• Lauren M Maloney, Timur Alptunaer, Gia Coleman, Suleiman Ismael, Peter J McKenna, R Trevor Marshall, Cristina Hernandez, and Daryl W Williams.
• Department of Emergency Medicine, Stony Brook University Hospital, Stony Brook, New York.
• J Emerg Med. 2020 Dec 1; 59 (6): 872-883.

BackgroundThe purpose of this study was to evaluate prehospital and emergency department (ED) interventions and outcomes of patients who received prehospital naloxone for a suspected opioid overdose.ObjectivesThe primary objective was to evaluate if the individual dose, individual route, total dose, number of prehospital naloxone administrations, or occurrence of a prehospital adverse event (AE) were associated with the occurrence of AEs in the ED. Secondary objectives included a subset analysis of patients who received additional naloxone while in the ED, or were admitted to an intensive care or step-down unit (ICU).MethodsThis was a retrospective, observational chart review of adult patients who received prehospital naloxone and were transported by ambulance to a suburban academic tertiary care center between 2014 and 2017. Descriptive, univariate, and multivariate statistics were used, with p < 0.05 indicating significance.ResultsThere were 513 patients included in the analysis, with a median age of 29 years, and median total prehospital naloxone dose of 2 mg. An increasing number of prehospital naloxone doses, an occurrence of a prehospital AE, and a route of administration other than intranasally for the first dose of prehospital naloxone were significantly associated with an increased likelihood of an ED AE. Patients who received < 2 mg of prehospital naloxone had the least likelihood of being admitted to an ICU, whereas patients who received at least 6 mg had a dramatically increased likelihood of ICU admission.ConclusionsOur results suggest that an increasing number of prehospital naloxone doses was significantly associated with an increased likelihood of an ED adverse event.Copyright © 2020 Elsevier Inc. All rights reserved.

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