Risk factors for the need for advanced care among prescription and over-the-counter drug overdose patients

Abstract

Aim

Prescription drug and over-the-counter (OTC) drug overdose is a major problem in emergency departments in Japan, and some need advanced care which is more than observation. We aimed to identify the prehospital risk factors for the need of advanced care among overdose patients.

Methods

This was a single-center retrospective cohort study. We included overdoses patients of prescription drugs or OTC drugs, who admitted to our hospital between 2016 and 2021. We grouped them into advanced care and non-advanced care. The main outcome was the need for advanced care. We performed a multiple logistic regression analysis, calculated the PAV score (Paracetamol use, Alcohol use, abnormal Vital signs on scene) and performed a receiver operating characteristic (ROC) analysis.

Results

There were 229 subjects. The logistic regression analysis revealed that alcohol, paracetamol, and the abnormal vital signs on scene were associated with advanced care (alcohol-odds ratio [OR]: 2.95; 95% confidence interval [CI]: 1.29–6.75; paracetamol-OR: 5.47; 95% CI: 2.18–13.71; abnormal vital signs-OR: 4.61, 95% CI: 2.07–10.27). The rate of advanced care in the high PAV score (2 and 3) group was statistically higher than that in the low PAV score (0–1) group (p = 0.04). Area under the ROC curve of the PAV score was 0.72 (95% CI, 0.65–0.80).

Conclusion

Alcohol, paracetamol use and abnormal vital signs on scene might be risk factors for advanced care among prescription drugs or OTC drugs overdose patients, and the PAV score may predict the need for advanced care.