Predicting the need for ICU admission in intentional drug overdose.

Dam, M. van (Mirja) (2014) Predicting the need for ICU admission in intentional drug overdose. thesis, Medicine.

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Abstract

Background: Patients with intentional drug overdose constitute a substantial part of all emergency department (ED) visits. Because of the uncertainty about the nature and amount of drugs ingested, many patients are admitted to an intensive care unit (ICU) while they often do not require ICU interventions. To avoid unnecessary diagnostics, ward monitoring, treatment and medical costs, it is crucial to identify those patients who are at risk for complications. Methods: We performed a retrospective cohort study, in which 255 cases of intentional drug overdose, admitted to the ICU of the Deventer Hospital between 2007 and 2013, were analyzed. We attempted to develop easily observable ICU admission criteria for managing patients presenting to the ED with an intentional drug overdose. To achieve this purpose, we compared an existing model (Model 1) and an adjusted version of this (Model 2) with a newly established model (Model 3), and with the ICU admission guidelines used in the Deventer Hospital (Model 4). Diagnostic values were tested on two sets of ICU interventions: ICU interventions which were used in earlier research, and interventions considered relevant by us. Results: Of 255 included cases, 35 cases required at least one of the ICU intervention(s) as defined in earlier research. Applied to these interventions, Model 1 and Model 2 had a sensitivity of 85.7% and 97.1% respectively. 70 cases required ICU interventions which were considered relevant by us. Applying these interventions, Model 1 and 2 did not come to an acceptable level of sensitivity. Application of Model 3 and Model 4 resulted in a sensitivity of 92.9% and 94.2%. Conclusion: In intentional drug overdose, the regular ICU admission guidelines were best in predicting ICU interventions considered relevant in this study.

Item Type:	Thesis (Thesis)
Supervisor name:	Oever, drs. H.L.A. van den and Deventer Hospital and Intensive Care Unit
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:47
Last Modified:	25 Jun 2020 10:47
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/872

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