Predictors of clinical severity in subjects attending the Emergency Department for substance use: a ten-year cross-sectional study

• Published in: The American journal of emergency medicine 2021-11, Vol.49, p.287-290
• Main Authors: Covino, Marcello, Di Nicola, Marco, Pepe, Maria, Moccia, Lorenzo, Panaccione, Isabella, Lanzotti, Pierluigi, Montanari, Silvia, Janiri, Luigi, Sani, Gabriele, Franceschi, Francesco
• Format: Article
• Language: English
• Subjects: Alcohol; Anxiety disorders; Comorbidity; Confidence intervals; Cross-sectional studies; Demographics; Drug use; Drugs; Eating disorders; Emergency medical care; Health services; Mental disorders; Mental health care; Multiple substance use; Overdose; Patients; Personality disorders; Population studies; Psychiatric comorbidity; Psychosis; Risk factors; Self destructive behavior; Self-injury; Substance use; Suicidal behaviors; Suicide; Suicides & suicide attempts; Triage
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2021.06.022

Substance-related referrals to the Emergency Department (ED) are rising. Multiple substance use is frequent, and psychiatric patients represent a high-risk population. Our study aimed at identifying risk factors for increased severity in ED attendances for substance use. We retrospectively evaluated consecutive patients attending the ED over ten years for substance-related problems, subdivided according to the triage code as having a life-threatening (LT), potentially life-threatening (P-LT), and non-life-threatening (N-LT) condition. Substance/drug intake for deliberate self-harm was a risk factor for being classified as LT compared to both P-LT (OR = 6.357; p ≤ 0.001) and N-LT (OR = 28.19; p ≤ 0.001). Suicide attempts (OR = 4.435; p = 0.022) and multiple substance use (OR = 1.513; p = 0.009) resulted as risk factors for P-LT, compared to N-LT. Psychiatric diagnosis (OR = 1.942; p = 0.042) and multiple substance use (OR = 1.668; p = 0.047) were risk factors for being classified as LT rather than N-LT. In our sample, self-harming overdoses were the strongest risk factor for highest overall severity in a real-world setting. Psychiatric disorders and multiple substance use also increased the risk for greater severity at presentation. Substance use worsens patients' clinical picture and management, suggesting the need for consultation-liaison psychiatry services in emergency contexts and highlighting the role of EDs as key sites for identification and early intervention. •Referrals to Emergency Departments (ED) for substance use increased over the years.•Patients with mental illness are at high-risk for substance-related ED accesses.•Substance intake for deliberate self-harm predicted highest severity at presentation.•Psychiatric diagnosis and multiple substance use were associated with greater severity.•Consultation-liaison psychiatry is crucial to make ED key sites for early intervention.