scholarly journals What are kids getting into these days? A retrospective chart review of substance use presentations to a Canadian pediatric emergency department

CJEM ◽  
2015 ◽  
Vol 17 (4) ◽  
pp. 345-352 ◽  
Author(s):  
G. Emmi Driedger ◽  
Kathryn A. Dong ◽  
Amanda S. Newton ◽  
Rhonda J. Rosychuk ◽  
Samina Ali
Keyword(s):  
Emergency Department ◽  
Substance Use ◽  
Chart Review ◽  
Social Issues ◽  
Admission Rate ◽  
Retrospective Chart Review ◽  
Pediatric Emergency ◽  
Problematic Substance Use ◽  
Level Of Consciousness ◽  
Problematic Substance

AbstractObjectivesGoals for this study were to characterize the substances being used by youth who presented to an emergency department (ED), their demographic descriptors, and to describe the associated acute morbidity and mortality.MethodsWe conducted a retrospective review of all youth, ages 10–16 years, who presented to a pediatric ED with complaints related to recreational drug use (n=641) for 2 years ending on December 31, 2009.ResultsThe median age of patients was 15 years; 56% were female. Six percent of patients were homeless, and 21% were wards of the state. The most frequent ingestions included ethanol (74%), marijuana (20%), ecstasy (19%), and medications (15%). Over one third of patients had ingested two or more substances. Ninety percent of patients were brought to the ED by the emergency medical services; 63% of these activations were by non-acquaintances. Of the 47% of youth who presented with a decreased level of consciousness, half had a Glasgow Coma Scale less than 13. The Canadian Triage and Acuity Scale score was 1 or 2 for 44% of patients. Sixty-eight percent received IV fluids, 42% received medication, and 4% were intubated. The admission rate was 9%.ConclusionsYouth who presented to the ED for substance use represented a socially vulnerable population whose use of recreational substances resulted in high medical acuity and significant morbidity. Improved clinical identification of such high-risk youth and subsequent design of interventions to address problematic substance use and social issues are urgently needed to complement the acute medical care that youth receive.

scholarly journals Substance-related problems in patients visiting an urban Canadian emergency department

CJEM ◽  
2008 ◽  
Vol 10 (03) ◽  
pp. 198-204 ◽  
Author(s):  
Jeffrey R. Brubacher ◽  
Amy Mabie ◽  
Michelle Ngo ◽  
Riyad B. Abu-Laban ◽  
Jan Buchanan ◽  
...  
Keyword(s):  
Emergency Department ◽  
Substance Use ◽  
Intervention Program ◽  
Hospital Admissions ◽  
Screening Program ◽  
Tertiary Care ◽  
Admission Rate ◽  
Problematic Substance Use ◽  
Problematic Substance ◽  
Ed Visits

ABSTRACTObjective:For many patients with addiction and other substance problems, the emergency department (ED) is the sole provider of medical care. This study sought to determine the prevalence and characteristics of substance-related medical problems in ED patients, as defined by documentation in the medical record. We also sought to compare the ED resource use (length of ED stay and number of revisits) of patients with and without substance problems.Methods:Trained evaluators using explicit criteria reviewed all ED charts during a 6-week period at a Canadian tertiary care teaching centre. Data was collected on demographics, documentation of problematic substance use and whether the ED visit was due to substance problems. Using a computerized database, we determined how many patients with and without substance problems had 1 or more subsequent ED visits during the 1-year period from Sept. 1, 2002, to Aug. 31, 2003.Results:Of 6064 visits made by 5194 patients, 6026 visits (99.4%) representing 5188 patients (99.9%) were captured for review. Of those visits, 674 (11.2%, 95% confidence interval [CI] 10.4%–12.0%), made by 600 patients, had documentation of problematic substance use and 521 visits (8.6%, 95% CI 7.9%–9.4%) by 469 patients were caused by substance problems. The mean age of patients with a visit due to a substance problem was 39.2 years, compared with 48.5 years for those with other visits (p< 0.001). The admission rate for substance-related visits was 25.3%, compared with 17.6% for other visits (p< 0.001). For discharged patients, the median length of the ED visit owing to substance-related problems lasted 232 minutes (IQR [interquartile range] 267 min), compared with 164 minutes (IQR 167 min) for other visits (p< 0.001). In 1 year of follow-up, 161 of 600 patients (26.8%) with a substance problem made 466 revisits (mean 0.78 revisits/patient), compared with 975 of 4588 patients (21.3%) without a substance problem who made a total of 2150 revisits (mean 0.47 revisits/patient,p< 0.001).Conclusion:Substance problems contribute significantly to ED visits, hospital admissions and duration of ED stay at a tertiary centre. It is likely that our methodology underestimates the scope of the problem and that a universal screening program would find a higher prevalence. The magnitude of this problem supports the need for an interdisciplinary identification and intervention program for ED patients with substance-related issues.

scholarly journals P008: Addressing chronic pain and problematic substance use of opioids in the emergency department: can a comprehensive framework for care work?

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S81-S81
Author(s):  
M.A. Allen
Keyword(s):  
Emergency Department ◽  
Chronic Pain ◽  
Substance Use ◽  
Best Practice ◽  
Electronic Record ◽  
Emergency Department Visits ◽  
Direct Result ◽  
Complex Needs ◽  
Problematic Substance Use ◽  
Problematic Substance

Introduction: Chronic pain and substance misuse are complex chronic illness that are subject to prejudice, misinterpretation and cultural biases. They require a broad, multi-disciplined approach if they are to be effectively managed. Barrier’s to effective care in the emergency department include our reliance on pain scales alone to effectively triage and manage chronic pain, differing philosophy’s and attitudes regarding the appropriate use of high risk pain pharmacology including opioids and confusing classifications systems used to describe pain and problematic substance use which can often lead to further stigmatization and over medicating. Methods: The charts of thirteen patients with complex pain and problematic substance use who had more than 360 visits to a regional emergency department in one year were reviewed retrospectively and data collected regarding frequency of visits and disposition after the implementation of a comprehensive pain and addiction strategy from April 2011 to August 2015. Results: In the first year of implementation there was a 70% drop in the frequency of emergency department visits. Five patients (38%) required a comprehensive pain plan. Six agreed (46%) to a direct referral to our mental health, addiction and chronic pain services. Two patients (15%) were lost to follow-up. Review of the electronic record to track patient visits to provincial emergency departments did not show an increase in visits to other facilities within the province. Review of visits in 2015 show a 97% drop in the frequency of visits. Family Physicians in the community did not report an increase in the frequency of patient visits as a direct result of the implementation of this strategy nor was there an increase in complaints to administration regarding ineffective pain management. Conclusion: Although survey numbers are low it suggests that a framework for the management of complex pain and substance use disorders can be successfully implemented in the emergency department improving timely access to appropriate management and resources for patients based on best practice to address their complex needs.

scholarly journals P063: Identification of emergency department patients for referral to rapid-access addiction services: A retrospective chart review

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S86
Author(s):  
J. Hann ◽  
H. Wu ◽  
A. Gauri ◽  
K. Dong ◽  
N. Lam ◽  
...  
Keyword(s):  
Emergency Department ◽  
Substance Use ◽  
Chart Review ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Care Team ◽  
Addiction Medicine ◽  
Multivariable Logistic Regression Model ◽  
Factors Associated ◽  
Extract Information

Introduction: Emergency Department (ED) visits related to substance use are rapidly increasing. Despite this, few Canadian EDs have immediate access to addiction medicine specialists or on-site addiction medicine clinics. This study characterized substance-related ED presentations to an urban tertiary care ED and assessed need for an on-site rapid-access addiction clinic (RAAC). Methods: This prospective enrollment, retrospective chart review was conducted from June to August 2018. Adult patients presenting to the ED with a known or suspected substance use disorder were enrolled by any member of their ED care team using a 1-page form. Retrospective chart review of the index ED visit was conducted and the Emergency Department Information System was used to extract information related to the visit. A multivariable logistic regression model was fit to examine factors associated with recommendation for referral to a hypothetical on-site RAAC.This prospective enrollment, retrospective chart review was conducted from June to August 2018. Adult patients presenting to the ED with a known or suspected substance use disorder were enrolled by any member of their ED care team using a 1-page form. Retrospective chart review of the index ED visit was conducted and the Emergency Department Information System was used to extract information related to the visit. A multivariable logistic regression model was fit to examine factors associated with recommendation for referral to a hypothetical on-site RAAC. Results: Of the 557 enrolment forms received, 458 were included in the analysis. 64% of included patients were male and 36% were female, with a median age of 35.0 years. Polysubstance use was seen in 23% of patients, and alcohol was the most common substance indicated (60%), followed by stimulants (32%) and opioids (16%). The median ED length of stay for included patients was 483 minutes, compared to 354 minutes for all-comers discharged from the ED during the study period. 28% of patients had a previous ED visit within 7 days of the index visit, and an additional 17% had a visit in the preceding 30 days. The ED care team indicated ‘Yes’ for RAAC referral from the ED for 66% of patients, for a mean of 4.3 patients referred per day during the study period. Multivariable analysis showed that all substances (except cannabis) correlated to a statistically significant increase in likelihood for indicating ‘Yes’ for RAAC referral from the ED (alcohol, stimulants, opioids, polysubstance; p < 0.05). Patients presenting to the ED with a chief complaint related to substance use were also more likely to be referred (p = 0.01). Conclusion: This retrospective chart review characterized substance-related presentations at a Canadian urban tertiary care ED. Approximately four patients per day would have been referred to an on-site RAAC had one been available. The RAAC model has been implemented in other Canadian hospitals, and collaborating with these sites to begin developing this service would be an important next step.

scholarly journals Screening procedures to identify problematic substance use in medical emergency department patients

2012 ◽  
Vol 7 (S1) ◽  
Author(s):  
Michael Bogenschutz ◽  
Dennis Donovan ◽  
Cameron Crandall ◽  
Robert Lindblad ◽  
Raul Mandler ◽  
...  
Keyword(s):  
Emergency Department ◽  
Substance Use ◽  
Medical Emergency ◽  
Problematic Substance Use ◽  
Problematic Substance ◽  
Screening Procedures ◽  
Emergency Department Patients

scholarly journals Quality assurance evaluation of a simple linear protocol for the treatment of impending status epilepticus in a pediatric emergency department 2 years postimplementation

CJEM ◽  
2014 ◽  
Vol 16 (04) ◽  
pp. 304-313 ◽  
Author(s):  
Geneviève Tourigny-Ruel ◽  
Dubravka Diksic ◽  
Elise Mok ◽  
David McGillivray
Keyword(s):  
Emergency Department ◽  
Status Epilepticus ◽  
Chart Review ◽  
Positive Airway Pressure ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Pediatric Emergency ◽  
Seizure Duration ◽  
Triage Category ◽  
Seizure Episode

ABSTRACTObjective:To evaluate the efficacy and safety of a simple linear midazolam-based protocol for the management of impending status epilepticus in children up to 18 years of age.Methods:This is a descriptive, quality assessment, retrospective chart review of children presenting with the chief complaint of seizure disorder in the emergency department (ED) of a tertiary care pediatric hospital and a triage category of resuscitation or urgent from April 1, 2009, to August 31, 2011. In children with at least one seizure episode in the ED treated according to the linear protocol, three main outcomes were assessed: compliance, effectiveness, and complications.Results:Of the 128 children meeting the above study criteria, 68 had at least one seizure episode in the ED, and treatment was required to terminate at least one seizure episode in 46 of 68 patients (67.6%). Fifty-five seizure episodes were treated in the 46 patients: 51 of 55 seizure episodes were treated with midazolam (92.7%) and 4 of 55 with lorazepam or diazepam (7.3%). Of those treated with midazolam, 86.3% (44 of 51) were successfully treated with one or two doses of midazolam. The median seizure duration for all treated patients was 6 minutes. Of the 42 patients treated with midazolam, 7 required either continuous positive airway pressure or intubation, and two patients were treated for hypotension. One patient died of pneumococcal meningitis.Conclusion:This simple linear protocol is an effective and safe regimen for the treatment of impending status epilepticus in children.

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