Overdose in the Intensive Care Unit: Severity and Barriers to Care
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Abstract
Objective: Whilst drug Overdose (OD) is increasingly prevalent in critical care, the burden of care of those patients admitted to the ICU has been minimally described. We aim to explore three domains in this cohort: the historical and demographical features on presentation, their supportive care requirements and duration of admission within the ICU, and the factors surrounding psychiatric assessment.
Design: A retrospective study of data from the Canberra Health Service (CHS) Digital Health Record system (MetaVision) of those admitted with a drug overdose.
Setting: A single-centre study within a tertiary ICU for the Australian Capital Territory (ACT).
Participants: All patients admitted to the ICU with a primary diagnosis of drug overdose from 2018 to the conclusion of 2021.
Main Outcome measures: The Primary outcome measure was ICU length of stay. A composite outcome measure (≥ 2 ICU therapies required) was used to quantify an eventful admission for risk assessment.
Results: 419 admissions occurred during the study period, representing 4.73% of all ICU admissions during this period. The majority were polypharmacy overdoses (63%), with most having a known psychiatric diagnosis (73%). The median ICU length of stay was found to be 37.70 hours (IQR, 20.90-62.35), lower when compared with a median of all admissions (48.8 hours, 25.2-94.4). Most patients required multiple therapies (50.12%); however, a proportion were identified as non-required admissions (20.76%) with overall low illness severity amongst admissions (ANZROD 0.63). Psychiatric review was requested with 68.74% of presentations, but only 72% were reviewed during their ICU stay. Those either living in a regional location (OR 3.30; p < 0.005) or transferred from a regional hospital (OR 2.65; p = <0.005) were at greater risk of an eventful admission.
Conclusion: Drug overdose accounts for a notable proportion of ICU admissions and is associated with multiple ICU therapies with a high psychiatric workload, despite low mortality and illness severity. Further exploration is required for various at-risk groups.
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