Background and importance Drug-induced somnolence is an important cause of emergency department (ED) visits in frailty patients.
Aim and objectives To describe the drugs involved in ED visits due to drug-induced somnolence in frailty patients and to evaluate the risk factors involved in ED revisits 30 days after discharge.
Material and methods Retrospective observational study. Patients admitted to the frailty area of an ED who consulted for drug-induced somnolence were included (October 2020–March 2021). Patients admitted due to suicide attempts were excluded.
To evaluate the risk factors associated with 30-day revisits, a multivariate analysis was performed using logistic regression, including in the model those variables related to the comorbidities, destiny at discharge, polypharmacy (>9 drugs), treatment modification and number of central nervous system (CNS) depressant drugs prescribed at discharge with a p value <0.2 in a previous univariate analysis.
Results 80 patients were included (mean age 80.1 (SD 13.1) years). Median number of drugs at admission was 9 (range 3–20), being the median of chronic pathologies 6 (range 1–12). Of these patients, 35 (43.7%) had dementia, and a moderate-severe dependence was found in 32 (40.0%).
Median number of CNS depressant drugs on admission was 3 (range: 1–6). Antidepressants (63.7% of patients), benzodiazepines (58.6%), antipsychotics (47.5%) and opioids (45.0%) were the drugs most frequently prescribed on admission. The combination of benzodiazepines and opioids was present in 20 (25.0%) patients. At hospital discharge, CNS depressant drugs prescriptions were modified in 44 (55.0%) patients.
Eighteen (25.0%) patients revisited the ED 30 days after discharge, 16 (22.2%) of them due to episodes related to the use of CNS depressant drugs. The presence of chronic kidney disease, dementia, and more than three CNS depressant drugs at discharge were included in the multivariate analysis (p<0.2), observing a trend towards a higher risk of revisits in patients with chronic kidney disease (OR (95% CI): 2.87 (0.80 to 7.27)), without reaching a statistically significant association.
Conclusion and relevance Frailty patients who visit the ED due to drug-induced somnolence frequently have multiple contributing drugs. Nearly 25% of patients revisited the ED 30 days after discharge, most of them due to new episodes related to these drugs. Chronic renal failure may be associated with an increased risk of 30-day revisits.
Conflict of interest No conflict of interest
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