Abstract
Emergency management of deliberate self-poisoning (DSP) by drug overdose is common in emergency medicine. There is a paucity of data about the prehospital care of these patients. The principal aim was to describe the intensity of care received by patients with DSP who were managed by prehospital emergency medical service (EMS) physicians. A 48-h cross-sectional study was conducted in 319 EMS and emergency units in France. Patient and poisoning characteristics and treatments administered were recorded. Complications of poisoning, hospitalization, intensive care unit admission and death were recorded until day 30. The primary endpoint was the probability of receiving prehospital intensive care, including fluid resuscitation, vasopressor therapy, invasive ventilation, or antidotal treatments, depending whether prehospital treatment was carried out by an EMS physician or not. Data from 703 patients (median age was 43 [30–52] years, 288 (40%) men) were analyzed. One hundred and fifteen (16%) patients were attended by an EMS physician. Patients attended by EMS physicians were more likely to receive intensive treatment in the prehospital setting [odds ratio (OR) 7.4, 95% confidence interval 4.3–12.9]. These patients had more severe poisoning as suggested mainly by a lower Glasgow Coma Score (13 [8–15] vs. 15 [15–15]; p < 0.001) and a higher rate of admission to an intensive care unit [29 (25%) vs. 15 (2%), p < 0.001]. Patients with DSP attended by prehospital EMS physicians frequently received intensive care. The level of care seemed appropriate for the severity of the poisoning.
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Acknowledgements
The authors thank Dr. Alison Foote (Grenoble Alpes University Hospital) and Johanna Robertson, Ph.D., for critically editing the manuscript.
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This work was supported by the French Society for Emergency Medicine (Société Française de Médecine d’Urgence, SFMU); and by Grenoble Alpes University Hospital.
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The study was approved by our national Review Board [Advisory Committee on the treatment of information in the field of Health Research- (CCTIRS) the national commission for Liberties and Data Protection (CNIL)] and the ethics committee of Clermont-Ferrand, Grenoble, France (IRB 5891).
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According to French law and the observational nature of this study, patients’ oral consent was required. Informed consent was obtained from all individual participants included in the study.
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Maignan, M., Viglino, D., Collomb Muret, R. et al. Intensity of care delivered by prehospital emergency medical service physicians to patients with deliberate self-poisoning: results from a 2-day cross-sectional study in France. Intern Emerg Med 14, 981–988 (2019). https://doi.org/10.1007/s11739-019-02108-1
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DOI: https://doi.org/10.1007/s11739-019-02108-1