Trends in a decade of drug abuse presentation to an inner city ED

Temporal factors on the periodic presentations has been described for many diseased states (ie, asthma, seizures, coronary attacks). We now report an analysis of factors that could affect the periodic character regarding emergency department (ED) presentation of drugs of abuse. All drugs presentations consistent with the Drug Abuse Warning Network (DAWN) reporting program from January 1988 through December 1997 were categorized. Data collection was based on daily chart review of ED medical records from Rush-Presbyterian-St. Luke's Hospital (Chicago, IL). Data were computer analyzed using SPSS and Pharmfit programs and analyzed for time, age, disposition, sex, and reasons for presentation and taking the drugs. During the above period, the Rush ED saw 369,770 patients of which 2,561 (0.7%) presented with a drug-related problem. The average age of men was 33. 7 + 0.29 and women 30.5 + 0.37 years. One hundred thirty-nine patients (5.4%) were under 17 years of age whereas only 72 patients (2.8%) were over 55 years of age. Cocaine was the most common drug presentation with a total of 859 visits. Seven hundred sixty-one (29. 7%) presented with an unexpected reaction, 754 (29.4%) experienced an over dosage, 135 (5.3%) had a drug withdrawal, 546 (21.3%) experienced chronic effects, 1,380 (53.9%) were drug dependent, 218 (8.5%) were suicide attempts, and the remaining 2.7% were unknown. There were 1,078 (42.2%) patients who were treated and released, 1, 394 (54.6%) who were admitted into the hospital, 74 (2.9%) left against medical advice whereas 9 patients (0.4%) died. Peak time for presentation was 5:03 PM (P =.00002). Suicide intent presentations were more likely to be women (P <.0001), older (P <.001), and present at a later time that of recreational drug use (acrophase 18:49 versus 16:39; P =.00011). Almost 90% of patients presenting to our urban ED over past 10 years with drug-related problems arrive because of drug abuse or dependency issues. ED staff should be most prepared to deal with these issues in the late afternoon.