title: Long-term outcomes after severe drug overdose.
abstract: OBJECTIVE
  The long-term outcomes of patients with drug overdose admitted to the intensive care unit compared with those admitted to general wards have not been assessed. We aimed to compare the recurrence of overdose, mortality after hospital discharge, cause of death and quality-of-life scores (using the EQ-5D questionnaire) between the ICU patients and general ward patients.
  
  
  METHODS
  We performed a retrospective cohort study of 102 ICU patients with drug overdose and 102 matched general ward patients with drug overdose in a university-affiliated teaching hospital between 2009 and 2013. We undertook standardised follow-up of patients for recurrence of overdose, long-term mortality and quality-oflife assessment.
  
  
  RESULTS
  At 4-year follow-up, 33.3% of ICU patients had experienced further self-harm attempts, compared with 36.3% of general ward patients (P = 0.66). Ten ICU patients (10%) and five general ward patients (5%) had died. Causes of death included hanging in three patients and drug overdose in another three. On multivariate regression analysis, previous overdose attempts significantly predicted future overdoses and self-harm (odds ratio, 2.34; 95% CI, 1.27-4.30; P = 0.006). Overall, 101 patients (49.5%) were lost to follow-up and eight (3.9%) refused participation. For those remaining, EQ-5D scores were low, especially in the dimensions of anxiety/depression, usual activities and pain/discomfort.
  
  
  CONCLUSIONS
  ICU and general ward patients with overdose have similar, overwhelming prevalences of psychiatric disease, and similar outcome profiles. Such patients experience frequent overdoses and, despite being young, if admitted to the ICU, have a 10% 4-year mortality, with self-harm the dominant cause of death. Finally, among survivors who responded to the follow-up questionnaire, quality of life is poor.
authors.affiliation: Department of Emergency Medicine, Austin Hospital, Melbourne, VIC, Australia. Leeyung.wong@austin.org.au.
authors.forename: Lee Y
authors.initials: LY
authors.lastname: Wong
authors.affiliation: Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia.
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Bellomo
authors.affiliation: Department of Administrative Informatics, Austin Hospital, Melbourne, VIC, Australia.
authors.forename: Ray
authors.initials: R
authors.lastname: Robbins
authors.affiliation: Department of Anaesthesia and Intensive Care Medicine, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Martensson
authors.affiliation: Department of Psychiatry, University of Melbourne, Austin Hospital, Melbourne, VIC, Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: Kanaan
authors.affiliation: Department of Psychiatry, University of Melbourne, Austin Hospital, Melbourne, VIC, Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: Newton
authors.affiliation: Department of Administrative Informatics, Austin Hospital, Melbourne, VIC, Australia.
authors.forename: Chih-Chiang
authors.initials: CC
authors.lastname: Hu
authors.affiliation: Department of Emergency Medicine, Austin Hospital, Melbourne, VIC, Australia.
authors.forename: David M
authors.initials: DM
authors.lastname: Taylor
mesh_terms: D000328:Adult; D015331:Cohort Studies; D062787:Drug Overdose / Q000150:complications; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors