Factors related to emergency department revisits after cocaine use

Objectives: Acute adverse reactions to cocaine have become a significant reason for visits and revisits to emergency departments. Our aim was to determine the rate of cocaine-related revisiting in our department and identify related factors. Methods: Study of patients treated at a tertiary-care hospital emergency department in a 12-month period. We included all patients with a toxicology report that was positive for cocaine, collecting information on 12 independent variables. Factors related to epidemiology were sex, age, place where the cocaine use occurred, and means of transport to the emergency department. Clinical characteristics were concomitant drug use, history of emergency department visits related to drug use, direct relation between cocaine use and the current visit, and requirement for psychiatric consultation or admission. A revisit to the same emergency department in relation to drug use was the dependent variable. Results: Of the 220 patients included, 6% revisited within 30 days of the first visit, 8% within 3 months, and 17% within 1 year. Four independent variables were significantly related to revisiting in the bivariate analysis, but only 2 proved to be significant predictors: having a prior history of visits related to drug use (hazard ratio [HR], 3.28; 95% confidence interval [Cl], 1.46-7.31) and requirement for psychiatric consultation (HR, 2.52, 95% Cl, 1.22-5.20). At the end of the year, the revisit rate in the absence of these factors was 5.5%; the rate rose to 20.5% when 1 predictor was present and to 46.9% when 2 were present. Conclusions: Emergency patients with a cocaine-positive toxicology report are more likely to require emergency care again if they have a history of drug-related emergency department visits or if they have required emergency psychiatric care. When these risk factors are present, the health care system should arrange for follow-up care that is specifically for drug addiction with the aim of trying to reduce the number of severe adverse events. [Emergencias 2010;22:408-414]