Trending gabapentin exposures in Kentucky after legislation requiring use of the state prescription drug monitoring program for all opioid prescriptions.

OBJECTIVE: Gabapentin is a gamma-aminobutyric acid (GABA) analog approved by the Food and Drug Administration (FDA) for partial seizures and post-herpetic neuralgia. Due to its wide therapeutic window and minimal adverse effects, it is frequently prescribed for additional off-label uses. The purpose of this study was to characterize the number, exposure reason, medical outcomes, and disposition of gabapentin exposures reported to one regional poison control center (PCC). METHODS: A retrospective cross-sectional review of exposures reported to one regional PCC was performed from January 1, 2012 to December 31, 2015. The primary outcomes were the number of gabapentin-only exposures and multi-agent exposures including gabapentin reported. Exposure reason, medical outcome, and disposition were identified for each exposure. RESULTS: There were 424 gabapentin-only exposures during the study period. The number of exposures increased each year, from 39 in 2012 to 160 in 2015. There were 1321 multi-agent exposures that included gabapentin. These exposures increased from 165 in 2012 to 440 in 2015. Comparatively, total human exposures reported to the regional PCC decreased during the study period. The majority of gabapentin-only and multi-agent exposures was intentional versus unintentional. Nine patients (2%) had a major medical outcome and three patients (1%) died in the gabapentin-only group. Comparatively, 76 patients (6%) had a major medical outcome and 12 patients (1%) died in the multi-agent group. Almost half of the multi-agent exposures required admission to the intensive care unit (ICU). CONCLUSIONS: Both gabapentin-only and multi-agent exposures increased significantly from 2012 to 2015, with the majority of cases intentional ingestion, specifically suspected suicide. The increased number of gabapentin exposures coincided with Kentucky's implementation of prescription opioid reform legislation. Providers are encouraged to call their local PCC, regardless of exposure type, to effectively monitor and evaluate exposure trends.

Reasons prehospital personnel do not administer aspirin to all patients complaining of chest pain.

INTRODUCTION: Aspirin is administered to patients with acute coronary syndromes (ACSs), but prehospital providers do not administer aspirin to all patients with chest pain that could be secondary to an ACS. OBJECTIVE: To identify reasons prehospital providers fail to administer aspirin to all patients complaining of chest pain. METHODS: A convenience sample of prehospital providers was surveyed as they transported patients with a chief complaint of chest pain to the emergency department. The providers were asked if they had given aspirin, nitroglycerin, or oxygen, or if they utilized a monitor. If the medications had not been administered, the paramedic was asked about the reason. The patient's age and previous cardiac history also was recorded. RESULTS: A total of 52 patients with chest pain who were transported were identified over eight weeks, and all of the providers agreed to participate in the study. Only 13 of the patients (25%) received aspirin. Reasons given for not administering aspirin to the other 39 patients included: (1) chest pain was not felt to be cardiac in 13 patients (33%); (2) 10 patients already had taken aspirin that day (26%); (3) the medical provider was a basic-level emergency medical technician (EMT)-Basic and could not administer aspirin to six patients (15%); (4) pain subsided prior to arrival of emergency medical services (EMS) in these three patients; and (5) other reasons were provided for the remaining seven patients. CONCLUSIONS: The most common reason that paramedics did not administer aspirin was the paramedic's belief that the chest pain was not of a cardiac nature. Another common reason for not giving aspirin was the inability of EMT-Basic providers to administer aspirin.

Prehospital provider prediction of emergency department disposition: implications for selective diversion.

OBJECTIVE: To determine whether emergency medical services (EMS) personnel can use selective diversion and accurately predict those patients being transported who are unlikely to need a critical care bed and those patients unlikely to require admission to the hospital. METHODS: This was a prospective study of patients being transported by the local EMS service. The EMS providers were asked to predict disposition of the patient. Emergency department (ED) personnel were asked to indicate on the study sheet the actual disposition of the patient. RESULTS: A total of 411 patient transports were entered into the study. The EMS providers predicted that 246 (59.9%) would be discharged to home, 96 (23.3%) would be admitted to a floor bed, and 69 (16.8%) would be admitted to a critical care bed (CCB). The actual dispositions of the patients were: 253 (61.6%) discharged to home, 99 (24.1%) admitted to a floor bed, and 59 (9.9%) admitted to a CCB. The EMS providers performed well at predicting those patients who would not need a CCB: negative predictive value 96.2% (95% confidence interval [CI]) (93.4-97.9). They also correctly identified most patients who were discharged to home: 209 of 253, 85% (95% CI is equal to 79.7-89.1%). CONCLUSIONS: EMS providers appear to be capable of using selective diversion categories. EMS providers correctly identified most patients who will not require a critical care bed. The EMS providers also correctly identified most patients who will be discharged from the ED after treatment.