Dataset Information

Identifying Life-Threatening Admissions for Drug Dependence or Abuse (ILIADDA): Derivation and Validation of a Model.

ABSTRACT: Given that drug abuse and dependence are common reasons for hospitalization, we aimed to derive and validate a model allowing early identification of life-threatening hospital admissions for drug dependence or abuse. Using the French National Hospital Discharge Data Base, we extracted 66,101 acute inpatient stays for substance abuse, dependence, mental disorders or poisoning associated with medicines or illicit drugs intake, recorded between January 1^st, 2009 and December 31^st, 2014. We split our study cohort at the center level to create a derivation cohort and a validation cohort. We developed a multivariate logistic model including patient's age, sex, entrance mode and diagnosis as predictors of a composite primary outcome of in-hospital death or ICU admission. A total of 2,747 (4.2%) patients died or were admitted to ICU. The risk of death or ICU admission was mainly associated with the consumption of opioids, followed by cocaine and other narcotics. Particularly, methadone poisoning was associated with a substantial risk (OR: 35.70, 95% CI [26.94-47.32], P < 0.001). In the validation cohort, our model achieved good predictive properties in terms of calibration and discrimination (c-statistic: 0.847). This allows an accurate identification of life-threatening admissions in drug users to support an early and appropriate management.

SUBMITTER: Nguyen TL

PROVIDER: S-EPMC5349588 | biostudies-literature | 2017 Mar

REPOSITORIES: biostudies-literature

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Identifying Life-Threatening Admissions for Drug Dependence or Abuse (ILIADDA): Derivation and Validation of a Model.

Nguyen Tri-Long TL Boudemaghe Thierry T Leguelinel-Blache Géraldine G Eiden Céline C Kinowski Jean-Marie JM Le Manach Yannick Y Peyrière Hélène H Landais Paul P

Scientific reports 20170314

Given that drug abuse and dependence are common reasons for hospitalization, we aimed to derive and validate a model allowing early identification of life-threatening hospital admissions for drug dependence or abuse. Using the French National Hospital Discharge Data Base, we extracted 66,101 acute inpatient stays for substance abuse, dependence, mental disorders or poisoning associated with medicines or illicit drugs intake, recorded between January 1<sup>st</sup>, 2009 and December 31<sup>st</s ...[more]

PMID: 28290530

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Project description:ObjectivesTo derive and validate a risk adjustment model for predicting seven day mortality in emergency medical admissions, to test the value of including physiology and blood parameters, and to explore the constancy of the risk associated with each model variable across a range of settings.DesignMixed prospective and retrospective cohort study.SettingNine acute hospitals (n = 3 derivation, n = 9 validation) and associated ambulance services in England, Australia, and Hong Kong.ParticipantsAdults with medical emergencies (n = 5644 derivation, n = 13,762 validation) who were alive and not in cardiac arrest when attended by an ambulance and either were admitted to hospital or died in the ambulance or emergency department.InterventionsData were either collected prospectively or retrospectively from routine sources and extraction from ambulance and emergency department records.Main outcome measureMortality up to seven days after hospital admission.ResultsIn the derivation phase, age, ICD-10 code, active malignancy, Glasgow coma score, respiratory rate, peripheral oxygen saturation, temperature, white cell count, and potassium and urea concentrations were independent predictors of seven day mortality. A model based on age and ICD-10 code alone had a C statistic of 0.80 (95% confidence interval 0.78 to 0.83), which increased to 0.81 (0.79 to 0.84) with the addition of active malignancy. This was markedly improved only when physiological variables (C statistic 0.87, 0.85 to 0.89), blood variables (0.87, 0.84 to 0.89), or both (0.90, 0.88 to 0.92) were added. In the validation phase, the models with physiology variables (physiology model) and all variables (full model) were tested in nine hospitals. Overall, the C statistics ranged across centres from 0.80 to 0.91 for the physiology model and from 0.83 to 0.93 for the full model. The rank order of hospitals based on adjusted mortality differed markedly from the rank order based on crude mortality. ICD-10 code, Glasgow coma score, respiratory rate, systolic blood pressure, oxygen saturation, haemoglobin concentration, white cell count, and potassium, urea, creatinine, and glucose concentrations all had statistically significant interactions with hospital.ConclusionA risk adjustment model for emergency medical admissions based on age, ICD-10 code, active malignancy, and routinely recorded physiological and blood variables can provide excellent discriminant value for seven day mortality across a range of settings. Using risk adjustment markedly changed hospitals' rankings. However, evidence was found that the association between key model variables and mortality were not constant. Supplementary data appendix.

Project description:BackgroundThis is an update of the section on complications that are associated with coughing in the 2006 CHEST cough guidelines that addresses two aims: (1) to systematically identify and thematically categorize the diverse complications of cough by providing a guide for future studies and (2) to identify gaps in the literature for future research.Research questionWhat are the potential complications that are associated with the act of coughing that have been reported in infants, children, adolescents, and adults?Study design and methodsA scoping review was performed with the use of PubMed and SCOPUS databases that were searched from their beginning until September 6, 2019.ResultsTwo hundred forty-seven publications met our inclusion criteria. To these, we added 38 articles from the 2006 complications paper that were not identified in the literature search plus the paper itself for a final total of 286 publications that formed the basis of this review. Since 2006, three new categories of complications have been reported: ear, nose and throat; disease transmission; and laboratory testing. Multiple additional complications that fall outside of these three categories have also been identified and included in the following categories: cardiovascular, constitutional symptoms, dermatologic, GI, genitourinary, musculoskeletal, neurologic, ophthalmologic, psychosocial/quality of life, and respiratory. Not previously highlighted is that some of the complications led to serious morbidity that included death, especially in patients with comorbid conditions, and potentially resulted in harm to others when cough resulted in a motor vehicle accident.InterpretationOur work identified a large number of cough complications that we thematically categorized primarily by organ system so that future studies of each system or each complication can be conducted. The gap in the literature that future studies should address is to identify the frequency of the complications and the strength of their association with cough. Only then will one be able to describe the findings in a manner that allows specific recommendations for avoiding these complications. In the meantime, patients with cough should be evaluated and treated according to evidence-based guidelines to mitigate or prevent the myriad of potential complications that are associated with coughing.

Project description:ContextThere are no effective pharmacotherapies for stimulant dependence but there are many plausible targets for development of novel therapeutics. We hypothesized that dopamine-related targets are relevant for treatment of stimulant dependence, and there will likely be individual differences in response to dopaminergic challenges.ObjectiveTo measure behavioral and brain functional markers of drug-related attentional bias in stimulant-dependent individuals studied repeatedly after short-term dosing with dopamine D(2)/D(3) receptor antagonist and agonist challenges.DesignRandomized, double-blind, placebo-controlled, parallel-groups, crossover design using pharmacological functional magnetic resonance imaging.SettingClinical research unit (GlaxoSmithKline) and local community in Cambridge, England.ParticipantsStimulant-dependent individuals (n = 18) and healthy volunteers (n = 18).InterventionsAmisulpride (400 mg), pramipexole dihydrochloride (0.5 mg), or placebo were administered in counterbalanced order at each of 3 repeated testing sessions.Main outcome measuresAttentional bias for stimulant-related words was measured during functional magnetic resonance imaging by a drug-word Stroop paradigm; trait impulsivity and compulsivity of dependence were assessed at baseline by questionnaire.ResultsDrug users demonstrated significant attentional bias for drug-related words, which was correlated with greater activation of the left prefrontal and right cerebellar cortex. Attentional bias was greater in people with highly compulsive patterns of stimulant abuse; the effects of dopaminergic challenges on attentional interference and related frontocerebellar activation were different between high- and low-compulsivity subgroups.ConclusionsGreater attentional bias for and greater prefrontal activation by stimulant-related words constitute a candidate neurocognitive marker for dependence. Individual differences in compulsivity of stimulant dependence had significant effects on attentional bias, its brain functional representation, and its short-term modulation by dopaminergic challenges.

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Identifying Life-Threatening Admissions for Drug Dependence or Abuse (ILIADDA): Derivation and Validation of a Model.

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Identifying Life-Threatening Admissions for Drug Dependence or Abuse (ILIADDA): Derivation and Validation of a Model.

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