急诊科临床医生能否仅根据临床观察来诊断 γ-羟基丁酸 (GHB) 中毒？,Emergency Medicine Journal

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急诊科临床医生能否仅根据临床观察来诊断 γ-羟基丁酸 (GHB) 中毒？
Emergency Medicine Journal ( IF 2.7 ) Pub Date : 2021-07-01 , DOI: 10.1136/emermed-2020-209577
Thomas A Smits ₁ , Femke Mj Gresnigt ₂ , Milly E Attema-de Jonge ₃ , Eric Jf Franssen ₁

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目的 γ-羟基丁酸 (GHB) 是一种滥用药物，具有中枢抑制作用，可能导致昏迷，GCS 评分低至 3。快速诊断“GHB 中毒”可以防止不必要的诊断检查，并可能导致指导、微创，治疗。本研究的目的是评估急诊科医师的临床评估是否足以诊断疑似 GHB 中毒的患者。方法在急诊室就诊、GCS<15 和潜在滥用药物中毒并对其进行尿毒理学筛查的患者被连续纳入。在第一次评估后，急诊科医生在医院信息系统中登记了最可能的初步诊断。这些患者的尿液使用经过验证的 GHB 气相色谱分析方法（确认测试）进行了测试。将初始诊断与确认测试的结果进行比较。结果共纳入506例患者，GHB阳性100例，GHB阴性406例。与确认试验相比，急诊科医生诊断 GHB 中毒的敏感性和特异性分别为 63%（95% CI 52 至 73）和 93%（95% CI 90 至 95）。阳性预测值为 67%（95% CI 60 至 77），阴性预测值为 92%（95% CI 88 至 94）。结论医生低估了 GHB 中毒的存在，不能仅根据临床观察来诊断 GHB 中毒。在未来，除了临床判断之外，快速可靠的初始分析 GHB 测试可能对减少假阴性诊断很有价值。可应合理要求提供数据。在去标识化（文本和表格）后，将提供作为本文报告结果基础的个人参与者数据。从文章发表后 9 个月开始到 36 个月结束，这些数据将可用于个人参与者数据荟萃分析。数据将与研究人员共享，其提议的数据使用已由为此目的确定的独立审查委员会批准。提案应发送至 FMJGresnigt@olvg.nl。要获得访问权限，数据请求者需要签署数据访问协议。数据将与研究人员共享，其提议的数据使用已由为此目的确定的独立审查委员会批准。提案应发送至 FMJGresnigt@olvg.nl。要获得访问权限，数据请求者需要签署数据访问协议。数据将与研究人员共享，其提议的数据使用已由为此目的确定的独立审查委员会批准。提案应发送至 FMJGresnigt@olvg.nl。要获得访问权限，数据请求者需要签署数据访问协议。

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Can emergency department clinicians diagnose gamma-hydroxybutyrate (GHB) intoxication based on clinical observations alone?

Objectives Gamma-hydroxybutyrate (GHB) is a drug of abuse with central depressing effects, which may cause coma with a GCS score as low as 3. A rapid diagnosis ‘GHB intoxication’ may prevent unnecessary diagnostic work-up and may lead to guided, less invasive, treatment. The aim of this study was to evaluate if ED physicians’ clinical evaluation were sufficient for diagnosis in patients with suspected GHB-intoxication. Methods Patients presenting at the ED with a GCS<15 and a potential intoxication with drugs of abuse for whom urine toxicology screen was performed were included consecutively. After a first assessment, the ED physician registered the most likely initial diagnosis in the hospital information system. Urine of these patients was tested with a validated gas chromatography analytical method for GHB (confirmation test). The initial diagnoses were compared for agreement with the results of the confirmation test. Results A total of 506 patients were included, 100 patients tested positive for GHB and 406 patients tested negative for GHB. Sensitivity and specificity of the ED physicians compared with the confirmation test to diagnose GHB intoxications were 63% (95% CI 52 to 73) and 93% (95% CI 90 to 95), respectively. The positive predictive value was 67% (95% CI 60 to 77) and the negative predictive value was 92% (95% CI 88 to 94). Conclusion Physicians underestimate the presence of GHB intoxication and can fail to diagnose GHB intoxication based on clinical observations alone. In the future, a rapid reliable initial analytical GHB test in addition to clinical judgement could be valuable to reduce false negative diagnosis. Data are available upon reasonable request. Individual participant data that underlie the results reported in this article will be available, after deidentification (text and tables). The data will be available for individual participant data meta-analysis beginning 9 months and ending 36 months following article publication. Data will be shared with investigators whose proposed use of the data has been approved by an independent review committee identified for this purpose. Proposals should be directed to F.M.J.Gresnigt@olvg.nl. To gain access, data requestors will need to sign a data access agreement.

更新日期：2021-06-22

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