title: Evaluation of a QT nomogram for risk assessment after antidepressant overdose.
abstract: OBJECTIVE
  A QT-heart rate nomogram has recently been proposed as a means of identifying patients at risk of torsades de pointes after antidepressant overdose, based on published cases of drug-induced torsades de pointes. The present study sought to examine the performance of the nomogram in patients who ingest an antidepressant overdose but do not develop arrhythmia.
  
  
  METHODS
  A retrospective case control study of patients presenting to hospital after overdose of citalopram, mirtazapine and venlafaxine was carried out. The primary outcome variable was QT higher than the nomogram, and was compared with occurrence of QT(c) (QT corrected by Bazett's formula) greater than ≥440 ms and QT(c) ≥500 ms, with comparison between drugs. Data are expressed as proportions in each group with 95% confidence intervals.
  
  
  RESULTS
  There were 858 electrocardiograms from 541 patients. QT was higher than the nomogram in 2.4% (1.4, 4.1%), whereas QT(c) was ≥440 ms in 23.1% (95% CI 19.8, 26.8%), and QT(c) was ≥500 ms in 1.1% (0.5, 2.5%). Citalopram overdose was more likely to be associated with QT higher than the nomogram compared with the other agents (difference 7.0%, 95% CI 2.9, 11.9%, P = 0.001) and more likely to be associated with QT(c) ≥440 ms (difference = 11.0%, 95% CI 2.6, 19.0%, P = 0.013).
  
  
  CONCLUSIONS
  The QT nomogram was associated with a lower false positive rate than widely accepted QT(c) criteria, and allowed detection of different effects of individual drugs. The nomogram offers potential advantages over QT(c) criteria and merits further investigation in a clinical setting.
authors.affiliation: Scottish Poisons Information Bureau, Royal Infirmary of Edinburgh, UK. stephen.waring@york.nhs.uk
authors.forename: W Stephen
authors.initials: WS
authors.lastname: Waring
authors.forename: Ann
authors.initials: A
authors.lastname: Graham
authors.forename: Julie
authors.initials: J
authors.lastname: Gray
authors.forename: Allen D
authors.initials: AD
authors.lastname: Wilson
authors.forename: Catherine
authors.initials: C
authors.lastname: Howell
authors.forename: D Nicholas
authors.initials: DN
authors.lastname: Bateman
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000506:poisoning*; D015283:Citalopram / Q000506:poisoning; D003511:Cyclohexanols / Q000506:poisoning; D062787:Drug Overdose; D004562:Electrocardiography / Q000379:methods; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008133:Long QT Syndrome / Q000139:chemically induced / Q000175:diagnosis*; D008297:Male; D008803:Mianserin / Q000031:analogs & derivatives / Q000506:poisoning; D000078785:Mirtazapine; D049451:Nomograms; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D016171:Torsades de Pointes / Q000139:chemically induced / Q000175:diagnosis; D000069470:Venlafaxine Hydrochloride
chemical_list: D000928:Antidepressive Agents; D003511:Cyclohexanols; D015283:Citalopram; D008803:Mianserin; D000069470:Venlafaxine Hydrochloride; D000078785:Mirtazapine