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首页> 外文期刊>Prehospital emergency care >Measuring a Crisis: Questioning the Use of Naloxone Administrations as a Marker for Opioid Overdoses in a Large US EMS System
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Measuring a Crisis: Questioning the Use of Naloxone Administrations as a Marker for Opioid Overdoses in a Large US EMS System

机译：衡量危机：质疑使用纳洛酮施用作为阿磷酸盐的标记物，在大型美国EMS系统中

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Objective: The United States is currently experiencing a public health crisis of opioid overdoses. To determine where resources may be most needed, many public health officials utilize naloxone administration by EMS as an easily-measured surrogate marker for opioid overdoses in a community. Our objective was to evaluate whether naloxone administration by EMS accurately represents EMS calls for opioid overdose. We hypothesize that naloxone administration underestimates opioid overdose. Methods: We conducted a chart review of suspected overdose patients and any patients administered naloxone in Wake County, North Carolina, from January 2013 to December 2015. Patient care report narratives and other relevant data were extracted from electronic patient care records and the resultant database was analyzed by two EMS physicians. Cases were divided into categories including known opioid use, presumed opioid use, no known opioid, altered mental status, cardiac arrest with known opioid use, cardiac arrest with no known opioid use, or suspected alcohol intoxication, and then further separated based on whether naloxone was administered. Patient categories were compared by patient demographics and incident year. Using the chart review classification as the gold standard, we calculated the sensitivity and positive predictive value (PPV) of naloxone administration for opioid overdose. Results: A total of 4,758 overdose cases from years 2013-15 were identified. During the same period, 1,351 patients were administered naloxone. Of the 1,431 patients with known or presumed opioid use, 57% (810 patients) received naloxone and 43% (621 patients) did not. The sensitivity of naloxone administration for the identification of patients with known or presumed opioid use was 57% (95% CI: 54%-59%) and the PPV was 60% (95% CI: 57%-63%). Conclusion: Among patients receiving care in this large urban EMS system in the United States, the overall sensitivity and positive predictive value for naloxone administration for identifying opioid overdoses was low. Better methods of identifying opioid overdose trends are needed to accurately characterize the burden of opioid overdose within and among communities.
机译：目的：美国目前正在体验阿片类药物过度的公共卫生危机。为了确定资源可能是最需要的，许多公共卫生官员利用EMS作为一个易于测量的替代品标记，用于在社区中的阿片类药物过量。我们的目标是评估EMS准确代表EMS的纳洛酮类给药是否要求阿片类药物过量给药。我们假设纳洛酮施用低估OpioID过量。方法：我们对北卡罗来纳州南卡罗来纳州苏醒县的任何患者进行了对怀疑过量患者和任何患者的抑制患者的图表审查。患者护理报告叙述和其他相关数据是从电子患者护理记录中提取的，所得到的数据库由两个EMS医生分析。病例分为类别，包括已知的阿片类药物使用，假设阿片类药物使用，未知的阿片类药物，改变的心理状态，具有已知的阿片类药物的心脏骤停，没有已知的阿片类药物使用或疑似酒精中毒，然后基于纳洛酮进一步分离管理。患者类别由患者人口统计学和事故年进行比较。使用图表审查分类作为黄金标准，我们计算了纳洛酮施用的敏感性和阳性预测值（纳洛酮施用）阿片类药物过量。结果：确定了来自2013-15年来的4,758例过量案件。在同一时期，1,351名患者被纳伦酮酮施用。在1,431名已知或假设阿片类药物的患者中，57％（810名患者）获得纳洛酮，43％（621名患者）没有。 Naloxone给药对已知或假发的阿片类药物使用患者的敏感性为57％（95％CI：54％-59％），PPV为60％（95％Ci：57％-63％）。结论：在美国的大型城市EMS系统接受护理的患者中，纳洛酮施用核磷脂菌施用的整体敏感性和阳性预测值低。需要更好地确定阿片类药物过量趋势的方法，以准确地表征群体内部和社区中的阿片类药物的负担。

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