Early discharge of patients with presumed opioid overdose: development of a clinical prediction rule.
OBJECTIVE
To develop a clinical prediction rule to identify patients who can be safely discharged one hour after the administration of naloxone for presumed opioid overdose.


METHODS
Patients who received naloxone for known or presumed opioid overdose were formally evaluated one hour later for multiple potential predictor variables. Patients were classified into two groups: those with adverse events within 24 hours and those without. Using classification and regression tree methodology, a decision rule was developed to predict safe discharge.


RESULTS
Clinical findings from 573 patients allowed us to develop a clinical prediction rule with a sensitivity of 99% (95% CI = 96% to 100%) and a specificity of 40% (95% CI = 36% to 45%). Patients with presumed opioid overdose can be safely discharged one hour after naloxone administration if they: 1) can mobilize as usual; 2) have oxygen saturation on room air of >92%; 3) have a respiratory rate >10 breaths/min and <20 breaths/min; 4) have a temperature of >35.0 degrees C and <37.5 degrees C; 5) have a heart rate >50 beats/min and <100 beats/min; and 6) have a Glasgow Coma Scale score of 15.


CONCLUSIONS
This prediction rule for safe early discharge of patients with presumed opioid overdose performs well in this derivation set but requires validation followed by confirmation of safe implementation.
Christenson
J
J
St. Paul's Hospital Department of Emergency Medicine, The Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, BC, Canada. jimchris@interchange.ubc.ca
Etherington
J
J
Grafstein
E
E
Innes
G
G
Pennington
S
S
Wanger
K
K
Fernandes
C
C
Spinelli
J J
JJ
Gao
M
M
D000328:Adult; D000704:Analysis of Variance; D001955:British Columbia; D015331:Cohort Studies; D004334:Drug Administration Schedule; D062787:Drug Overdose / Q000175:diagnosis / Q000188:drug therapy; D004635:Emergency Medicine / Q000379:methods*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009270:Naloxone / Q000008:administration & dosage*; D009294:Narcotics / Q000506:poisoning*; D009293:Opioid-Related Disorders / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality; D010351:Patient Discharge; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D015996:Survival Rate
D009294:Narcotics; D009270:Naloxone