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402 One-Year Mortality of Opioid Overdose Victims Who Received Naloxone by Emergency Medical Services

2017; Elsevier BV; Volume: 70; Issue: 4 Linguagem: Inglês

10.1016/j.annemergmed.2017.07.281

1097-6760

Scott G. Weiner, Olesya Baker, Dana Bernson, Jeremiah D. Schuur,

Poisoning and overdose treatments

Study Objectives: Whole body computed tomography (WBCT¼CT head, chest, abd/pelvis), or "pan scanning", is a rapid diagnostic strategy used in blunt trauma.Studies suggest that WBCT decreases emergency department (ED) length of stay and time to diagnosis when compared to a selective scanning (SS) strategy, but may increase radiation exposure, cost, and unnecessary investigations of incidental findings.As increased radiation exposure has substantial public health implications for future malignancy, understanding trends in utilization may be beneficial.We sought to describe adult blunt trauma patients undergoing WBCT and SS, comparing 2009 to 2013.Methods: We used data from the National Trauma Databank (NTDB) National Sample Program (NSP) and IRB considered study exempt.Data files were merged into single year databases using R statistical software.Patients with age < 18, mechanism other than blunt trauma, transfer in from outside hospital, and from facilities not reporting CT procedures were excluded.CTs of the head, thorax, and abdomen/pelvis, obtained in first 24 hours, were identified by procedure codes (87.03, 87.41, and 88.01, respectively).SS was defined by at least one, but not all three, of these scans done in first 24 hours.Data was stratified by ISS (1-15 vs. >15) and facility key.Patients receiving WBCT and SS were compared by age, sex, race, payer status, alcohol use, drug use, Glasgow Coma Scale (GCS), and ED disposition using the appropriate statistical tests to calculate p-values and confidence intervals.Results: There were 33218 and 70589 patients meeting inclusion criteria in the 2009 and 2013 datasets, respectively.In 2009, 21.2% (7055/33218) trauma patients had WBCT and in 2013, 27.6%(19473/70589) had WBCT (p<.0001).In 2009, 40.9%(13603/33218) trauma patients had SS, compared to 32.9%(23274/70589) in 2013 (p<.0001).Rates of any CT scanning (ie, WBCT or SS) decreased slightly with 62.1%(20658/33218) receiving at least one scan in 2009 and 60.6% (42746/70589) in 2013 (p<.001).For patients with ISS 1-15, WBCT increased with 15.7% (4099/ 26079)in 2009 and 23.7%(13463/56710) in 2013 got WBCT (p<.001), but decreased for SS with 39.7%(10343/26079) in 2009 and 32.5%(18459/56710) in 2013, p<.001.Conclusions: Rates of adult blunt trauma patients receiving one or more CT scans remained stable or slightly decreased in 2013 compared to 2009, but in 2013 patients were more likely to get WBCT and less likely to get a SS approach.No RCT has shown mortality benefit from WBCT, and although WBCT includes potential increased future malignancy risk, the practice appears to be increasing.The use of WBCT in relatively minor trauma (ISS 1-15) seems to be increasing as well, despite the American College of Surgeons identifying WBCT in minor trauma as "low-value care" in the Choosing Wisely campaign.Our study has several limitations including its retrospective design and the reporting bias inherent to database research.However, it seems much more likely that CT scans were underreported in the database, and so the rates of WBCT in minor traumas would be expected to be underestimates.Long-term consequences need further study.The projected increased malignancy risk per cost of scans has not been fully investigated, and may ultimately determine more harm than good from trauma practices that routinely order WBCT's.