The American journal of emergency medicine · 2025
"Are you worried about going into withdrawal today?" Retrospective analysis of single-question, patient-centered screen for substance use and care linkage.
СтатьяПоддержка NIH: внешняя программаНазвание и аннотация: Перевод в очереди
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London Kory S, Hurwitz Beth, Davis Jennifer, Warrick-Stone TaReva, Cherney Alan, Randolph Frederick, Bradley-O'Toole Bernice, Deis Kate, Alexander Karen
Аннотация
BACKGROUND: Emergency Department (ED) screening for substance use disorder (SUD) is limited by a lack of standardization and challenging clinical environments. Existing tools may be focused on informing clinicians rather than supporting patients. This study assessed a novel single-question screening tool to identify patients at risk of withdrawal and link those with opioid use disorder (OUD) to standardized treatment.
METHODS: A cross-sectional, retrospective study was conducted at two urban EDs in Philadelphia, PA, using electronic health record data between November 8, 2022, and February 28, 2025. Patients were included in the study if they arrived ambulatory to the emergency department, were aged 18 years and older, and able to answer screening questions. Demographic, encounter, screening response, disposition, and withdrawal order set utilization data were obtained. Data analysis was primarily descriptive, and bivariate associations were examined using odds ratios to assess the strength of relationships between key variables.
RESULTS: 106,212 patient encounters met the inclusion criteria during the study period. 70,603 (66.5 %) of those patients answered the screening question. 4686 (6.6 %) patients answered affirmatively to a concern over withdrawal. 1512 patients (2.1 %) received medications from the opioid withdrawal order set, including 186 patients who did not express a withdrawal concern. Screening positive for a withdrawal concern was associated with a 2.28-fold increase in the odds of patient-directed discharge from the ED (OR = 2.28, 95 % CI = 2.10-2.47, p < .001). Patients who received the withdrawal protocol had significantly lower rates of patient-directed discharge (9.1 %) compared to those who screened positive for withdrawal overall (17.8 %) (OR = 0.41, 95 % CI: 0.33-0.51, p < .001).
CONCLUSION: Use of a single-question ED screening tool to identify individuals in withdrawal and link them to withdrawal treatments may be an effective tool. Additional studies should assess barriers to screening and withdrawal treatment, and long-term outcomes of those who screen positive for withdrawal concern in the ED.
METHODS: A cross-sectional, retrospective study was conducted at two urban EDs in Philadelphia, PA, using electronic health record data between November 8, 2022, and February 28, 2025. Patients were included in the study if they arrived ambulatory to the emergency department, were aged 18 years and older, and able to answer screening questions. Demographic, encounter, screening response, disposition, and withdrawal order set utilization data were obtained. Data analysis was primarily descriptive, and bivariate associations were examined using odds ratios to assess the strength of relationships between key variables.
RESULTS: 106,212 patient encounters met the inclusion criteria during the study period. 70,603 (66.5 %) of those patients answered the screening question. 4686 (6.6 %) patients answered affirmatively to a concern over withdrawal. 1512 patients (2.1 %) received medications from the opioid withdrawal order set, including 186 patients who did not express a withdrawal concern. Screening positive for a withdrawal concern was associated with a 2.28-fold increase in the odds of patient-directed discharge from the ED (OR = 2.28, 95 % CI = 2.10-2.47, p < .001). Patients who received the withdrawal protocol had significantly lower rates of patient-directed discharge (9.1 %) compared to those who screened positive for withdrawal overall (17.8 %) (OR = 0.41, 95 % CI: 0.33-0.51, p < .001).
CONCLUSION: Use of a single-question ED screening tool to identify individuals in withdrawal and link them to withdrawal treatments may be an effective tool. Additional studies should assess barriers to screening and withdrawal treatment, and long-term outcomes of those who screen positive for withdrawal concern in the ED.