Home > Epidemiology, clinical features and management of patients presenting to European emergency departments with acute cocaine toxicity: comparison between powder cocaine and crack cocaine cases.

Miró, Òscar and Dargan, Paul I and Wood, David M and Dines, Alison M and Yates, Christopher and Heyerdahl, Fridtjof and Hovda, Knut Erik and Giraudon, Isabelle and Galicia, Miguel (2019) Epidemiology, clinical features and management of patients presenting to European emergency departments with acute cocaine toxicity: comparison between powder cocaine and crack cocaine cases. Clinical Toxicology , 578 , (8) , pp. 718-726.

OBJECTIVE
To analyse the epidemiology, clinical picture and emergency department (ED) management of a large series of patients who presented to European EDs after cocaine consumption, comparing data from powder (C group) and crack (C group) consumers.

METHODS
Between October 2013 and December 2016, the Euro-DEN Plus Registry recorded 17,371 consecutive acute recreational drug toxicity presentations to 22 EDs in 14 European countries. Epidemiological and demographic data, co-ingestion of alcohol and other drugs, clinical features, ED management and outcome (death) were analysed for cocaine cases, and comparison of clinical picture in C and C patients were performed adjusting for alcohol and other drug co-ingestion.

RESULTS
We included 3002 cases (C: 2600; C: 376; mixed consumption: 26): mean age 32(9) years, 23% female. The proportion of presentations involving cocaine varied significantly between countries (>30% in Malta, Spain, France, Denmark) and only centres in France, United Kingdom, Poland, Ireland and Malta recorded crack-related cases. Cocaine was frequently used with ethanol (74.3%, C>C) and other drugs (56.8%, C>C), the most frequent amphetamine (19.4%, C>C) and opioids (18.9%, C>C). C patients were more likely to have clinically significant episodes of hypotension (adjusted OR = 2.35; 95%CI = 1.42-3.89), and bradypnea (1.81; 1.03-3.16) and systolic blood pressure >180 mmHg on ED arrival (2.59; 1.28-5.25); while less likely anxiety (0.51; 0.38-0.70), chest pain (0.47; 0.31-0.70), palpitations (0.57; 0.38-0.84), vomiting (0.54; 0.32-0.90), and tachycardia on ED arrival (0.52; 0.39-0.67). Sedative drugs were given in 29.3%. The median length of hospital stay was 4:02 h, 22.1% patients were hospitalized, and 0.4% (n = 12) died.

CONCLUSION
Cocaine is commonly involved in European ED presentations with acute recreational drug toxicity, but there is variation across Europe not just in the involvement of cocaine but in the proportion related to powder versus crack. Some differences in clinical picture and ED management exist between powder cocaine and crack consumers.


Item Type:Article
Date:2019
Page Range:pp. 718-726
Publisher:Taylor & Francis
Volume:578
Number:8
EndNote:View
Related URLs:
Subjects:B Substances > Cocaine
B Substances > Cocaine > Crack cocaine
E Concepts in biomedical areas > Pharmacology and toxicology
J Health care, prevention and rehabilitation > Health care programme or facility > Hospital
VA Geographic area > Europe
VA Geographic area > Europe > Ireland

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