4. Deaths among acute drug toxicity presentations to the Euro-DEN Plus Network, 2014-2020
More than 5200 fatal overdoses are reported annually in Europe. Many have an history of previous episodes of acute toxicity (overdose). We aim to describe the characteristics of acute drug toxicity presentations to Emergency Departments (ED) in Europe between January 2014 and December 2020 and to identify factors associated with a fatal outcome.
Data for all presentations with acute drug toxicity were extracted from the Euro-DEN Plus database of 37 centres in 24 countries. Patient demographics, agents involved, treatment and outcomes are described. Factors associated with fatal outcomes, identified using a logistic regression model, will be discussed.
Out of 52976 presentations, 199 (0.4%), in 25 centres, had a fatal outcome. The proportion of deaths varied by centre, reaching 3.7% in Izmir (Turkey), 2.7% in Tallinn (Estonia) and more than 1% in 6 other centres. Presentations with fatal outcome involved older patients (median 36 (13-69) vs 31 (10-90) years, p < 0.001). They were more likely to involve heroin (21.6% vs 18.6%), cocaine (21.1% vs 20.7%), methadone (13.1% vs 3.4%), amphetamine (11.1 % vs 10.2%), MDMA (9.5% vs 8.1%), benzodiazepine not specified (8.5% vs 4.2%) and fentanyl (5.5% vs 0.4%). They were more likely to arrive by ambulance (94.9% vs 73.4%), to have required naloxone pre-hospital (19.6% vs 7.1%), flumazenil (4.0% vs 1.7%), and to be in coma on arrival (80.3% vs 9.3%).
This large series of fatal presentations to European EDs showed geographical variations across centres. It highlights the increased risk of fatal outcome associated with opioids and benzodiazepines in particular as well as some stimulants. Implications for responses will be discussed.