Early discharge of patients with presumed opioid overdose: development of a clinical prediction rule

Acad Emerg Med. 2000 Oct;7(10):1110-8. doi: 10.1111/j.1553-2712.2000.tb01260.x.


Objective: To develop a clinical prediction rule to identify patients who can be safely discharged one hour after the administration of naloxone for presumed opioid overdose.

Methods: Patients who received naloxone for known or presumed opioid overdose were formally evaluated one hour later for multiple potential predictor variables. Patients were classified into two groups: those with adverse events within 24 hours and those without. Using classification and regression tree methodology, a decision rule was developed to predict safe discharge.

Results: Clinical findings from 573 patients allowed us to develop a clinical prediction rule with a sensitivity of 99% (95% CI = 96% to 100%) and a specificity of 40% (95% CI = 36% to 45%). Patients with presumed opioid overdose can be safely discharged one hour after naloxone administration if they: 1) can mobilize as usual; 2) have oxygen saturation on room air of >92%; 3) have a respiratory rate >10 breaths/min and <20 breaths/min; 4) have a temperature of >35.0 degrees C and <37.5 degrees C; 5) have a heart rate >50 beats/min and <100 beats/min; and 6) have a Glasgow Coma Scale score of 15.

Conclusions: This prediction rule for safe early discharge of patients with presumed opioid overdose performs well in this derivation set but requires validation followed by confirmation of safe implementation.

Publication types

  • Clinical Trial

MeSH terms

  • Adult
  • Analysis of Variance
  • British Columbia
  • Cohort Studies
  • Drug Administration Schedule
  • Drug Overdose / diagnosis
  • Drug Overdose / drug therapy
  • Emergency Medicine / methods*
  • Emergency Service, Hospital
  • Female
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Naloxone / administration & dosage*
  • Narcotics / poisoning*
  • Opioid-Related Disorders / diagnosis*
  • Opioid-Related Disorders / drug therapy*
  • Opioid-Related Disorders / mortality
  • Patient Discharge*
  • Predictive Value of Tests
  • Prognosis
  • Prospective Studies
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Severity of Illness Index
  • Survival Rate


  • Narcotics
  • Naloxone