Determinants of Admission to Critical Care Following Acute Recreational Drug Toxicity: A Euro-DEN Plus Study

Roberta Noseda; Matteo Franchi; Alberto Pagnamenta; Laura Müller; Alison M Dines; Isabelle Giraudon; Fridtjof Heyerdahl; Florian Eyer; Knut Erik Hovda; Matthias E Liechti; Òscar Miró; Odd Martin Vallersnes; Christopher Yates; Paul I Dargan; David M Wood; Alessandro Ceschi; Euro-DEN Research Group

doi:10.3390/jcm12185970

Determinants of Admission to Critical Care Following Acute Recreational Drug Toxicity: A Euro-DEN Plus Study

J Clin Med. 2023 Sep 14;12(18):5970. doi: 10.3390/jcm12185970.

Authors

Roberta Noseda¹, Matteo Franchi^{2

3}, Alberto Pagnamenta^{4

5

6}, Laura Müller¹, Alison M Dines⁷, Isabelle Giraudon⁸, Fridtjof Heyerdahl^{9

10}, Florian Eyer¹¹, Knut Erik Hovda¹², Matthias E Liechti¹³, Òscar Miró¹⁴, Odd Martin Vallersnes^{15

16}, Christopher Yates¹⁷, Paul I Dargan^{7

18}, David M Wood^{7

18}, Alessandro Ceschi^{1

4

19

20}; Euro-DEN Research Group

Collaborators

Euro-DEN Research Group:
Monia Aloise, Jacek Sein Anand, Lukasz Sein Anand, Kurt Anseeuw, Erato Antoniou, Robertas Badaras, George Bailey, Jeffrey Bonnici, Miran Brvar, Carl Byrne, Blazena Caganova, Feriyde Calýskan, Laurence Daveloose, Miguel Galicia, Birgit Gartner, Johan Gillebeert, Ketevan Gorozia, Damjan Grenc, Femke M J Gresnigt, Laura Hondebrink, Gesche Jürgens, Jutta Konstari, Jan Kruczynski, Soso Kutubidze, Gabija Laubner, Evangelia Liakoni, Viesturs Liguts, Cathelijne Lyphout, Bruno Mégarbane, Adrian Moughty, Aymen M’Rad, Gabriela Viorela Nitescu, Niall O'Connor, Raido Paasma, Juan Ortega Perez, Marius Perminas, Per Sverre Persett, Kristiina Põld, Erik Puchon, Jordi Puiguriguer, Julia Radenkova-Saeva, Jan Rulisek, Caroline Samer, Maro H Sandel, Yasmin Schmid, Irene Scholz, Roberts Stašinskis, Jonas Surkus, Irma van den Hengel-Koot, Federico Vigorita, Severin B Vogt, William Stephen Waring, Ioanna Yiasemi, Sergej Zacharov, Tobias Zellner

Affiliations

¹ Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland.
² Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy.
³ National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, 20126 Milan, Italy.
⁴ Clinical Trial Unit, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland.
⁵ Department of Intensive Care, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland.
⁶ Division of Pneumology, University of Geneva, 1211 Geneva, Switzerland.
⁷ Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London SE1 7EH, UK.
⁸ European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), 1249-289 Lisbon, Portugal.
⁹ Prehospital Division, Oslo University Hospital, 0424 Oslo, Norway.
¹⁰ The Norwegian Air Ambulance Foundation, 0184 Oslo, Norway.
¹¹ Department of Clinical Toxicology, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany.
¹² The Norwegian CBRNE Centre of Medicine, Oslo University Hospital, 0450 Oslo, Norway.
¹³ Clinical Pharmacology and Toxicology, University Hospital and University of Basel, 4056 Basel, Switzerland.
¹⁴ Emergency Department, Hospital Clínic, University of Barcelona, 08036 Catalonia, Spain.
¹⁵ Department of General Practice, University of Oslo, 0318 Oslo, Norway.
¹⁶ Oslo Accident and Emergency Outpatient Clinic, City of Oslo Health Agency, 0182 Oslo, Norway.
¹⁷ Emergency Department and Clinical Toxicology Unit, Hospital Universitario Son Espases, 07120 Mallorca, Spain.
¹⁸ Clinical Toxicology, Faculty of Life Sciences and Medicine, King's College London, London WC2R 2LS, UK.
¹⁹ Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland.
²⁰ Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, 8091 Zurich, Switzerland.

Abstract

This study aimed to characterize patients admitted to critical care following Emergency Department (ED) presentation with acute recreational drug toxicity and to identify determinants of admission to critical care. A retrospective multicenter matched case-control study was conducted by the European Drug Emergency Network Plus (Euro-DEN Plus) over the period 2014-2021. The cases were ED presentations with acute recreational drug toxicity admitted to critical care, the controls consisted of ED presentations with acute recreational drug toxicity medically discharged directly from the ED. The potential determinants of admission to critical care were assessed through multivariable conditional stepwise logistic regression analysis and multiple imputation was used to account for the missing data. From 2014 to 2021, 3448 Euro-DEN Plus presentations involved patients admitted to critical care (76.9% males; mean age 33.2 years; SD 10.9 years). Patient age ≥35 years (as compared to ≤18 years) was a determinant of admission to critical care following acute recreational drug toxicity (adjusted odds ratio, aOR, 1.51, 95% confidence interval, CI, 1.15-1.99), along with polydrug use (aOR 1.39, 95% CI 1.22-1.59), ethanol co-ingestion (aOR 1.44, 95% CI 1.26-1.64), and the use of gamma-hydroxybutyrate/gamma-butyrolactone (GHB/GBL, aOR 3.08, 95% CI 2.66-3.57). Conversely, lower odds of admission to critical care were associated with the use of cocaine (aOR 0.85, 95% CI 0.74-0.99), cannabis (aOR 0.44, 95% CI 0.37-0.52), heroin (aOR 0.80, 95% CI 0.69-0.93), and amphetamine (aOR 0.65, 95% CI 0.54-0.78), as was the arrival to the ED during the night (8 p.m.-8 a.m., aOR 0.88, 95% CI 0.79-0.98). These findings, which deserve confirmation and further investigation, could contribute to a more complete understanding of the decision-making process underlying the admission to critical care of patients with acute recreational drug toxicity.

Keywords: Emergency Department presentation; Euro-DEN Plus; determinants of critical care admission; recreational drug use; toxicity.

Grants and funding

The Euro-DEN project received financial support from the DPIP/ISEC Programme of the European Union (2013–2015) and the Euro-DEN Plus project has received financial support from the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) from 2015 onwards. EL received financial support from the Burgergemeinde Bern.