Heroin Overdose: Demographics, Treatments, and Outcomes from an ICU perspective

Location

Medical Education Building, LSUHSC-NO

Presentation Date

10-10-2019 10:00 AM

End Date

10-10-2019 12:00 PM

Description

While data about ED presentations has improved, a paucity of data describing heroin overdoses admitted to the intensive care unit (ICU) in the era of expanding naloxone programs currently exists. The purpose of the current study was to examine the epidemiology, morbidity, and mortality of heroin overdoses requiring ICU treatment.

We identified patients using ICD-10 codes and conducted a retrospective chart review of patients admitted to the ICU due to a heroin drug overdose between April 2017 and April 2019. Demographic, comorbidities, treatment, and outcome data were abstracted. Chi-square, Mann- Whitney U test, and logistic regression were used to compare patient outcomes.

The cohort included 52 patients, 63.5% were male and 76.9% was Caucasian. Most of the patients were Medicaid recipients (65.4%) and mean age of 37.4±10.45 years. Geocoding of patient addresses revealed that our patient cohort came from neighborhoods with a median annual income of $28,291.69 and a poverty rate of 20.24%. The average ICU and hospital lengths of stay were 1.22±1.18 days and 3.76±4.71, respectively. Overall patient treatment plans included use of naloxone in 72.5%, mechanical ventilation support in 30.8%, empiric antibiotic prescription in 51.9% and vasopressors in 7.7%. 65.4% of patients had a lactate measured in the ED with a mean value of 4.53±2.91 mmol/L. 36% has a LA >4 exposing them to potential empiric antibiotics and crystalloid bolus per SEP-1 core measure. Prominent complications were SOFA defined acute kidney injury (38.5%) and rhabdomyolysis (17.3%). 17.3% had a history of Hepatitis C (HepC) and 7 new cases of HepC were diagnosed in the current admission (antibody and RNA positive). The cohort had a 30-day ED revisit rate of 25.6%. Factors associated with higher readmission percentages were the presence of HepC infection(66.7% v 18.6%, p=0.003), psychiatry evaluation consult during a prior admission,(46.7% v 18.9%, p=0.041), and an elevated point of care ED lactate acid level (μ=2.66±2.51, M=5.50, v. μ=5.10±2.81, M=1.40, p=0.022). A logistic regression model adjusted for these factors showed that patients with HepC are more likely to revisit the ED within 30 days (OR=11.38, 95%CI=1.2,107.1).

Despite a majority of patients were able to be discharged to home, this population represents a substantial impact on the healthcare system with a high 30-day ED revisit. Focused efforts at rehabilitation, programmatic quality improvement projects, and resource allocation may have larger impact if a focus on patients admitted to the ICU is utilized.

Comments

Mentor: Diana Hamer (Academic Research Director: Internal Medicine; Our Lady of the Lake)

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Oct 10th, 10:00 AM Oct 10th, 12:00 PM

Heroin Overdose: Demographics, Treatments, and Outcomes from an ICU perspective

Medical Education Building, LSUHSC-NO

While data about ED presentations has improved, a paucity of data describing heroin overdoses admitted to the intensive care unit (ICU) in the era of expanding naloxone programs currently exists. The purpose of the current study was to examine the epidemiology, morbidity, and mortality of heroin overdoses requiring ICU treatment.

We identified patients using ICD-10 codes and conducted a retrospective chart review of patients admitted to the ICU due to a heroin drug overdose between April 2017 and April 2019. Demographic, comorbidities, treatment, and outcome data were abstracted. Chi-square, Mann- Whitney U test, and logistic regression were used to compare patient outcomes.

The cohort included 52 patients, 63.5% were male and 76.9% was Caucasian. Most of the patients were Medicaid recipients (65.4%) and mean age of 37.4±10.45 years. Geocoding of patient addresses revealed that our patient cohort came from neighborhoods with a median annual income of $28,291.69 and a poverty rate of 20.24%. The average ICU and hospital lengths of stay were 1.22±1.18 days and 3.76±4.71, respectively. Overall patient treatment plans included use of naloxone in 72.5%, mechanical ventilation support in 30.8%, empiric antibiotic prescription in 51.9% and vasopressors in 7.7%. 65.4% of patients had a lactate measured in the ED with a mean value of 4.53±2.91 mmol/L. 36% has a LA >4 exposing them to potential empiric antibiotics and crystalloid bolus per SEP-1 core measure. Prominent complications were SOFA defined acute kidney injury (38.5%) and rhabdomyolysis (17.3%). 17.3% had a history of Hepatitis C (HepC) and 7 new cases of HepC were diagnosed in the current admission (antibody and RNA positive). The cohort had a 30-day ED revisit rate of 25.6%. Factors associated with higher readmission percentages were the presence of HepC infection(66.7% v 18.6%, p=0.003), psychiatry evaluation consult during a prior admission,(46.7% v 18.9%, p=0.041), and an elevated point of care ED lactate acid level (μ=2.66±2.51, M=5.50, v. μ=5.10±2.81, M=1.40, p=0.022). A logistic regression model adjusted for these factors showed that patients with HepC are more likely to revisit the ED within 30 days (OR=11.38, 95%CI=1.2,107.1).

Despite a majority of patients were able to be discharged to home, this population represents a substantial impact on the healthcare system with a high 30-day ED revisit. Focused efforts at rehabilitation, programmatic quality improvement projects, and resource allocation may have larger impact if a focus on patients admitted to the ICU is utilized.