Early discharge of patients with presumed opioid overdose: Development of a clinical prediction rule

Objective: To develop a clinical prediction rule to identify patients who c an be safely discharged one hour after the administration of naloxone for p resumed opioid overdose. Methods: Patients who received naloxone for known or presumed opioid overdose were formally evaluated one hour later for mult iple potential predictor variables. Patients were classified into two group s: those with adverse events within 24 hours and those without. Using class ification and regression tree methodology, a decision rule was developed to predict safe discharge. Results: Clinical findings from 573 patients allow ed us to develop a clinical prediction rule with a sensitivity of 99% (95% CI = 96% to 100%) and a specificity of 40% (95% CI = 36% to 45%). Patients with presumed opioid overdose can be safely discharged one hour after nalox one administration if they: 1) can mobilize as usual; 2) have oxygen satura tion on room air of >92%; 3) have a respiratory rate 110 breaths/min and <2 0 breaths/min; 4) have a temperature of >35.0 degrees C and <37.5 degrees C ; 5) have a heart rate >50 beats/min and <100 beats/min; and 6) have a Glas gow Coma Scale score of 15. Conclusions: This prediction rule for safe earl y discharge of patients with presumed opioid overdose performs well in this derivation set but requires validation followed by confirmation of safe im plementation.