Decision Rule Allows Early Discharge After Naloxone for Opioid Overdose

January 7, 2019

By Reuters Staff

NEW YORK—A six-component early-discharge rule allows for safe discharge of some patients one hour after naloxone administration for suspected opioid overdose, researchers report.

The St. Paul's Early Discharge Rule suggested that patients could be safely discharged following naloxone administration for opiate overdose if they could mobilize as usual and had normal oxygen saturation, respiratory rate, temperature, heart rate and Glasgow Coma Scale score.

Dr. Brian M. Clemency from Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, New York, and colleagues compared clinical judgment with a modified version of St. Paul's Early Discharge Rule (increasing the threshold for normal oxygen saturation from >92% to >95%, but otherwise unchanged) one hour after administration of prehospital naloxone for predicting adverse events in the first 24 hours in a observational validation study of 538 patients.

Overall, 82 patients (15.4%) experienced adverse events, with no deaths.

The Early Discharge Rule had 84.1% sensitivity, 62.1% specificity and 95.6% negative predictive value for adverse events in the first 24 hours. It failed to predict 13 adverse events, the researchers report in Academic Emergency Medicine, online December 28.

In comparison, provider judgment exhibited 85.4% sensitivity, 60.9% specificity, and 95.8% negative predictive value and failed to predict 12 adverse events.

The combination of provider judgment plus the rule slightly improved sensitivity (to 87.8%) and negative predictive value (96.0%), but still failed to predict 10 adverse events.

"The adverse events identified in patients with normal examinations following naloxone administration for parenteral opiate overdose were generally minor and unlikely to be life-threatening," the researchers note.

"Further study is needed to determine the exact performance characteristics of the rule in the context of overdoses of various drugs, drug combinations, and routes of administration subgroups," they conclude.

Dr. Clemency did not respond to a request for comments.


Acad Emerg Med 2018.

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