Table 4.
Case criteria met for cases confirmed by three approaches, by site
| Case criteria classification scheme n (%) | Clinical impression n (%) | Encounter documentation n (%) | ||||
|---|---|---|---|---|---|---|
| Criteria | Site 1 (n=68) | Site 2 (n=86) | Site 1 (n=69) | Site 2 (n=81) | Site 1 (n=66) | Site 2 (n=71) |
| Major criteria category 1: Signs of respiratory depression | ||||||
| 1. Respiratory rate <10 or bradypnea or apnea | 24 (35.3) | 45 (52.3) | 22 (31.9) | 40 (49.4) | 22 (33.3) | 35 (49.3) |
| 2. Respiratory failure | 14 (20.6) | 20 (23.3) | 10 (14.5) | 17 (21.0) | 9 (13.6) | 14 (19.7) |
| At least one major criteria in category 1 | 30 (44.1) | 49 (57.0) | 25 (36.2) | 44 (54.3) | 24 (36.4) | 38 (53.5) |
| Major criteria category 2: Altered mental status | ||||||
| 1. Abnormal Glasgow coma score (<15) | 4 (5.9) | 58 (67.4) | 3 (4.4) | 48 (59.3) | 2 (3.0) | 44 (62.0) |
| 2. Unresponsive/unconscious | 29 (42.7) | 41 (47.7) | 27 (39.1) | 36 (44.4) | 26 (39.4) | 33 (46.5) |
| 3. Altered/sedated/confused/ somnolent/stupor | 60 (88.2) | 80 (93.0) | 51 (73.9) | 67 (82.7) | 49 (74.2) | 57 (80.3) |
| At least one major criteria in category 2 | 64 (94.1) | 82 (95.4) | 55 (79.7) | 69 (85.2) | 53 (80.3) | 59 (83.1) |
| Major criteria category 3: Opioid antagonist treatment receipt/response | ||||||
| 1. Naloxone given | 33 (48.5) | 60 (69.8) | 32 (46.4) | 55 (67.9) | 31 (47.0) | 48 (67.6) |
| 2. Responded to naloxone | 30 (44.1) | 50 (58.1) | 29 (42.0) | 48 (59.3) | 28 (42.4) | 42 (59.2) |
| 3. Required more than 1 dose of naloxone | 15 (22.1) | 20 (23.3) | 14 (20.3) | 20 (24.7) | 14 (21.2) | 19 (26.8) |
| 4. Required continuous naloxone | 8 (11.8) | 4 (4.7) | 8 (11.6) | 4 (4.9) | 8 (12.1) | 4 (5.6) |
| At least one major criteria in category 3 | 34 (50.0) | 62 (72.1) | 33 (47.8) | 57 (70.4) | 32 (48.5) | 49 (69.0) |
| No major criteria | 0 | 0 | 11 (15.9) | 8 (9.9) | 10 (15.2) | 8 (11.3) |
| Minor criteria | ||||||
| 1. Encounter documents indicate opioid overdose | 56 (82.4) | 67 (77.9) | 63 (91.3) | 72 (88.9) | 62 (93.9) | 63 (88.7) |
| 2. Witness or patient report | 49 (72.1) | 62 (72.1) | 52 (75.4) | 69 (85.2) | 52 (78.8) | 56 (78.9) |
| 3. Heroin/opioids/opioid pills/fentanyl patches around or on patient | 6 (8.8) | 13 (15.1) | 7 (10.1) | 15 (18.5) | 6 (9.1) | 13 (18.3) |
| 4. Toxicology positive for opioids | 24 (35.3) | 27 (31.4) | 27 (39.1) | 25 (30.9) | 26 (39.4) | 22 (31.0) |
| 5. Patient taking prescription opioids | 48 (70.6) | 27 (31.4) | 44 (63.8) | 23 (28.4) | 41 (62.1) | 20 (28.2) |
| 6. Patient known to use heroin or have history of heroin use disorder | 12 (17.7) | 55 (64.0) | 15 (21.7) | 56 (69.1) | 13 (19.7) | 49 (69.0) |
| 7. Patient is currently/recently in medication assisted treatment | 6 (8.8) | 8 (9.3) | 8 (11.6) | 8 (9.9) | 7 (10.6) | 7 (9.9) |
| 8. Needle / paraphernalia, fresh track marks / puncture wounds | 2 (2.9) | 25 (29.1) | 2 (2.9) | 27 (33.3) | 2 (3.0) | 23 (32.4) |
| 9. Miosis/Pinpoint pupils | 13 (19.1) | 49 (57.0) | 11 (15.9) | 45 (55.6) | 11 (16.7) | 41 (57.8) |
| At least one minor criteria | 67 (98.5) | 86 (100.0) | 69 (100.0) | 81 (100.0) | 66 (100.0) | 70 (98.6) |