Publications by authors named "Miguel Galicia"

23 Publications

  • Page 1 of 1

Factors associated with revisits by patients with SARS-CoV-2 infection discharged from a hospital emergency department.

Emergencias 2020 Nov;32(6):386-394

Área de Urgencias, Hospital Clinic, Universitat de Barcelona, España.

Objectives: To analyze emergency department (ED) revisits from patients discharged with possible coronavirus disease 2019 (COVID-19).

Material And Methods: Retrospective observational study of consecutive patients who came to the ED over a period of 2 months and were diagnosed with possible COVID-19. We analyzed clinical and epidemiologic variables, treatments given in the ED, discharge destination, need to revisit, and reasons for revisits. Patients who did or did not revisit were compared, and factors associated with revisits were explored.

Results: The 2378 patients included had a mean age of 57 years; 49% were women. Of the 925 patients (39%) discharged, 170 (20.5%) revisited the ED, mainly for persistence or progression of symptoms. Sixty-six (38.8%) were hospitalized. Odds ratios (ORs) for the following factors showed an association with revisits: history of rheumatologic disease (OR, 2.97; 95% CI, 1.10-7.99; P = .03), digestive symptoms (OR, 1.73; 95% CI, 1.14-2.63; P = .01), respiratory rate over 20 breaths per minute (OR, 1.03; 95% CI, 1.0-1.06; P = .05), and corticosteroid therapy given in the ED (OR, 7.78; 95% CI, 1.77-14.21, P = .01). Factors associated with hospitalization after revisits were age over 48 years (OR, 2.57; 95% CI, 1 42-4.67; P = .002) and fever (OR, 4.73; 95% CI, 1.99-11.27; P = .001).

Conclusion: Patients under the age of 48 years without comorbidity and with normal vitals can be discharged from the ED without fear of complications. A history of rheumatologic disease, fever, digestive symptoms, and a respiratory rate over 20 breaths per minute, or a need for corticosteroid therapy were independently associated with revisits. Fever and age over 48 years were associated with a need for hospitalization.
View Article and Find Full Text PDF

Download full-text PDF

Source
November 2020

Influence of previous coronary artery bypass grafting in the difficulty of acute coronary syndrome diagnosis.

Eur J Emerg Med 2020 Sep 23. Epub 2020 Sep 23.

Emergency Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain.

Objectives: To investigate whether the diagnosis of acute coronary syndrome (ACS) in coronary artery bypass grafting (CABG) patients with chest pain (CP) is more difficult based on the initial clinical and electrocardiogram (ECG) findings.

Methods: We included consecutive CP patients attended at a single emergency department (ED) during a 10-year period. CABG status and the final diagnosis of ACS were considered as stated in the ED discharge report. We evaluated the frequency of 21 CP characteristics (CPC) and four ECG signatures, their individual and collective association with ACS, and ED length of stay (LOS) in CABG and non-CABG patients.

Results: We included 34 429 patients [median age: 61 years; female: 41.8%; CABG: 2204 patients (6.4%)], and ACS was diagnosed in 6727 (19.5%; CABG/non-CABG 37.2%/18.3%; P < 0.001). CABG patients more frequently had CPC and ECG findings typically associated with ACS, but their final association with ACS was weaker than in non-CABG patients (only significant after adjustment for attendant diaphoresis, throat irradiation, ST-segment elevation and T-wave inversion). The collective discriminative capacity was significantly lower in CABG patients (area under the curve 0.710 vs. 0.793; P < 0.001), even after adjustment (0.708 vs. 0.790; P < 0.001). ED LOS was longer for CABG patients, overall (P < 0.001) and for patients diagnosed with ACS (P = 0.008) and non-ACS (P < 0.001), but these differences disappeared after adjustment.

Conclusion: CABG substantially reduces the diagnostic performance of CPC and ECG findings to suggest ACS. A longer LOS in the ED in CABG patients is more related to their baseline characteristics than to CABG itself.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/MEJ.0000000000000755DOI Listing
September 2020

Acute adverse effects of synthetic drugs: beginning to understand the magnitude of the problem in Spain.

Authors:
Miguel Galicia

Emergencias 2020 02;32(1):7-8

Área de Urgencias, Hospital Clinic, Barcelona, España. Grupo de Trabajo de Toxicología de la Societat Catalana de Medicina d'Urgències i Emergencies (SoCMUETox).

View Article and Find Full Text PDF

Download full-text PDF

Source
February 2020

Changes in cases of nontraumatic chest pain treated in a chest pain unit over the 10-year period of 2008-2017.

Emergencias 2019 Dic;31(6):377-384

Área de Urgencias. Hospital Clínic. Universitat de Barcelona. Barcelona, España.

Objectives: To analyze changes in the characteristics of consecutively treated patients attended in the chest pain unit of a hospital emergency department over a 10-year period.

Material And Methods: All patients presenting with nontraumatic chest pain (NTCP) were included. We analyzed changes over time in epidemiologic characteristics, initial diagnostic classification (on clinical and electrocardiographic evaluation), final diagnosis (on discharge), and time until these diagnoses.

Results: A total of 34 552 consecutive patients with a mean (SD) age of 59 (13) years were included; 42% were women. The annual number of visits rose over time. Visits were fewer in summer and more numerous on workdays and between the hours of 8 AM and 4 PM (P<.001, both comparisons). The number of women increased over time (up 0.29% annually, P<.05) as did the number of patients under the age of 50 years (up 0.92% annually, P<.001). With time, patients had fewer cardiovascular risk factors and less often had a history of ischemic heart disease. Fewer cases of NTCP had signs suggestive of acute coronary syndrome (ACS). ACS was ruled out at the time of initial and final diagnoses in 52.2% and 80.4%, respectively, and these percentages which rose over the 10-year period by 1.86% (P<.001) and 0.56% (P=.04). Time to initial diagnosis did not change. However, time to final diagnosis did increase (P<.001), and the delay was longer in patients diagnosed with ACS (P<.001).

Conclusion: The chest pain unit was more active at the end of the period, in keeping with the increase in patients with NTCP whose characteristics were not typical of coronary disease. The percentages of patients initially and finally diagnosed with ACS decreased with time.
View Article and Find Full Text PDF

Download full-text PDF

Source
September 2020

[About the sources of knowledge of drug use and its consequences].

Rev Esp Salud Publica 2019 08 27;90:e1-e3. Epub 2019 Aug 27.

Área de Urgencias. Hospital Clínic. Universitat de Barcelona. Barcelona. España.

View Article and Find Full Text PDF

Download full-text PDF

Source
August 2019

Clinical relevance of ethanol coingestion in patients with GHB/GBL intoxication.

Toxicol Lett 2019 Oct 10;314:37-42. Epub 2019 Jul 10.

Emergency Department, Hospital Clínic, Barcelona, IDIBAPS, Barcelona, Spain; Medical School, University of Barcelona, Spain.

Objective: Ethanol intake can increase the sedative effects of gamma-hydroxybutyrate/gamma-butyrolactone (GHB/GBL), although the real clinical impact is unknown. We studied the clinical impact of the co-ingestion of ethanol in patients presenting to the Emergency Department (ED) with acute toxicity related to GHB/GBL use.

Method: We performed a secondary analysis of the Euro-DEN Plus Registry (14 countries, 22 EDs) which includes 17,371 consecutive patients presenting to the ED with acute recreational drug toxicity over 39 consecutive months (October 2013 - December 2016). We compared the epidemiological and clinical characteristics and ED management of patients identified as presenting with acute toxicity related to lone GHB/GBL (Group A) or GHB/GBL combined with ethanol (Group B) without other concomitant drugs.

Results: A total of 609 patients were included (age 32 (8) years; 116 women (19%); Group A: 183 patients and Group B: 426). The most common features were reduction in consciousness (defined as Glasgow Coma Score <13 points: 56.1%) and agitation/aggressiveness (33.6%). Those with ethanol co-ingestion were younger patients (Group A/B: 31.5/33.1 years, p = 0.029) and ethanol co-ingestion was associated with a lower frequency of bradycardia (23.5%/15.7%, p = 0.027) and more frequent arrival at the ED by ambulance (68.3/86.6%; p < 0.001), reduction in consciousness (58.9%/49.1%; p = 0.031), need for treatment in the ED (49.2%/60.4%; p = 0.011), use of sedatives (20.1%/12.8%; p = 0.034), admission to critical care units (22.4%/55.3%; p < 0.001), and longer hospital stay (stay longer than 6 h: 16.9%/28.4%; p = 0.003).

Conclusions: Co-ingestion of ethanol increases the adverse effects of patients intoxicated by GHB/GBL, leading to greater depression of consciousness, need for treatment, admission to the ICU and longer hospital stay.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.toxlet.2019.07.001DOI Listing
October 2019

Author’s reply.

Emergencias 2019 06;31(3):220

Área de Urgencias, Hospital Clínic, Barcelona, España.

View Article and Find Full Text PDF

Download full-text PDF

Source
June 2019

Authors' reply to comment on "Epidemiology, clinical features and management of patients presenting to European emergency departments with acute cocaine toxicity: comparison between powder cocaine and crack cocaine cases".

Clin Toxicol (Phila) 2020 01 17;58(1):72-74. Epub 2019 May 17.

Emergency Department, Hospital Clínic, IDIBAPS, Barcelona, Spain.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/15563650.2019.1613549DOI Listing
January 2020

Epidemiology, clinical features and management of patients presenting to European emergency departments with acute cocaine toxicity: comparison between powder cocaine and crack cocaine cases.

Clin Toxicol (Phila) 2019 Aug 30;57(8):718-726. Epub 2019 Jan 30.

Emergency Department , Hospital Clínic, Barcelona; IDIBAPS , Barcelona , Spain.

: To analyse the epidemiology, clinical picture and emergency department (ED) management of a large series of patients who presented to European EDs after cocaine consumption, comparing data from powder (C group) and crack (C group) consumers. : Between October 2013 and December 2016, the Euro-DEN Plus Registry recorded 17,371 consecutive acute recreational drug toxicity presentations to 22 EDs in 14 European countries. Epidemiological and demographic data, co-ingestion of alcohol and other drugs, clinical features, ED management and outcome (death) were analysed for cocaine cases, and comparison of clinical picture in C and C patients were performed adjusting for alcohol and other drug co-ingestion. : We included 3002 cases (C: 2600; C: 376; mixed consumption: 26): mean age 32(9) years, 23% female. The proportion of presentations involving cocaine varied significantly between countries (>30% in Malta, Spain, France, Denmark) and only centres in France, United Kingdom, Poland, Ireland and Malta recorded crack-related cases. Cocaine was frequently used with ethanol (74.3%, C>C) and other drugs (56.8%, C>C), the most frequent amphetamine (19.4%, C>C) and opioids (18.9%, C>C). C patients were more likely to have clinically significant episodes of hypotension (adjusted OR = 2.35; 95%CI = 1.42-3.89), and bradypnea (1.81; 1.03-3.16) and systolic blood pressure >180 mmHg on ED arrival (2.59; 1.28-5.25); while less likely anxiety (0.51; 0.38-0.70), chest pain (0.47; 0.31-0.70), palpitations (0.57; 0.38-0.84), vomiting (0.54; 0.32-0.90), and tachycardia on ED arrival (0.52; 0.39-0.67). Sedative drugs were given in 29.3%. The median length of hospital stay was 4:02 h, 22.1% patients were hospitalized, and 0.4% ( = 12) died. : Cocaine is commonly involved in European ED presentations with acute recreational drug toxicity, but there is variation across Europe not just in the involvement of cocaine but in the proportion related to powder versus crack. Some differences in clinical picture and ED management exist between powder cocaine and crack consumers.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/15563650.2018.1549735DOI Listing
August 2019

Acute street drug poisoning in the patient with human immunodeficiency virus infection: the role of chemsex.

Emergencias 2018 Dic;30(6):405-407

Área de Urgencias, Hospital Clínic, Barcelona, España.

Objectives: To identify the drugs usually abused in cases of acute poisoning in human immunodeficiency virus (HIV) infected patients.

Material And Methods: Retrospective study of episodes of acute street drug poisoning in HIV-infected patients in our emergency department over a period of 1 year. Chemsex was defined as the use of methamphetamines, -hydroxybutyrate (GHB), -butyrolactone (GBL), and/or mephedrone in order to prolong sexual activity.

Results: We included 101 patients, 93 (92%) of whom were men. The drug that caused the most cases of acute poisoning was cocaine, detected in 52 patients (51%). GHB and amphetamines were the next most frequently implicated street drugs. The prevalence of chemsex in this series was 87%. Mortality was 2%. Amphetamine poisoning was related to intensive care unit admission (odds ratio, 9,2 [95% CI, 1.6-52.2], P=.012).

Conclusion: Cocaine use was the main cause of acute poisoning in this series. The prevalence of chemsex was high.
View Article and Find Full Text PDF

Download full-text PDF

Source
July 2019

Emergencies related to recreational drug abuse in Spain compared to emergencies attended in 3 European areas.

Emergencias 2018 Dic;30(6):385-394

Área de Urgencias, Hospital Clínic, Barcelona; Grupo de Investigación "Urgencias: Procesos y Patologías", IDIBAPS, Barcelona, España.

Objectives: To analyze epidemiologic, clinical, and care characteristics in cases in which patients came to 2 Spanish emergency departments (EDs) with symptoms caused by recreational drug abuse. To compare the characteristics with those reported for other areas of Europe.

Material And Methods: Secondary analysis of the registry of the European Drug Emergencies Network (Euro-DEN Plus), which collects cases in 14 European countries and 20 EDs. The registry included all patients attending EDs with symptoms of recreational drug abuse (excepting cases involving alcohol alone) over a period of 39 consecutive months (October 2013 to December 2016). We compared the cases from the 2 Spanish EDs (in Barcelona and Palma de Mallorca) to those from the 5 EDs in Ireland and the UK, 6 in northern Europe, and 7 in central Europe.

Results: A total of 17 104 patients' cases were included: Spain, 1186; UK and Ireland, 6653; northern Europe, 6097; and central Europe, 3168. Spain saw more emergencies related to cocaine (48.4%) and fewer related to opioids (12.4%) than the other areas. The Spanish patients were younger (32.2 years) on average than those in northern Europe and older than those in the UK and Ireland and central Europe. Fewer patients were women in Spain (21.9%) than in northern or central Europe. Fewer arrived in ambulances in Spain (70.0%) than in the UK and Ireland or northern Europe. The Spanish EDs recorded the temperature and respiratory frequency of fewer patients (29.8% and 30.3%, respectively). Clinical signs differed between geographical areas attributable to differences in drug-use patterns. In Spain, naloxone was used by fewer patients (9.6%) than in the UK and Ireland and northern Europe, and flumazenil was used by more patients (5.6%) than in other areas. Spain saw lower percentages of admissions (4.6%) and patients who left without an ED discharge (6.2%) in comparison with other areas. Mortality rates in the Spanish EDs (0.4%) and after discharge from them (0.7%) were higher than in northern Europe.

Conclusion: The characteristics of emergencies related to recreational drug abuse registered by the Spanish EDs were differed from those registered in other parts of Europe due to different patterns of drug use. We also detected differences between the Spanish and other European EDs with respect to examinations or tests performed, treatment given, and discharge disposition.
View Article and Find Full Text PDF

Download full-text PDF

Source
July 2019

Intoxication by gamma hydroxybutyrate and related analogues: Clinical characteristics and comparison between pure intoxication and that combined with other substances of abuse.

Toxicol Lett 2017 Aug 1;277:84-91. Epub 2017 Jun 1.

Pomeranian Centre of Toxicology, Gdansk, Poland; Medical University Gdansk, Department of Clinical Toxicology, Gdansk, Poland.

Objective: To study the profile of European gamma-hydroxybutyrate (GHB) and gammabutyrolactone (GBL) intoxication and analyse the differences in the clinical manifestations produced by intoxication by GHB/GBL alone and in combination with other substances of abuse.

Method: We prospectively collected data on all the patients attended in the Emergency Departments (ED) of the centres participating in the Euro-DEN network over 12 months (October 2013 to September 2014) with a primary presenting complaint of drug intoxication (excluding ethanol alone) and registered the epidemiological and clinical data and outcomes.

Results: We included 710 cases (83% males, mean age 31 years), representing 12.6% of the total cases attended for drug intoxication. Of these, 73.5% arrived at the ED by ambulance, predominantly during weekend, and 71.7% consumed GHB/GBL in combination with other substances of abuse, the most frequent additional agents being ethanol (50%), amphetamine derivatives (36%), cocaine (12%) and cannabis (8%). Among 15 clinical features pre-defined in the project database, the 3 most frequently identified were altered behaviour (39%), reduced consciousness (34%) and anxiety (14%). The severity ranged from mild cases requiring no treatment (308 cases, 43.4%) to severe cases requiring admission to intensive care (103 cases, 14.6%) and mechanical ventilation (49 cases, 6.9%). No deaths were reported. In comparison with only GHB/GBL consumption, patients consuming GHB/GBL with co-intoxicants presented more vomiting (15% vs. 3%, p<0.001) and cardiovascular symptoms (5.3% vs. 1.5%, p<0.05), a greater need for treatment (59.8% vs. 48.3%, p<0.01) and a longer ED stay (11.3% vs. 3.6% patients with ED stay >12h, p<0.01).

Conclusions: The profile of the typical GHB/GBL-intoxicated European is a young male, requiring care for altered behaviour and reduced level of consciousness, mainly during the weekend. The clinical features are more severe when GHB is consumed in combination with other substances of abuse.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.toxlet.2017.05.030DOI Listing
August 2017

MARRIED-cocaine score: validating a tool for detecting the risk of ED revisit in cocaine users.

Emerg Med J 2016 Mar 19;33(3):218-23. Epub 2015 Oct 19.

Área de Urgencias, Hospital Clínic, Barcelona, Spain Grupo de Investigación "Urgencias: procesos y patologías", IDIBAPS, Barcelona, Spain.

Objective: According to a previous study, 17% of patients who attended an emergency department (ED) following cocaine use returned to the same ED over the next year for a problem related to drug use. This previous study proposed a scale (Multicenter Assessment of the Revisit Risk In the Emergency Department (MARRIED)-cocaine score) to quantify the risk of ED revisit. The aim of the present study was to validate this scale by analysing a new set of patients attending for cocaine use in nine Spanish EDs.

Methods: We performed a retrospective, multicentre, cohort study with consecutive patient inclusion, and without an intervention or control group. During 12 months (January-December 2010) we collected data from patients attending the ED after cocaine use. The MARRIED-cocaine score, ranging from 0 to 400 points, was calculated for each patient. The dependent variable was the identification of further visits associated with drug consumption to the same ED. Further analysis was performed to define risk categories.

Results: The study included 933 patients, with a mean follow-up of 466 (SD 189) days, and 185 patients returned to the same ED for problems related to drug consumption. The cumulative probability of ED revisit was 4.2%, 8.3%, 16.8% and 21.2% at 1 month, 3 months, 12 months and 24 months, respectively. The area under the curve receiver operating characteristic for the MARRIED-cocaine scale was 0.69 (p<0.001). Four categories for ED revisit risk were defined: low risk (0-40 points, n=416), moderate risk (41-100 points, n=235), high risk (101-210 points, n=71) and very high risk (210-400 points, n=211), with HRs for ED revisit (with respect to the low-risk group) of 1.82 (95% CI 1.18 to 2.80, p=0.007), 2.65 (95% CI 1.50 to 4.66, p=0.001) and 5.06 (95% CI 3.49 to 7.35, p<0.001), respectively.

Conclusions: The MARRIED-cocaine score has a moderate discriminative capacity to predict revisit among patients who attend the ED for cocaine drug-related emergencies, and allows classification of patients according to the risk of ED revisit.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/emermed-2014-203683DOI Listing
March 2016

[Methoxetamine-associated emergencies. First Spanish descriptions of this new drug].

Med Clin (Barc) 2015 Nov 24;145(9):416-7. Epub 2015 Mar 24.

Laboratorio de Toxicología, Centro de Diagnóstico Biomédico, Hospital Clínic, Barcelona, España.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.medcli.2015.01.018DOI Listing
November 2015

[Reply].

Med Clin (Barc) 2015 Sep 5;145(5):228-9. Epub 2015 Mar 5.

Servicio de Urgencias, Hospital Universitario de Canarias, Santa Cruz de Tenerife, España; Facultad de Ciencias de la Salud, Universidad Europea de Canarias, La Orotava, Santa Cruz de Tenerife, España.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.medcli.2015.01.011DOI Listing
September 2015

Presentations to the Emergency Department Following Cannabis use--a Multi-Centre Case Series from Ten European Countries.

J Med Toxicol 2015 Dec;11(4):415-21

Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, Westminster Bridge Road, SE1 7EH, London, UK.

Cannabis is the most commonly used illicit drug in Europe, and is generally regarded as having low acute toxicity. We present the findings of the first 6 months of data collection from the Euro-DEN project on presentations related to cannabis use to further understand the acute toxicity related to the use of cannabis. Data was extracted on clinical features, treatment and outcome from the Euro-DEN minimum dataset for all cases of acute recreational drug toxicity reported 1st October 2013 to 31st March 2014 for all cannabis-related presentations. Of 2198 presentations reported by 14 of the 16 Euro-DEN centres, 356 (16.2 %) involved cannabis either alone or together with other drugs/alcohol. There were 36 that involved lone use of cannabis (1.6 % of all presentations). Of the 35 non-fatal lone cannabis presentations, the most commonly reported features were neuro-behavioural (agitation/aggression 8 (22.9 %), psychosis 7 (20.0 %), anxiety 7 (20.0 %)) and vomiting 6 (17.1 %). Most patients (25, 71.4 %) received no treatment and 30 (85.7 %) were discharged/self-discharged from the ED. There was one fatality amongst these lone-cannabis cases: an 18-year-old male collapsed with an asystolic cardiac arrest whilst smoking cannabis and suffered hypoxic brain injury related to prolonged cardiac arrest. THC was detected in a urine sample taken at ED arrival; no other drugs were detected. Lone acute cannabis toxicity was typically associated with neuro-behavioural symptoms and vomiting. Although uncommon, severe toxicity including cardiovascular toxicity and death may be under-recognised, and it is important that Emergency Physicians are aware of this.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s13181-014-0460-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4675614PMC
December 2015

The epidemiology of clinical and health effects associated with cocaine.

Rev Esp Cardiol (Engl Ed) 2014 Nov 18;67(11):966-7. Epub 2014 Sep 18.

Servicio de Urgencias, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain; Departamento de Medicina Física y Farmacología, Facultad de Ciencias de la Salud, Universidad de La Laguna, Santa Cruz de Tenerife, Spain. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.rec.2014.07.002DOI Listing
November 2014

[Ten years of emergency attendances for cocaine-users in Spain].

Med Clin (Barc) 2014 Oct 21;143(7):322-6. Epub 2014 Jan 21.

Servicio de Urgencias, Hospital Universitario de Canarias, Tenerife, Santa Cruz de Tenerife, España; Facultad de Ciencias de la Salud, Universidad Europea de Canarias, La Orotava, Santa Cruz de Tenerife, España.

Cocaine is the second most consumed illegal drug in the western world, following cannabis. Since 1998, it is also the drug that more attendances generate in different emergency devices, and it is responsible for more of 60% of the emergencies directly related to drug consumption. This work reviews the main Spanish scientific articles published in the last 10 years, in which different factors related to the use of this drug have been analyzed in relation to the use of emergency by cocaine users. A total of 8,795 patients were included (interval 57-1,755), with an average age of 32.64 years (SD 3.02), and an average percentage of positives to cocaine of 54.78% (SD 47.03); there were 7 works with 100% of subjects being positive to cocaine. Males predominated with an average of 78.69% (SD 12). They presented cardiovascular symptoms in 30% cases (SD 22.7), neurological symptoms in 11.6% cases (SD 4.28) and psychiatric symptoms in 49.32% cases (SD 23.87). There was a multiple consumption in 49.02% of patients (interval 4.3-76.2), fundamentally associated with alcohol (57.78%, SD 6.18) and cannabis (21.56%, SD 10.72). Two hundred and forty-six patients (2.8%) needed admission and 8 died (0.09%).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.medcli.2013.11.023DOI Listing
October 2014

The role of the emergency department in detecting high-risk cocaine users.

Eur J Emerg Med 2012 Jun;19(3):205-6

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/MEJ.0b013e32834dd305DOI Listing
June 2012

Multicenter assessment of the revisit risk for a further drug-related problem in the emergency department in cocaine users (MARRIED-cocaine study).

Clin Toxicol (Phila) 2012 Mar;50(3):176-82

Emergency Department, Hospital Clìnic, Barcelona, Spain.

Introduction And Objectives: Emergency departments (EDs) in Spanish hospitals daily attend a large number of patients for adverse reactions or clinical complications resulting from cocaine use. After discharge, some of these patients revisit the ED for the same reason within a year. The objective of the present study was to quantify the rate of such revisits and identify the factors associated with them.

Method: We performed a retrospective, multicenter study with cohort follow-up and without a control group, conducted in the EDs of six Spanish hospitals during 12 months (January-December 2009). We included all ED patients attended for cocaine-related symptoms who reported recent cocaine use and those with cocaine-positive urine analysis by immunoassay without declared consumption. Twelve independent variables assessed for each hospital ED were collected: sex, age, place of consumption, month, day, and time of consumption, mode of arrival at the ED, discharge diagnosis, psychiatric assessment on the ED episode, concomitant drugs, destination on discharge, and history of previous ED visits related with drug use and alcohol use. The dependent variable was a subsequent visit to the ED associated with drug use, identified using the computerized hospital admissions system.

Results: The study included 807 patients, of whom 6.7% revisited the ED within 30 days, 11.9% within 3 months and 18.9% within 1 year. The variables significantly associated with ED revisits were: presence of clinical manifestations directly related to cocaine (p < 0.05), ED attendance on a working day (p < 0.05), history of ED visits related with the consumption of alcohol (p < 0.001) or drugs (p < 0.001), and the need for urgent consultation with a psychiatrist (p < 0.001), although only the last four were independent predictors in multivariate analysis. We derived a score based on these variables to predict risk of revisits (MARRIED-score, ranging from 0 to 400 points), which had a reasonably good predictive value for revisit (area under ROC of 0.75; 95% CI 0.71-0.79).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3109/15563650.2012.658917DOI Listing
March 2012

Liquid ecstasy intoxication: clinical features of 505 consecutive emergency department patients.

Emerg Med J 2011 Jun;28(6):462-6

Emergency Department, Hospital Clínic, Calle Villarroel 170, 08036 Barcelona, Spain.

Background: To describe the epidemiological profile and clinical manifestations of liquid ecstasy (GHB) poisonings.

Methods: All cases of GHB poisoning or overdose admitted to the Emergency Department (ED) of the Hospital Clinic (Barcelona) between 2000 and 2007 were recorded.

Results: A total of 505 patients (mean age 24.7 years, 68% men) were included. Most patients were brought to the hospital by ambulance (98%), during the weekend (89%) and during the early morning (75%). Symptoms began in a public place in 97%. Reduced consciousness was the most important clinical manifestation: 72% of patients had a Glasgow Coma Score of ≤ 12. 76% of patients had consumed other drugs: ethanol (64%), amphetamines and derivates (30%), cocaine (28%), ketamine (11%), cannabis (9%) and others (5%). Treatment was required in 26% of cases and an antidote was administered in 35 cases with no response. There were no deaths. The combined GHB group had a longer time to complete recovery of consciousness (71 ± 40 vs 59 ± 40 min, p < 0.001) and a higher percentage of patients with severely reduced consciousness at ED arrival (54% vs 37%, p = 0.01), need for treatment (29% vs 16%, p < 0.01) and need for mechanical ventilation (3% vs 0%, p < 0.05) compared with the pure GHB group.

Conclusions: GHB intoxication leading to reduced consciousness is a frequent reason for ED admission, above all in young people and in the early morning at the weekend. Symptoms are more severe in patients who have taken GHB in combination with other substances of abuse.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/emj.2008.068403DOI Listing
June 2011

Trends in research activity in toxicology and by toxicologists in seven European countries.

Toxicol Lett 2009 Aug 9;189(1):1-4. Epub 2009 May 9.

Emergency Department, Hospital Clínic, Villarroel Street 170, Barcelona 08036, Catalonia, Spain.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.toxlet.2009.04.029DOI Listing
August 2009

[Poisoning by liquid ecstasy (GHB) in hospital emergency departments of Barcelona: a 2-years study].

Med Clin (Barc) 2008 Mar;130(7):254-8

Servicio de Urgencias, Hospital Clínic, Barcelona, España.

Background And Objective: Liquid ecstasy (GHB) is a new cause of drug overdose in our country. To describe the epidemiological profile and clinical manifestations, we analyzed cases of poisoning by GHB attended by the Emergency Departments (ED) of 2 hospitals of the city of Barcelona.

Patients And Method: During two years (2003-2004) all cases of poisoning or overdose due to GHB attended in the ED of the Hospital del Mar and the Hospital Clinic of Barcelona were collected. The diagnosis was clinical and/or by means of toxicological analysis. Epidemiological, clinical, laboratory and therapeutic variables as well as the evolution were collected.

Results: A total of 339 patients (mean age 23.5 years, 62% male) were identified. Most patients (89%) were admitted during the early morning and during weekends (89%). Symptoms began in a public place in 97%. Reduced consciousness was the most important clinical manifestation, since 72% of patients had a Glasgow Coma Score of 12 or less. Seventy per cent stated having consumed GHB with other drugs, mainly ethyl alcohol (53%) and cocaine (16%). Some form of treatment was required in 32% of cases and 20 cases were administered an antidote: naloxone (12 cases), flumazenil (8 cases) and physostigmine (6 cases). Five patients needed orotracheal intubation and ventilatory support. One patient needed advanced vital support. There were no deaths.

Conclusions: GHB intoxication leading to reduced consciousness is a frequent motive for admission to the ED, mostly in young people and in the early morning during the weekend. GHB intoxication should be discarded in all cases of coma of unknown origin.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1157/13116549DOI Listing
March 2008