■镇静剂过量的患者在被认为是医学上批准出院时可能会有残留的认知障碍。减值可能会影响高风险活动的绩效,包括开车。TrailMakingTest是一种字母数字评估,可以在床边进行评估认知功能。我们检查了镇静和非镇静药物过量的患者在医学上清除后的认知功能是否存在差异。
■预期,观察性研究使用2018年至2021年的TrailMakingTest评估了认知功能。如果患者(16岁及以上)会说英语并且以前没有神经系统损伤,则在医疗许可后完成测试。使用t检验或Mann-WhitneyU检验和多元线性回归比较连续协变量;使用逻辑回归对二元变量进行建模。
■在入组的171名患者中,111(65%)服用镇静剂过量;他们年龄较大(中位数为32.1岁和22.2岁),男性的可能性更大(58.6%和36.7%)。苯二氮卓类药物和对乙酰氨基酚是最常见的药物过量。镇静剂过量的患者在示踪测试部分A中表现较差(37.0对33.1秒,P=0.017)和跟踪测试部分B(112.4对81.5秒,P=0.004)。多元线性回归分析表明,患者年龄(P<0.001,每年慢1.7秒,95%置信区间:0.9-2.6秒)和感知恢复(P=0.006,如果感知未恢复则慢36.4秒,95%的置信区间:10.8-62.0秒)也与TrailMakingTestB部分时间相关。镇静剂过量的患者更有可能进入重症监护病房(赔率:4.9,95%置信区间:1.1-22.0;P=0.04)。
■我们的结果与以前发表的工作大致一致,但包括更广泛的药物过量情况(多重用药和娱乐性药物)。虽然患者对他们的认知障碍表现出一些感知,我们的模型不能可靠地用于提供个人出院建议.研究设计不允许我们证明认知障碍的因果关系,或将过量用药的强度与测试时间进行比较。
■跟踪测试结果表明,服用镇静剂药物过量的患者即使在医学上清除后也可能存在明显的认知缺陷。通过建议可以将伤害风险降至最低,以避免驾驶等高风险活动。在TrailMakingTestB部分中看到的影响比A部分更深远,这可能意味着高阶思维比简单的认知功能受到的影响更大。
UNASSIGNED: Patients with sedative overdose may have residual cognitive impairment at the time they are deemed medically cleared for discharge. Impairment could affect the performance of high-risk activities, including driving. The Trail Making Test is an alpha-numeric assessment that can be performed at the bedside to assess cognitive function. We examined whether there were differences in cognitive function when medically cleared between patients that overdosed on sedative and non-sedative drugs.
UNASSIGNED: A prospective, observational study assessed cognitive function using the Trail Making Test between 2018 and 2021. Patients (16 years and greater) completed testing upon medical clearance if they spoke English and had no previous neurological injury. Continuous covariates were compared using t-tests or Mann-Whitney U tests and multiple linear regression; binary variables were modelled using logistic regression.
UNASSIGNED: Of 171 patients enrolled, 111 (65 per cent) had sedative overdose; they were older (median 32.1 versus 22.2 years) and more likely to be male (58.6 per cent versus 36.7 per cent). Benzodiazepines and paracetamol were the commonest drug overdoses. Patients with sedative overdose performed worse on Trail Making Test part A (37.0 versus 33.1 seconds, P = 0.017) and Trail Making Test part B (112.4 versus 81.5 seconds, P = 0.004). Multiple linear regression analysis indicated that patient age (P < 0.001, 1.7 seconds slower per year, 95 per cent confidence interval: 0.9-2.6 seconds) and perception of recovery (P = 0.006, 36.4 seconds slower if perceived not recovered, 95 per cent confidence interval: 10.8-62.0 seconds) were also associated with Trail Making Test part B times. Patients with sedative overdose were more likely to be admitted to the intensive care unit (Odds Ratio: 4.9, 95 percent confidence interval: 1.1-22.0; P = 0.04).
UNASSIGNED: Our results are broadly in keeping with previously published work, but include a wider range of drug overdose scenarios (polypharmacy and recreational drugs). While patients demonstrated some perception of their cognitive impairment, our model could not reliably be used to provide individual discharge advice. The study design did not allow us to prove causation of cognitive impairment, or to make comparison between the strength of an overdose to the trail making test time.
UNASSIGNED: Trail Making Test results suggested that patients who had sedative drug overdoses may have significant cognitive deficits even when medically cleared. Risk of harm may be minimised with advice to avoid high-risk activities such as driving. More profound impacts seen on the Trail Making Test part B than A may mean higher-order thinking is more affected than simple cognitive function.