Predictive Factors of Abnormal Brain CT Scan in Patients with Opioid Poisoning: A Single-Center Study

Opioid poisoning is a major cause of morbidity and mortality, particularly in Iran; however, no clear guidelines exist regarding the appropriate timing for non-contrast BCTS in these patients. This study aims to identify clinical and laboratory factors that predict abnormal BCTS findings in individuals with opioid poisoning. We conducted the study among patients presenting to the emergency department of Shiraz Namazi Hospital with opioid poisoning.

This retrospective cross-sectional study was performed on 208 patients with opioid poisoning who were referred to the emergency department of Namazi Hospital between March 2019 and March 2021. Data collection involved accessing the archives of Namazi Hospital to gather the necessary information for this study.

Among 208 patients with opioid poisoning who underwent brain CT, 57 (27.4%) exhibited abnormal BCTS findings within this selected subgroup. Multivariable logistic regression identified two independent predictive factors for abnormal BCTS: advanced age (OR 1.041 per year; 95% CI 1.01-1.07; P=0.008) and lower serum bicarbonate (OR 0.908 per mEq/L; 95% CI 0.83-0.99; P=0.025). The most prevalent abnormal findings included microvascular ischemic damage, followed by ischemic infarctions.

Advanced age and lower serum bicarbonate levels are independent predictors of abnormal BCTS findings in patients with acute opioid poisoning. Clinicians should consider urgent BCTS in older patients or those with metabolic acidosis, as these groups are at higher risk and may derive the greatest benefit from emergent neuroimaging.