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Discharge One Hour After Naloxone for OD May Be Option

New rule has sensitivity, specificity of 84.1, 62.1 percent for patients receiving prehospital naloxone

syringe and medication

FRIDAY, Jan. 4, 2019 (Pharmacist's Briefing) -- A rule with six criteria can determine whether patients can be safely discharged from the emergency department after a one-hour observation period following prehospital naloxone administration, according to a study published online Dec. 28 in Academic Emergency Medicine.

Brian M. Clemency, D.O., from the University at Buffalo in New York, and colleagues conducted a prospective observational validation study involving 538 patients who received at least one administration of prehospital naloxone. Patients were assessed by emergency medicine providers one hour after naloxone administration. Patients were judged to have normal one-hour evaluation if all six criteria of the rule were met (if they could mobilize as usual and had a normal oxygen saturation, respiratory rate, temperature, heart rate, and Glasgow Coma Scale score).

The researchers found that adverse events occurred in 15.4 percent of patients. The rule exhibited sensitivity and specificity of 84.1 and 62.1 percent, respectively, with a negative predictive value of 95.6 percent. One patient with normal one-hour evaluation received additional naloxone after a presumed overdose of heroin.

"This prediction rule appears to be a useful tool for identifying suspected opioid overdose patients treated with naloxone who are safe for discharge after one hour," the authors write. "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."

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