Clinical Predictors for Intensive Care Unit Admission in Patients With Benzodiazepines Poisoning in the Emergency Department

Objective: To investigate the clinical predictors for intensive care unit (ICU) admission for patients with benzodiazepine (BZD) overdose and their clinical characteristics in the emergency department (ED). Methods: A retrospective case-control study of acute BZD overdose patients aged >= 18 years presenting to the ED in our hospital from July 1, 2012 through June 30, 2015 were enrolled in this study. We collected demographic information on underlying diseases, initial presentations, causes and the classifications of BZD, complications, dispositions, and outcomes. Analyses were conducted among subgroups and were identified the possible predictive clinical factors determining ICU admission in these patients. Results: A total of 140 patients were enrolled in the study, with a mean age of 51.3 +/- 19.1 years (mean +/- standard deviation [SD]) and female predominance with 2.59:1. The most common cause of BZD overdose was suicidal attempt. The most common underlying disease is major depression disease or bipolar disorder occupying 85.7% of all study patients. Suicide attempt accounted for 84.3% (118/140) of all study patients, among whom 41.4% (58/140) has previous history of suicide attempt. Sixty-nine point two percent (83/120) needed hospital admission, including 20 patients (14.3%) with ICU admission and a total three patients mortalities (2.1%, 3/140). Two clinical predictive factors of ICU admission were identified, including pneumonia and flumazenil use in ED. Conclusion: The incidence of mortality in patients with BZD overdose is low, but all-cause mortality remains high in those admitted to ICU (15%). Emergency physicians are suggested to pay more attentions on BZD overdose patients with suicidal attempt and major depression/bipolar disorder, who have pneumonia or flumazenil use in the ED. The incorporation of hospital healthcare team resource management in dealing with the recording, intervention, and prevention of these patients was mandatory to decrease repeat overdose, enhance care quality, and improve outcomes.