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Fréquence et facteurs de risque des Smur de seconde intention dans les intoxications médicamenteuses volontaires

Rate and factors of secondary mobile intensive care unit dispatch following acute self-poisoning

  • Article Original / Original Article
  • Published:
Annales françaises de médecine d'urgence

Résumé

Objectif

Les intoxications médicamenteuses volontaires (IMV) sont une situation fréquente en régulation médicale et en Smur. Plusieurs études semblent indiquer que la régulation médicale des IMV n’est pas performante. Nos objectifs étaient d’étudier les Smur de seconde intention en tant que critère de qualité de la régulation et d’identifier les facteurs de risque de Smur de seconde intention.

Matériel et méthodes

Étude rétrospective, monocentrique, du 1er janvier 2008 au 31 décembre 2010. Les patients majeurs pris en charge en Smur pour IMV et admis dans un hôpital universitaire étaient inclus. Une analyse univariée puis une régression logistique multiple étaient planifiées pour comparer les données épidémiologiques et toxicologiques entre les patients bénéficiant de l’envoi immédiat ou secondaire d’une ambulance médicalisée.

Résultats

Trois cent douze patients étaient inclus dont 69 % de femmes. L’âge médian était de 45 [35; 53] ans. Le Smur était envoyé en première intention pour 131 patients (41 %). Les patients pris en charge secondairement par un Smur étaient plus souvent intubés (n = 67 [47 %] vs n = 111 [61 %], p = 0,001) et admis en réanimation (n = 87 [66 %] vs n = 147 [81 %], p = 0,001). Aucun critère épidémiologique ou toxicologique n’était un facteur de risque de Smur de seconde intention.

Conclusion

Le Smur est secondairement déclenché dans plus de la moitié des IMV et est associé à des mesures de réanimation plus fréquentes. Les décisions d’envoi du Smur en seconde intention ne sont pas expliquées par des critères épidémiologiques ou toxicologiques.

Abstract

Aim

Acute drug self-poisoning (DSP) is frequently encountered in emergency medical services. Previous studies seem to show that poisoning dispatch is not efficient. Our aim was to investigate secondary dispatch of mobile intensive care units (MICUs) as a criterion of quality and we also wanted to identify factors associated with secondary dispatch.

Procedure

We conducted a retrospective and monocentric study from 01 January 2008 to 31 December 2010.We included DSP patients who benefitted from a MICU dispatch.We compared epidemiological (age, gender, co-morbidities) and toxicological (drug class and supposed ingested dose) data between patients who were immediately treated by a MICU team and patients for whom a MICU was secondarily dispatched upon the request of first-responders. Variables significantly different between groups were then included in a multiple regression analysis.

Results

Three hundred and twelve DSP patients were included with 69% of women and a median age of 45 years [35; 53]. A MICU team was immediately dispatched for 131 patients (41%). Patients with a secondary MICU dispatch were more frequently intubated (N = 67 [47%] vs N = 111 [61%], P = 0.001) and admitted to an intensive care unit (N = 87 [66%] vs N = 147 [81%], P = 0.001). Epidemiological and toxicological data were not different between groups.

Conclusion

A MICU is secondarily dispatched in more than 60% of severe DSP cases. Secondary dispatch is associated with an increased risk of intensive treatment. Toxicological and epidemiological data do not explain secondary dispatch.

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Authors and Affiliations

  1. Pôle urgences Samu-Smur, CHU Michallon, CS 10217, F-38043, Grenoble cedex 09, France

    A. Richard, G. Debaty, P. Pommier, F. -X. Koch, R. Briot, F. Loizzo, F. Carpentier, V. Danel & M. Maignan

  2. UJF-Grenoble-I/CNR/TIMC-IMAG UMR 5525/PRETA Team, F-38041, Grenoble, France

    G. Debaty, R. Briot & M. Maignan

Authors
  1. A. Richard
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  2. G. Debaty
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  4. F. -X. Koch
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  8. V. Danel
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  9. M. Maignan
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Correspondence to M. Maignan.

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Richard, A., Debaty, G., Pommier, P. et al. Fréquence et facteurs de risque des Smur de seconde intention dans les intoxications médicamenteuses volontaires. Ann. Fr. Med. Urgence 4, 23–28 (2014). https://doi.org/10.1007/s13341-013-0388-9

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  • DOI: https://doi.org/10.1007/s13341-013-0388-9

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