{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T01:25:07Z","timestamp":1792113907842,"version":"4.4.0"},"reference-count":27,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2023,9,14]],"date-time":"2023-09-14T00:00:00Z","timestamp":1694649600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"DPIP\/ISEC Programme of the European Union (2013\u20132015)"},{"name":"European Monitoring Centre for Drugs and Drug Addiction (EMCDDA)"},{"name":"Burgergemeinde Bern"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>This study aimed to characterize patients admitted to critical care following Emergency Department (ED) presentation with acute recreational drug toxicity and to identify determinants of admission to critical care. A retrospective multicenter matched case-control study was conducted by the European Drug Emergency Network Plus (Euro-DEN Plus) over the period 2014\u20132021. The cases were ED presentations with acute recreational drug toxicity admitted to critical care, the controls consisted of ED presentations with acute recreational drug toxicity medically discharged directly from the ED. The potential determinants of admission to critical care were assessed through multivariable conditional stepwise logistic regression analysis and multiple imputation was used to account for the missing data. From 2014 to 2021, 3448 Euro-DEN Plus presentations involved patients admitted to critical care (76.9% males; mean age 33.2 years; SD 10.9 years). Patient age \u226535 years (as compared to \u226418 years) was a determinant of admission to critical care following acute recreational drug toxicity (adjusted odds ratio, aOR, 1.51, 95% confidence interval, CI, 1.15\u20131.99), along with polydrug use (aOR 1.39, 95% CI 1.22\u20131.59), ethanol co-ingestion (aOR 1.44, 95% CI 1.26\u20131.64), and the use of gamma-hydroxybutyrate\/gamma-butyrolactone (GHB\/GBL, aOR 3.08, 95% CI 2.66\u20133.57). Conversely, lower odds of admission to critical care were associated with the use of cocaine (aOR 0.85, 95% CI 0.74\u20130.99), cannabis (aOR 0.44, 95% CI 0.37\u20130.52), heroin (aOR 0.80, 95% CI 0.69\u20130.93), and amphetamine (aOR 0.65, 95% CI 0.54\u20130.78), as was the arrival to the ED during the night (8 p.m.\u20138 a.m., aOR 0.88, 95% CI 0.79\u20130.98). These findings, which deserve confirmation and further investigation, could contribute to a more complete understanding of the decision-making process underlying the admission to critical care of patients with acute recreational drug toxicity.<\/jats:p>","DOI":"10.3390\/jcm12185970","type":"journal-article","created":{"date-parts":[[2023,9,15]],"date-time":"2023-09-15T04:06:13Z","timestamp":1694750773000},"page":"5970","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Determinants of Admission to Critical Care Following Acute Recreational Drug Toxicity: A Euro-DEN Plus Study"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4946-7926","authenticated-orcid":false,"given":"Roberta","family":"Noseda","sequence":"first","affiliation":[{"name":"Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9620-8057","authenticated-orcid":false,"given":"Matteo","family":"Franchi","sequence":"additional","affiliation":[{"name":"Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy"},{"name":"National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, 20126 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Pagnamenta","sequence":"additional","affiliation":[{"name":"Clinical Trial Unit, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland"},{"name":"Department of Intensive Care, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland"},{"name":"Division of Pneumology, University of Geneva, 1211 Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"M\u00fcller","sequence":"additional","affiliation":[{"name":"Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alison M.","family":"Dines","sequence":"additional","affiliation":[{"name":"Clinical Toxicology, Guy\u2019s and St Thomas\u2019 NHS Foundation Trust and King\u2019s Health Partners, London SE1 7EH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabelle","family":"Giraudon","sequence":"additional","affiliation":[{"name":"European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), 1249-289 Lisbon, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9602-4370","authenticated-orcid":false,"given":"Fridtjof","family":"Heyerdahl","sequence":"additional","affiliation":[{"name":"Prehospital Division, Oslo University Hospital, 0424 Oslo, Norway"},{"name":"The Norwegian Air Ambulance Foundation, 0184 Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4753-2747","authenticated-orcid":false,"given":"Florian","family":"Eyer","sequence":"additional","affiliation":[{"name":"Department of Clinical Toxicology, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6341-8699","authenticated-orcid":false,"given":"Knut Erik","family":"Hovda","sequence":"additional","affiliation":[{"name":"The Norwegian CBRNE Centre of Medicine, Oslo University Hospital, 0450 Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1765-9659","authenticated-orcid":false,"given":"Matthias E.","family":"Liechti","sequence":"additional","affiliation":[{"name":"Clinical Pharmacology and Toxicology, University Hospital and University of Basel, 4056 Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00d2scar","family":"Mir\u00f3","sequence":"additional","affiliation":[{"name":"Emergency Department, Hospital Cl\u00ednic, University of Barcelona, 08036 Catalonia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1213-392X","authenticated-orcid":false,"given":"Odd Martin","family":"Vallersnes","sequence":"additional","affiliation":[{"name":"Department of General Practice, University of Oslo, 0318 Oslo, Norway"},{"name":"Oslo Accident and Emergency Outpatient Clinic, City of Oslo Health Agency, 0182 Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Yates","sequence":"additional","affiliation":[{"name":"Emergency Department and Clinical Toxicology Unit, Hospital Universitario Son Espases, 07120 Mallorca, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul I.","family":"Dargan","sequence":"additional","affiliation":[{"name":"Clinical Toxicology, Guy\u2019s and St Thomas\u2019 NHS Foundation Trust and King\u2019s Health Partners, London SE1 7EH, UK"},{"name":"Clinical Toxicology, Faculty of Life Sciences and Medicine, King\u2019s College London, London WC2R 2LS, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David M.","family":"Wood","sequence":"additional","affiliation":[{"name":"Clinical Toxicology, Guy\u2019s and St Thomas\u2019 NHS Foundation Trust and King\u2019s Health Partners, London SE1 7EH, UK"},{"name":"Clinical Toxicology, Faculty of Life Sciences and Medicine, King\u2019s College London, London WC2R 2LS, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4308-0405","authenticated-orcid":false,"given":"Alessandro","family":"Ceschi","sequence":"additional","affiliation":[{"name":"Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland"},{"name":"Clinical Trial Unit, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland"},{"name":"Faculty of Biomedical Sciences, Universit\u00e0 della Svizzera Italiana, 6900 Lugano, Switzerland"},{"name":"Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, 8091 Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the Euro-DEN Plus Research 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European Monitoring Centre for Drugs and Drug Addiction. European Drug Report. Trend and Developments. Available online: http:\/\/www.emcdda.europa.eu\/."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/j.chest.2019.08.2180","article-title":"Burden of Substance Abuse-Related Admissions to the Medical ICU","volume":"157","author":"Westerhausen","year":"2020","journal-title":"Chest"},{"key":"ref_3","first-page":"1178221819869327","article-title":"Alcohol and Drug Abuse Resource Utilization in the ICU","volume":"13","author":"Cervellione","year":"2019","journal-title":"Subst. Abuse"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1007\/s00134-023-07074-z","article-title":"More than patient benefit: Taking a broader view of ICU admission decisions","volume":"49","author":"Batten","year":"2023","journal-title":"Intensive Care Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1297","DOI":"10.1097\/01.CCM.0000215112.84523.F0","article-title":"Acute Physiology and Chronic Health Evaluation (APACHE) IV: Hospital mortality assessment for today\u2019s critically ill patients","volume":"34","author":"Zimmerman","year":"2006","journal-title":"Crit. Care Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1080\/20009666.2017.1356189","article-title":"Clinical and epidemiological characteristics of patients with acute drug intoxication admitted to ICU","volume":"7","author":"Orsini","year":"2017","journal-title":"J. Community Hosp. Intern. Med. Perspect."},{"key":"ref_7","first-page":"1174","article-title":"Deliberate drug poisonings admitted to an emergency department in Paris area\u2014A descriptive study and assessment of risk factors for intensive care admission","volume":"20","author":"Beaune","year":"2016","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1016\/j.ejim.2006.02.029","article-title":"General characteristics of hospitalized patients after deliberate self-poisoning and risk factors for intensive care admission","volume":"17","author":"Novack","year":"2006","journal-title":"Eur. J. Intern. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1080\/15563650.2016.1222616","article-title":"The need for ICU admission in intoxicated patients: A prediction model","volume":"55","author":"Brandenburg","year":"2017","journal-title":"Clin. Toxicol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"664","DOI":"10.1080\/15563650.2017.1401635","article-title":"Independent validation of the ICU requirement score in a cohort of acutely poisoned adults","volume":"56","author":"Romanek","year":"2018","journal-title":"Clin. Toxicol."},{"key":"ref_11","unstructured":"(2023, August 16). Available online: https:\/\/www.emcdda.europa.eu\/publications\/data-factsheet\/european-drug-emergencies-network-euro-den-plus-data-and-analysis_en."},{"key":"ref_12","unstructured":"European Monitoring Centre for Drugs and Drug Addiction (2020). Drug-Related Hospital Emergency Presentations in Europe: Update from the Euro-DEN Plus Expert Network, Publications Office of the European Union. Technical Report 2020."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Syse, V.L., Brekke, M., Grimsrud, M.M., Persett, P.S., Heyerdahl, F., Hovda, K.E., and Vallersnes, O.M. (2019). Gender differences in acute recreational drug toxicity: A case series from Oslo, Norway. BMC Emerg. Med., 19.","DOI":"10.1186\/s12873-019-0244-3"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1228","DOI":"10.1080\/03610910902859574","article-title":"Using the Standardized Difference to Compare the Prevalence of a Binary Variable between Two Groups in Observational Research","volume":"8","author":"Austin","year":"2009","journal-title":"Commun. Stat. Simul. Comput."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"b2393","DOI":"10.1136\/bmj.b2393","article-title":"Multiple imputation for missing data in epidemiological and clinical research: Potential and pitfalls","volume":"338","author":"Sterne","year":"2009","journal-title":"BMJ"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Geith, S., Lumpe, M., Schurr, J., Rabe, C., Ott, A., Zellner, T., Rentrop, M., and Eyer, F. (2022). Characteristics and predictive factors of severe or fatal suicide outcome in patients hospitalized due to deliberate self-poisoning. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0276000"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Mergl, R., Koburger, N., Heinrichs, K., Sz\u00e9kely, A., T\u00f3th, M.D., Coyne, J., Quint\u00e3o, S., Arensman, E., Coffey, C., and Maxwell, M. (2015). What Are Reasons for the Large Gender Differences in the Lethality of Suicidal Acts? An Epidemiological Analysis in Four European Countries. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0129062"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Freeman, A., Mergl, R., Kohls, E., Sz\u00e9kely, A., Gusmao, R., Arensman, E., Koburger, N., Hegerl, U., and Rummel-Kluge, C. (2017). A cross-national study on gender differences in suicide intent. BMC Psychiatry, 17.","DOI":"10.1186\/s12888-017-1398-8"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.jad.2011.08.032","article-title":"Preference of lethal methods is not the only cause for higher suicide rates in males","volume":"136","author":"Cibis","year":"2012","journal-title":"J. Affect. Disord."},{"key":"ref_20","first-page":"21","article-title":"Severity of emergency department presentations due to acute drug toxicity in Europe: A longitudinal analysis over a 6-year period (2014\u20132019) stratified by sex","volume":"30","author":"Schmid","year":"2022","journal-title":"Eur. J. Emerg. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1097\/MEJ.0000000000000932","article-title":"Clinical effect of ethanol co-use in patients with acute drug toxicity involving the use of central nervous system depressant recreational drugs","volume":"29","author":"Heier","year":"2022","journal-title":"Eur. J. Emerg. Med."},{"key":"ref_22","unstructured":"Baselt, R.C. (2017). Disposition of Toxic Drugs and Chemicals in Man, Biomedical Publications. [11th ed.]."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"13","DOI":"10.2147\/SAR.S315720","article-title":"Current Insights on the Impact of Gamma-Hydroxybutyrate (GHB) Abuse","volume":"13","author":"Tay","year":"2022","journal-title":"Subst. Abuse Rehabil."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"458","DOI":"10.3109\/15563650.2012.702218","article-title":"The clinical toxicology of \u03b3-hydroxybutyrate, \u03b3-butyrolactone and 1,4-butanediol","volume":"50","author":"Schep","year":"2012","journal-title":"Clin. Toxicol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1028","DOI":"10.1080\/15563650.2020.1726378","article-title":"Characteristics and circumstances of death related to gamma hydroxybutyrate (GHB)","volume":"58","author":"Darke","year":"2020","journal-title":"Clin. Toxicol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"896","DOI":"10.1080\/15563650.2021.1884693","article-title":"Variation of drugs involved in acute drug toxicity presentations based on age and sex: An epidemiological approach based on European emergency departments","volume":"59","author":"Waring","year":"2021","journal-title":"Clin. Toxicol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.toxlet.2019.07.001","article-title":"Clinical relevance of ethanol coingestion in patients with GHB\/GBL intoxication","volume":"314","author":"Galicia","year":"2019","journal-title":"Toxicol. 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