Scripties UMCG - Rijksuniversiteit Groningen
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Prospective validation of a six-step decision-making instrument for triage in intentional drug overdose patients.

(2018) Wiersma, T. (Tim)

Background: Intentional drug overdose poses a major healthcare problem in the world. Hospital admission rates are high and vary considerably between hospitals. In order to prevent unnecessary admissions to the ICU and to ensure optimal standardized and cost effective care, better allocations might be beneficial. Previously, a six-step decision tool to predict the need for an IC-intervention, and therefore admission, has been developed. In a retrospective cohort the sensitivity of this tool was 95.7%. The aim of the present study was to determine sensitivity, specificity, and positive and negative predictive values of this test prospectively.
Methods: We performed a prospective monocentric interim analysis, in which 34 patients with a history of intentional overdose of a potential toxic drug (e.g. acute effects on neurological, circulatory or ventilator function) were enrolled. We determined the specificity, sensitivity, positive and negative predictive values of the six-step decision tool through comparison of the predicted high-acuity patients based on the decision tool and the patients from practice who underwent an IC-intervention.
Results: Within the first three hours of observation the sensitivity and the negative predictive value of the decision tool was 100%. The specificity was 68% and the positive predictive value was 52.9%. The test characteristics did not improve after 4, 5 or 6 hours of observation.
Conclusion: This interim analysis showed 100% sensitivity and negative predictive value of the decision tool after three hours of observation. We recommend continuation of the study for the anticipated period of two years.

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