital Clinic, University of BarcelonaDivision of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero CantonaleDepartment of Acute Medicine, Oslo University HospitalEmergeny Medicine Department, North-Estonia Medical CentreClinical Pharmacology and Toxicology, University Hospital and University of BaselClinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, University of BernSan Gerardo Hospital [U.O.S. Pronto Soccorso], ASSTClinical Toxicology, Guy’s and St Thomas’ NHS Foundation Trust and King’s Health PartnersAbstract Background Self-discharge is a risk factor for readmission and excess mortality. We assess the rate of self-discharge from the emergency department (ED) among presentations for acute recreational drug toxicity and identify factors associated with self-discharge. Methods From the Euro-DEN Plus database of presentations to the ED with acute recreational drug toxicity, we extracted data from 11 centres in seven European countries from 2014 to 2017. Self-discharge was defined as taking one’s own discharge or escaping from the ED before being medically cleared. We used multiple logistic regression analyses to look for factors associated with self-discharge. Results Among 15,135 included presentations, 1807 (11.9%) self-discharged. Self-discharge rates varied from 1.7 to 17.1% between centres. Synthetic cannabinoids were associated with self-discharge, adjusted odds ratio 1.44 (95% confidence interval 1.10–1.89), as were heroin, 1.44 (1.26–1.64), agitation, 1.27 (1.10–1.46), and naloxone treatment, 1.27 (1.07–1.51), while sedation protected from self-discharge, 0.38 (0.30–0.48). Conclusion One in eight presentations self-discharged. There was a large variation in self-discharge rates across the participating centres, possibly partly reflecting different discharge procedures and practices. Measures to improve the management of agitation and cautious administration of naloxone to avoid opioid withdrawal symptoms may be approaches worth exploring to reduce self-discharge.https://doi.org/10.1186/s12245-023-00566-1Recreational drug toxicitySelf-dischargeLeaving against medical adviceDischarge against medical adviceLeaving without being seenSubstance use |
| spellingShingle | Odd Martin Vallersnes Alison M. Dines David M. Wood Fridtjof Heyerdahl Knut Erik Hovda Christopher Yates Isabelle Giraudon Blazena Caganova Alessandro Ceschi Miguel Galicia Evangelia Liakoni Matthias E. Liechti Òscar Miró Roberta Noseda Per Sverre Persett Kristiina Põld Yasmin Schmid Irene Scholz Federico Vigorita Paul I. Dargan Self-discharge during treatment for acute recreational drug toxicity: an observational study from emergency departments in seven European countries International Journal of Emergency Medicine Recreational drug toxicity Self-discharge Leaving against medical advice Discharge against medical advice Leaving without being seen Substance use |
| title | Self-discharge during treatment for acute recreational drug toxicity: an observational study from emergency departments in seven European countries |
| title_full | Self-discharge during treatment for acute recreational drug toxicity: an observational study from emergency departments in seven European countries |
| title_fullStr | Self-discharge during treatment for acute recreational drug toxicity: an observational study from emergency departments in seven European countries |
| title_full_unstemmed | Self-discharge during treatment for acute recreational drug toxicity: an observational study from emergency departments in seven European countries |
| title_short | Self-discharge during treatment for acute recreational drug toxicity: an observational study from emergency departments in seven European countries |
| title_sort | self discharge during treatment for acute recreational drug toxicity an observational study from emergency departments in seven european countries |
| topic | Recreational drug toxicity Self-discharge Leaving against medical advice Discharge against medical advice Leaving without being seen Substance use |
| url | https://doi.org/10.1186/s12245-023-00566-1 |
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