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El Efecto de la Intubación en la Intoxicación por ácido gamma‐hidroxibutírico en los Resultados Clave del Paciente en el Servicio de Urgencias
Author(s) -
Dietze Paul,
Horyniak Danielle,
Agius Paul,
Munir Venita,
Smit de Villiers,
Johnston Jennifer,
Fry Craig L.,
Degenhardt Louisa
Publication year - 2014
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/acem.12516
Subject(s) - medicine , intubation , glasgow coma scale , emergency department , confidence interval , emergency medicine , odds ratio , logistic regression , retrospective cohort study , confounding , anesthesia , psychiatry
Objectives The objective was to examine the effect of endotracheal intubation on emergency department ( ED ) length of stay ( LOS ) and admission rates for patients with gamma‐hydroxybutyrate ( GHB ) overdose. Methods A 3‐year retrospective electronic and paper audit of recreational drug presentations was carried out at two major inner‐city ED s in Melbourne, Australia. Different GHB overdose management strategies exist at the respective audit sites, namely: 1) all patients with a Glasgow Coma Scale ( GCS ) score of 8 or less are intubated or 2) uncomplicated patients with GCS scores of 8 or less are managed without intubation (conservative management), unless further complications arise. This difference allows for comparison of the effects of intubation. All suspected GHB ‐related cases (defined as cases where GHB or its analogs gamma‐butyrolactone or 1,4‐butanediol were recorded) in which altered consciousness state was noted as a presenting symptom at triage were selected from all recreational drug‐related presentations occurring between January 2008 and December 2010. The relationship between intubation and the primary outcome, ED LOS , was examined using robust regression after adjustment for potential confounders. The relationship between intubation and admission status (admission to hospital versus discharge) was also examined using logistic regression. Results After adjustment for potential confounders such as GCS score, intubation of GHB ‐related cases in the ED was associated with an increase in mean LOS of 41% (95% confidence interval [ CI ] = 19% to 65%) and an increase in the odds of admission to hospital of 9.95 (95% CI = 2.36 to 41.88) at one hospital site, compared to conservative airway management. Conclusions Conservative airway management (no intubation) is associated with shorter ED LOS in cases of uncomplicated GHB ‐related coma in the ED and may also be associated with lower admission rates for these patients.