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Official websites use. Share sensitive information only on official, secure websites. Understanding emergency department and healthcare utilisation related to acute recreational drug toxicity ARDT generally relies on nationally collated data based on ICD coding. The aim of this study was to investigate whether this is also the case elsewhere in Europe. There were presentations over the 6-month period. Two hundred thirteen Overall, only 8. While the majority of primary and secondary codes applied related to ARDT, often they did not identify the actual drug s involved. Keywords: Recreational drugs, Novel psychoactive substances, Acute toxicity, Clinical coding, Emergency department. Although ICD coding can generate representative data for routine surgical admissions to hospital and for general medical conditions for example, cancer and heart disease , previous UK studies have shown it is less robust at capturing recreational drug-related burden of health care utilisation \[ 2 , 3 \]. There are a number of reasons that potentially explain this. First, in many countries in Europe, ICD codes are usually only applied to patients admitted to hospital beyond the ED, based on local country coding mechanisms. Over three quarters of acute recreational drug toxicity ARDT patients are discharged directly from the ED, and since they are not admitted to hospital, they are not captured by the ICD coding system \[ 4 \]. Second, many established recreational drugs e. Similarly, the rapidly emerging number of new psychoactive substances NPS is also not codeable under existing ICD codes \[ 1 — 3 \]. Finally, national coding collation systems, such as HES, typically report on primary ICD diagnostic code, and even where codes do exist, the primary diagnostic code applied to an admission may reflect the condition caused by the recreational drug rather than the recreational drug used. For example, cocaine-related myocardial infarction may have a primary code of myocardial infarction with cocaine coded as a secondary or subsequent diagnostic code. Using only the primary ICD code will mean the recreational drug involvement will not be captured. However, there have been no studies to determine whether these issues are only representative of the UK, or whether this also occurs in other European healthcare systems. The development of the initial Euro-DEN project and the local approval processes have been previously described \[ 4 , 7 \]. Briefly, the initial Euro-DEN project and the subsequent Euro-DEN Plus projects collect the following data from routine medical notes of all patients presenting with acute recreational drug including NPS toxicity: patient demographics, drug s used, clinical features associated with the presentation and physiological observations on presentation, treatment s given, disposition from ED and overall survival to discharge , and length of stay \[ 4 , 7 , 8 \]. Each Euro-DEN Plus centre is responsible for ensuring all relevant cases are identified and entered into the project database. For each presentation, the reported drug s used were extracted. All of these hospitals are urban hospitals co-located with universities and act both as secondary care providers for their local residents and are tertiary referral centres for specialist care. The central hospital coding departments at participating hospitals were asked in the first quarter of whether any ICD codes had been applied to each presentation and what codes had been applied in order of coding primary, secondary and subsequent codes. The coding had been undertaken part of routine clinical care in each hospital at the time of the presentation. Those undertaking the coding were not aware of this future study. In addition, analysis was undertaken to determine whether ICD codes related to the drug category ies used defined as stimulants, cannabinoids, hallucinogens and depressants. Finally, sub-analysis comparing the concordance of drugs reported in the Euro-DEN Plus cases to the ICDcoded drugs was undertaken for the opioids, cannabinoids, cocaine, and mephedrone. Descriptive statistics, undertaken using Excel , were used to describe the proportion of cases in each group during any analysis. Of these presentations, Four hundred six Summary of coding and application of acute recreational drug-related ICD codes for all cases and by centre involved in the study. Of the coded presentations, One hundred fifty of the presentations The 63 presentations without a primary ARDT-related ICD code had 36 different primary ICD codes applied Table 2 ; the most commonly used codes related to: i alcohol 15 presentations , ii mental health 15 presentations and iii head injury 5 presentations. Of the 15 coded with an alcohol-related ICD code, all had recorded whether alcohol had either been used 13 A further 41 presentations 6. Of the ICDcoded presentations, only 18 8. This meant that a total of The accuracy of ICD coding and the detection of presentations by searching applied ICD codes for opioids, cannabinoids, cocaine and the NPS mephedrone is summarised below. Twenty-five presentations had a primary opioid toxicity-related ICD code F mental and behaviour disorders due to use of opioids or T Nineteen presentations had a primary cocaine toxicity-related ICD code F mental and behaviour disorders due to use of cocaine or T Seventeen presentations had a primary cannabinoid-related ICD code F mental and behaviour disorders due to use of cannabinoids or T Twenty-one mephedrone presentations were coded: 12 This study has demonstrated that the majority of primary and secondary codes applied related to acute recreational drug toxicity, but often they were not specific to the drug s used. The concordance of ICD coding with drugs used showed high specificity but low sensitivity: those presentations coded with a specific drug ICD code were likely to have taken that drug but the majority who had used the drug were not likely to be have the relevant ICD code applied. However, in Roskilde, Denmark, all of the presentations were coded as there is a requirement for all hospital presentations to be coded and reported to the National Register Landspatientregisteret. Use of ICD data in Denmark would potentially capture the burden of number of presentations; it would not allow true understanding of the burden for an individual drug, since the codes applied were not necessarily accurate for the drug s used. Further work is needed to understand whether other European countries utilise different methods for coding emergency presentations to see whether this variability in the capture of recreational drug presentations is replicated elsewhere. Of the presentations where a primary diagnostic code was recorded, only It is also interesting to note that the majority intent-related ICD codes applied related to accidental rather than intentional poisoning. It is unknown whether coders used accidental codes as individuals are unlikely to use them with an intent to overdose, even if there is intentional use of a substance that could be associated with the risk of acute toxicity when used. The main issue identified with this study is likely under detection of presentations through the utilisation of searching by ICD codes. There was high specificity to detect specific drugs, since when an ICD code was applied to a presentation, the majority of those presentations involved the use of that drug. However, there was low sensitivity since the majority of those who had actually used a specific drug did not have the relevant drug-specific ICD code applied to the presentation. Mephedrone was the most widely used and available NPS at the time of these Euro-DEN Plus presentations; since there is no ICD code for mephedrone, it is not possible to look at coded presentations to detect mephedrone use. However, when we look at the known mephedrone presentations, only around a third had an ICD code applied that related to the use of a stimulant recreational drug which would be the most appropriate for mephedrone in the absence of a specific ICD code. There have been no changes to the coding practice in the study centres since the cases used in this study, and therefore we would not expect there to have been any improvement in quality of local coding. However, following this study, the proposed ICD coding system was released on the 18th June \[ 9 \]. The proposed ICD coding system appears to have incorporated more coding categories related to the use of recreational drugs and novel psychoactive substances, including proposed specific codes for the synthetic cathinones, MDMA and related drugs and the synthetic cannabinoids. These changes may in part help with some of the coding issues that we have identified in this and previous studies, enabling better understanding of the burden of health care utilisation related to the use of a wider range of substances. However, despite the release of the proposed ICD coding system, the expectation is that this will be endorsed by the 72nd World Health Assembly in May and therefore it is unlikely to be used in routine coding reporting until onwards. However, the Euro-DEN Plus project has the advantage of collecting all cases presenting to each individual participating centre irrespective of whether they have been seen at the bedside by a medica or clinical toxicologist. A previous sub-group analysis of Euro-DEN Plus presentations with analytical confirmation of drugs used showed there was good correlation between self-reported use of drugs such as heroin, methadone, cocaine, and amphetamines \[ 22 \]. There was less correlation between cases of NPS-related toxicity, as NPS cannot be detected with the usual drug screening immunoassays, and some substances were not routinely screened for due to limited detection windows in biological matrices e. Currently, the main issue in understanding the burden of acute healthcare utilisation related to the use of recreational drugs and NPS is the lack of easily available locally, regionally, or nationally aggregate data on ED presentations. While there are plans to adapt the current ICD coding system \[ 9 \], further work to develop more automated and easily implementable systems would enable more rapid and complete capture on the acute health burdens associated with drugs and NPS. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. As a library, NLM provides access to scientific literature. J Med Toxicol. Find articles by David M Wood. Find articles by Luke De La Rue. Find articles by Ali A Hosin. Find articles by Gesche Jurgens. Find articles by Evangelia Liakoni. Find articles by Fritdjof Heyerdahl. Find articles by Knut Erik Hovda. Find articles by Alison Dines. Find articles by Isabelle Giraudon. Find articles by Matthias E Liechti. Find articles by Paul I Dargan. Open in a new tab. Primary ICD diagnostic codes not related to acute recreational drug toxicity. Basel London Roskilde Combined No. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel. Mental and behavioural disorders due to multiple drug use of other psychoactive substances. Poisoning by antiepileptic, sedative-hypnotic and antiparkinsonism drugs. Poisoning by diuretics and other and unspecified drugs, medicaments and biological substances. Poisoning: other and unspecified drugs, medicaments and biological substances. Accidental poisoning by and exposure to nonopioid analgesics, antipyretics and antirheumatics. Accidental poisoning by and exposure to antiepileptic, sedative-hypnotic, antiparkinsonism and psychotropic drugs, not elsewhere classified. Accidental poisoning by and exposure to narcotics and psychodysleptics hallucinogens , not elsewhere specified. Accidental poisoning by and exposure to other and unspecified drugs, medicaments and biological substances. Intentional self-poisoning by and exposure to antiepileptic, sedative-hypnotic, antiparkinsonism and psychotropic drugs, not elsewhere specified. Intentional self-poisoning by and exposure to narcotics and psychodysleptics hallucinogens , not elsewhere classified. Intentional self-poisoning by and exposure to other and unspecified drugs, medicaments and biological substances. Mental and behavioural disorders due to use of alcohol withdrawal state. Localization-related focal partial symptomatic epilepsy and epileptic syndromes with complex partial seizures. Other symptoms and signs involving emotional state suicidal ideation tendencies.

How can I buy cocaine online in Roskille