title: Clinical parameters that predict the need for medium or intensive care admission in intentional drug overdose patients: A retrospective cohort study.
abstract: Many patients with intentional drug overdose (IDO) are admitted to a medium (MC) or intensive care unit (IC) without ever requiring MC/IC related interventions. The objective of this study was to develop a decision tool, using parameters readily available in the emergency room (ER) for patients with an IDO, to identify patients requiring admission to a monitoring unit.
  
  
  
  Retrospective cohort study among cases of IDO with drugs having potentially acute effects on neurological, circulatory or ventilatory function, admitted to the MC/IC unit between 2007 and 2013. A decision tool was developed, using 6 criteria, representing intubation, breathing, oxygenation, cardiac conduction, blood pressure, and consciousness. Cases were labeled as 'high acuity' if one or more criteria were present.
  
  
  
  Among 255 cases of IDO that met the inclusion criteria, 197 were identified as "high acuity". Only 70 of 255 cases underwent one or more MC/IC related interventions, of which 67 were identified as 'high acuity by the decision tool (sensitivity 95.7%).
  
  
  
  In a population of patients with intentional drug overdose with agents having potentially acute effect on vital functions, 95.7% of MC/IC interventions could be predicted by clinical assessment, supplemented with electrocardiogram and blood gas analysis, in the ER.
authors.affiliation: Intensive Care Unit, Deventer Hospital, Nico Bolkesteinlaan 75, 7416 SE Deventer, The Netherlands. Electronic address: h.vandenoever@dz.nl.
authors.forename: Huub L A
authors.initials: HLA
authors.lastname: van den Oever
authors.affiliation: Intensive Care Unit, Deventer Hospital, Nico Bolkesteinlaan 75, 7416 SE Deventer, The Netherlands. Electronic address: mirjavandam@gmail.com.
authors.forename: Mirja
authors.initials: M
authors.lastname: van Dam
authors.affiliation: Teaching Hospital Deventer, Deventer Hospital, Nico Bolkesteinlaan 75, 7416 SE Deventer, The Netherlands. Electronic address: e.vantriet@dz.nl.
authors.forename: Esther
authors.initials: E
authors.lastname: van 't Riet
authors.affiliation: Department of Clinical Pharmacy, Deventer Hospital, Nico Bolkesteinlaan 75, 7416 SE Deventer, The Netherlands; Department of Pharmacotherapy, -Epidemiology and -Economics, University Groningen, Antonius Deusinglaan 1, 9713AV, Groningen, The Netherlands. Electronic address: f.jansman@dz.nl.
authors.forename: Frank G A
authors.initials: FGA
authors.lastname: Jansman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003422:Critical Care; D020000:Decision Support Systems, Clinical; D062787:Drug Overdose / Q000628:therapy*; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010343:Patient Admission; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013406:Suicide, Attempted; D014218:Triage; D055815:Young Adult
keywords: Admission avoidance; Clinical management; Deliberate self; Drug overdose; Medium care; Triage