Amphetamine-related presentations to an inner-city tertiary emergency department: a prospective evaluation.
OBJECTIVE
To describe the prevalence, characteristics and outcomes of amphetamine-related presentations to a tertiary hospital emergency department (ED).


METHODS
Prospective observational study of amphetamine-related presentations to the ED of the Royal Perth Hospital (RPH), an adult, inner-city, tertiary referral hospital, between 3 August and 2 November 2005. For all patients presenting to the ED, the treating doctors were automatically prompted by the computerised data entry system to consider amphetamine use.


METHODS
Proportion of ED presentations related to amphetamine use; demographic features and usage practices of amphetamine users; characteristics of presentations and admissions; associated psychiatric illnesses and use of other drugs.


RESULTS
Over the study period, there were 13 125 presentations, of which 156 (1.2%) were judged to be causally related to amphetamine use. Of those 156 patients, over half were habitual drug users (89 [57.1%] used amphetamines at least weekly), and the majority were men (111 [71.2%]). The mean age was 28 years (range, 16-55 years). Presentations were of high acuity: 104 patients [66.7%] were rated 1, 2 or 3 on the Australasian Triage Scale; 50 (32.1%) arrived by ambulance; and 25 (16.0%) arrived with police. The mean time spent in the ED was 6 h (range, 0.5-24 h). Fifty patients (32.1%) required sedation, and the likelihood of requiring sedation increased almost threefold if the heart rate was over 100 beats/min on presentation. Sixty-two patients (39.7%) were admitted and 58 (37.2%) required psychiatric evaluation. Repeat attendance was common, with 71 patients (45.5%) having previous amphetamine-related presentations to the RPH ED.


CONCLUSIONS
Amphetamine-related presentations comprise 1.2% of all ED attendances and have a major impact on hospital EDs. Patients are often agitated and aggressive, require extensive resources, and frequently re-attend. The burden of amphetamine-related illnesses on EDs is likely to increase in the future.
Gray
Suzanne D
SD
Royal Perth Hospital, Perth, WA, Australia. suzdgray@hotmail.com
Fatovich
Daniel M
DM
McCoubrie
David L
DL
Daly
Frank F
FF
D000293:Adolescent; D000328:Adult; D017109:Akathisia, Drug-Induced / Q000175:diagnosis; D019969:Amphetamine-Related Disorders / Q000175:diagnosis*; D001315:Australia; D000697:Central Nervous System Stimulants / Q000009:adverse effects*; D015331:Cohort Studies; D003693:Delirium / Q000139:chemically induced; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D013287:Illicit Drugs / Q000009:adverse effects; D008297:Male; D008694:Methamphetamine / Q000009:adverse effects*; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D011446:Prospective Studies; D011605:Psychoses, Substance-Induced / Q000175:diagnosis; D013997:Time Factors; D019037:Urban Health Services / Q000706:statistics & numerical data
D000697:Central Nervous System Stimulants; D006993:Hypnotics and Sedatives; D013287:Illicit Drugs; D008694:Methamphetamine