{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T08:16:47Z","timestamp":1790410607440,"version":"4.1.0"},"reference-count":17,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2018,12,28]],"date-time":"2018-12-28T00:00:00Z","timestamp":1545955200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2019,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>St. Paul's Early Discharge Rule was derived to determine which patients could be safely discharged from the emergency department after a 1\u2010hour observation period following naloxone administration for opiate overdose. The rule suggested that patients could be safely discharged if they could mobilize as usual and had a normal oxygen saturation, respiratory rate, temperature, heart rate, and Glasgow Coma Scale score. Validation of the St. Paul's Early Discharge Rule is necessary to ensure that these criteria are appropriate to apply to patients presenting after an unintentional presumed opioid overdose in the context of emerging synthetic opioids and expanded naloxone access.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In this prospective, observational validation study, emergency medicine providers assessed patients 1\u00a0hour after administration of prehospital naloxone. Unlike in the derivation study the threshold for normal oxygen saturation was set at 95% and patients were not immediately discharged after a normal 1\u2010hour evaluation. Patients were judged to have a normal 1\u2010hour evaluation if all six criteria of the rule were met. Patients were judged to have an adverse event (<jats:styled-content style=\"fixed-case\">AE<\/jats:styled-content>) if they had one or more of the preestablished <jats:styled-content style=\"fixed-case\">AE<\/jats:styled-content>s.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 538 patients received at least one administration of prehospital naloxone, were transported to the study hospital, and had a 1\u2010hour evaluation performed by a provider. <jats:styled-content style=\"fixed-case\">AE<\/jats:styled-content>s occurred in 82 (15.4%) patients. The rule exhibited a sensitivity of 84.1% (95% confidence interval [<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>]\u00a0= 76.2%\u201392.1%), a specificity of 62.1% (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\u00a0= 57.6%\u201366.5%), and a negative predictive value of 95.6% (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\u00a0= 93.3%\u201397.9%). Only one patient with a normal 1\u2010hour evaluation subsequently received additional naloxone following a presumed heroin overdose.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This rule may be used to risk stratify patients for early discharge following naloxone administration for suspected opioid overdose.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.13567","type":"journal-article","created":{"date-parts":[[2018,12,28]],"date-time":"2018-12-28T08:02:01Z","timestamp":1545984121000},"page":"7-15","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Hospital Observation Upon Reversal (<scp>HOUR<\/scp>) With Naloxone: A Prospective Clinical Prediction Rule Validation Study"],"prefix":"10.1111","volume":"26","author":[{"given":"Brian M.","family":"Clemency","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine Jacobs School of Medicine and Biomedical Sciences University at Buffalo Buffalo NY"},{"name":"Department of Exercise and Nutrition Science University at Buffalo Buffalo NY"},{"name":"Erie County Medical Center Buffalo NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Eggleston","sequence":"additional","affiliation":[{"name":"Upstate New York Poison Center Syracuse NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evan W.","family":"Shaw","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Jacobs School of Medicine and Biomedical Sciences University at Buffalo Buffalo NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Cheung","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Jacobs School of Medicine and Biomedical Sciences University at Buffalo Buffalo NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas S.","family":"Pokoj","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Jacobs School of Medicine and Biomedical Sciences University at Buffalo Buffalo NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael A.","family":"Manka","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Jacobs School of Medicine and Biomedical Sciences University at Buffalo Buffalo NY"},{"name":"Erie County Medical Center Buffalo NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donald J.","family":"Giordano","sequence":"additional","affiliation":[{"name":"Erie County Medical Center Buffalo NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Serafin","sequence":"additional","affiliation":[{"name":"Erie County Medical Center Buffalo NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Han","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Biostatistics University at Buffalo Buffalo NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather A.","family":"Lindstrom","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Jacobs School of Medicine and Biomedical Sciences University at Buffalo Buffalo NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Hostler","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Jacobs School of Medicine and Biomedical Sciences University at Buffalo Buffalo NY"},{"name":"Department of Exercise and Nutrition Science University at Buffalo Buffalo NY"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,12,28]]},"reference":[{"key":"e_1_2_10_2_1","volume-title":"Opioid\u2010Related Inpatient Stays and Emergency Department Visits by State, 2009\u20132014","author":"Weiss 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