Self‐discharge during treatment for acute recreational drug toxicity: an observational study from emergency departments in seven European countries

Self‐discharge during treatment for acute recreational drug toxicity: an observational study from emergency departments in seven European countries

Recreational drug toxicity, Self-discharge, Leaving against medical advice, Discharge against medical
advice, Leaving without being seen, Substance use, Substances of abuse, Opioids, Poisoning, Intoxication

Background Self-discharge is a risk factor for readmission and excess mortality. We assess the rate of self-discharge
from the emergency department (ED) among presentations for acute recreational drug toxicity and identify factors
associated with self-discharge.
Methods From the Euro-DEN Plus database of presentations to the ED with acute recreational drug toxicity, we
extracted data from 11 centres in seven European countries from 2014 to 2017. Self-discharge was defined as taking
one’s own discharge or escaping from the ED before being medically cleared. We used multiple logistic regression
analyses to look for factors associated with self-discharge.
Results Among 15,135 included presentations, 1807 (11.9%) self-discharged. Self-discharge rates varied from 1.7
to 17.1% between centres. Synthetic cannabinoids were associated with self-discharge, adjusted odds ratio 1.44 (95%
confidence interval 1.10–1.89), as were heroin, 1.44 (1.26–1.64), agitation, 1.27 (1.10–1.46), and naloxone treatment,
1.27 (1.07–1.51), while sedation protected from self-discharge, 0.38 (0.30–0.48).
Conclusion One in eight presentations self-discharged. There was a large variation in self-discharge rates
across the participating centres, possibly partly reflecting different discharge procedures and practices. Measures

to improve the management of agitation and cautious administration of naloxone to avoid opioid withdrawal symp-
toms may be approaches worth exploring to reduce self-discharge.

Keywords Recreational drug toxicity, Self-discharge, Leaving against medical advice, Discharge against medical
advice, Leaving without being seen, Substance use, Substances of abuse, Opioids, Poisoning, Intoxication

Odd Martin Vallersnes1,2*, Alison M. Dines3

, David M. Wood3,4, Fridtjof Heyerdahl5,6,7, Knut Erik Hovda7,8,

Christopher Yates9

, Isabelle Giraudon10, Blazena Caganova11, Alessandro Ceschi12, Miguel Galicia13,
Evangelia Liakoni14, Matthias E. Liechti15, Òscar Miró13, Roberta Noseda12, Per Sverre Persett8

, Kristiina Põld16,

Yasmin Schmid15, Irene Scholz14, Federico Vigorita17 and Paul I. Dargan3,4

https://doi.org/10.1186/s12245-023-00566-1

2023

Peri Irawan

pdf

english

text