Factors related to emergency department revisits after urgent attention for cocaine use

Miró O, Galicia M, Sánchez M, Nogué S

Objectives: Acute adverse reactions to cocaine have become a significant reason for

visits and revisits to emergency departments. Our aim was to determine the rate of

cocaine-related revisiting in our department and identify related factors.

Methods: Study of patients treated at a tertiary-care hospital emergency department in

a 12-month period. We included all patients with a toxicology report that was positive

for cocaine, collecting information on 12 independent variables. Factors related to

epidemiology were sex, age, place where the cocaine use occurred, and means of

transport to the emergency department. Clinical characteristics were concomitant drug

use, history of emergency department visits related to drug use, direct relation between

cocaine use and the current visit, and requirement for psychiatric consultation or

admission. A revisit to the same emergency department in relation to drug use was the

dependent variable.

Results: Of the 220 patients included, 6% revisited within 30 days of the first visit, 8%

within 3 months, and 17% within 1 year. Four independent variables were significantly

related to revisiting in the bivariate analysis, but only 2 proved to be significant

predictors: having a prior history of visits related to drug use (hazard ratio [HR], 3.28;

95% confidence interval [CI], 1.46-7.31) and requirement for psychiatric consultation

(HR, 2.52, 95% CI, 1.22-5.20). At the end of the year, the revisit rate in the absence of

these factors was 5.5%; the rate rose to 20.5% when 1 predictor was present and to

46.9% when 2 were present.

Conclusions: Emergency patients with a cocaine-positive toxicology report are more

likely to require emergency care again if they have a history of drug-related emergency

department visits or if they have required emergency psychiatric care. When these risk

factors are present, the health care system should arrange for follow-up care that is

specifically for drug addiction with the aim of trying to reduce the number of severe

adverse events.

Galicia M, Miró O, Nogué S, Sánchez M