Predicting Adverse Cardiovascular Events in Emergencies Due to Drug Overdose

预测因药物过量导致的紧急情况下的不良心血管事件

基本信息

批准号：
7809615
负责人：
Alex Francis Manini
金额：
$ 17.63万
依托单位：
ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-05-01 至 2014-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7809615
关键词：
Accident and Emergency department Acute Acute Physiology and Chronic Health Evaluation Address Admission activity Adverse event Affect Age-Years Annual Reports Antidepressive Agents Antipsychotic Agents Biological Markers Blinded Buprenorphine Cardiac Cardiology Cardiovascular system Cessation of life Characteristics Chest Pain Clinical Clinical Data Coma Complication Consensus Data Data Element Databases Demographic Aging Diagnostic tests Drug Prescriptions Drug abuse Economics Electrocardiogram Electrocardiographic Finding Emergency Care Emergency Situation Enrollment Epidemiology Ethnic Origin Evaluation Event Future Gender Guidelines Heart Arrest Hospitals Incidence Infarction Information Systems Injury International Ischemia Literature Mentored Patient-Oriented Research Career Development Award Mentors Mentorship Methamphetamine Morbidity - disease rate Myocardial New York City Opioid Overdose Patients Pharmaceutical Preparations Physical Examination Poison Poison Control Centers Poisoning Principal Investigator Prospective Studies Public Health Schools Race Recording of previous events Reporting Research Research Personnel Risk Risk Factors Scientist Seizures Sensitivity and Specificity Serum Severities Shock Stratification Subgroup Sympathomimetics Symptoms System Teaching Hospitals Testing Therapeutic Time Toxicology Training Activity Training Programs United States Ventricular Visit addiction adjudicate adjudication base clinical decision-making cohort demographics improved innovation medical schools meetings mortality novel prescription drug abuse prevent prognostic indicator prospective public health relevance socioeconomics statistics suicidal symposium tool

项目摘要

DESCRIPTION (provided by applicant): The purpose of this mentored patient-oriented research career development award (K23) is to assist Alex Manini, MD to become an independent research scientist in drug overdose emergencies. Guided by Dr. David Vlahov (mentor), he will collaborate with accomplished investigators to study adverse cardiovascular events (ACVE) in drug overdose, building upon exciting preliminary data. Training activities include courses in statistics and epidemiology at the Columbia Mailman School of Public Health; the Addiction Training program at Mount Sinai School of Medicine; focused mentorship in drug overdose, epidemiology, and cardiology; and presentation of interim results at regional, national, and international conferences. Proposed is a prognostic indicator study of emergency department patients with drug overdose to evaluate occurrence of in-hospital ACVE. Based on preliminary data, the hypothesis is that clinical risk factors (e.g., demographics, exposure intent, electrocardiogram) will independently predict in-hospital ACVE. The specific aims are: (1) to determine the incidence of ACVE in patients with drug overdose; (2) to identify prognostic indicators for in-hospital ACVE in patients with drug overdose; and (3) to derive a simple risk stratification scoring system based on the above prognostic indicators for ACVE and to test the diagnostic characteristics of the risk score to aid clinical decision-making for patients with acute drug overdose. To meet these aims, emergency department patients with drug overdose at two urban teaching hospitals will be prospectively enrolled and followed longitudinally for occurrence of in-hospital ACVE. Overdose severity will be assessed with Poison Severity Scores, Acute Physiology and Chronic Health Evaluation, and adjudicated ACVE endpoints. Interpretation of the admission electrocardiogram will be performed by a blinded cardiologist, and serum will be evaluated for toxicology screens and cardiac biomarkers. Prognostic indicators for ACVE will be derived and incorporated into a simple risk score with a cutpoint chosen to achieve optimal diagnostic test characteristics. Implementation of this risk stratification tool has the potential to prevent AGVE complications for an estimated 1.5 million drug-related emergency department visits in the U.S. annually. PUBLIC HEALTH RELEVANCE: Drug overdose and prescription drug abuse affect diverse demographics, races/ethnicities, and economic classes. Poisoning is the second leading cause of injury-related fatality in the U.S., and the leading cause of cardiac arrest in victims under 40 years of age. There are 2.4 million reported poison exposures and approximately 1.5 million drug-related emergencies in the U.S. annually.

描述（由申请人提供）：这项受过指导的以患者为导向的研究职业发展奖（K23）的目的是协助医学博士Alex Manini，成为药物过量紧急情况的独立研究科学家。在戴维·弗拉霍夫（David Vlahov）博士（导师）的指导下，他将与成熟的研究人员合作研究药物过量的不良心血管事件（ACVE），基于令人兴奋的初步数据。培训活动包括哥伦比亚邮政公共卫生学院的统计和流行病学课程；西奈山医学院的成瘾培训计划；专注于药物过量，流行病学和心脏病学的指导；以及在地区，国家和国际会议上的临时结果。提议的是对药物过量患者的预后指标研究，以评估院内囊泡的发生。基于初步数据，假设是临床危险因素（例如人口统计学，暴露意图，心电图）将独立预测院内障碍。具体目的是：（1）确定药物过量患者的ACVE的发生率；（2）确定药物过量患者院内囊泡的预后指标；（3）基于上述ACVE的预后指标得出一个简单的风险分层评分系统，并测试风险评分的诊断特征，以帮助急性药物过量患者的临床决策。为了满足这些目标，将有前瞻性地入学，在两家城市教学医院服用药物过量的急诊科患者，并纵向遵循发生院内障碍。过量的严重程度将通过毒药的严重程度评分，急性生理和慢性健康评估以及裁定的ACVE终点评估。盲人心脏病专家将对入院心电图进行解释，并将评估血清毒理学筛查和心脏生物标志物。 ACVE的预后指标将被得出并纳入简单的风险评分中，并选择一个可获得最佳诊断测试特征的切割点。该风险分层工具的实施有可能预防估计每年在美国进行150万次与药物有关的急诊科访问的agve并发症。公共卫生相关性：药物过量和处方药滥用会影响各种人口统计学，种族/种族和经济阶层。中毒是美国与受伤有关的第二大原因，也是40岁以下受害者心脏骤停的主要原因。每年在美国，有240万次毒药暴露和约150万与药物有关的紧急情况。