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ACEM Spring Symposium
ACEM Spring Symposium
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Predictors of ICU admission in intentional overdose presentations to emergency department

Presentation Description

Intentional overdose is a common cause of Emergency Department (ED) presentation and is estimated to account for 1% of all ED presentations in western countries1. Furthermore, up to 22% of these patients require admission to an Intensive Care Unit (ICU)2. ICU beds are a limited resource and are currently experiencing high demand3. Any information which could provide medical staff with early predictive indicators of correct disposition for these patients would help improve care, improve ED flow, and reduce the unnecessary use of resources. 
For intentional overdose patients: (i) audit the incidence of ED presentations requiring ICU admission; (ii) audit ED departmental adherence to ACEM triage guidelines; (iii) identify risk factors for ICU admission and ICU length of stay >24hrs; (iv) identify risk factors for an ED length of stay >6hrs; (v) characterize the 1-year mortality; (vi) estimate the cost burden to the NZ healthcare system of these presentations; and (vii) identify whether the COVID ‘lockdown’ of 2020 affected ED presentations or ICU admission rates. 
All patients aged 16+ who presented to Christchurch ED between 2018-2020 with a confirmed intentional overdose were included. Data was collected from medical notes, hospital databases, and ICU databases. 
During the study period 2,201 patients presented 3,270 times. 119 presentations (3.6%) resulted in ICU admission. We are currently collecting remaining data for patients who attended ED but did not go to ICU to try and identify predictors of the need for ICU admission. This data will be available by the Spring Symposium.

(1)  Maigan M, Pommier P, Clot S et al, Deliberate Drug Poisoning with Slight Symptoms on Admission: Are there Predictive Factors for Intensive Care Unit Referral? A three‐year Retrospective Study. Basic Clin Pharmacol Toxicol 2014, 114: 281-287. 
(2)  Athavale V, Green C, Lim KZ et al Characteristics and outcomes of patients with drug overdose requiring admission to Intensive Care Unit Australian Psychiatry 2017, 25(5): 489-493
(3)  Betteridge T and Henderson S, Intensive care in New Zealand: Time for a national network NZ NZMJ 21 August 2020, Vol 133 No 1520: 148-149