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ER Radiologists Can Help Identify, Educate Patients with Opioid Addictions

ER Radiologists Can Help Identify, Educate Patients with Opioid Addictions

Emergency radiologists see a high prevalence of patients with opioid-use disorders and are well-placed to educate patients about drug use and steer them towards hospital and community resources, according to a study presented at RSNA. 

Researchers from the United States performed a retrospective study to assess the prevalence and type of intravenous substance use disorders (IV-SUDs) imaging complications, mortality rate, and history of opioid prescriptions (OP) among patients who presented to the emergency department.

“We’ve seen a dramatic increase in the past year of patients coming into the Emergency Department with complications related to substance use disorders,” senior study author Efren J. Flores, MD, an emergency radiologist at Massachusetts General Hospital in Boston said in a release. “The patient population is underserved. By the time we see them, they have more advanced complications because they’re hesitant to ask for help due to social stigmas.”

The study included 1,031 patients (mean age 36); researchers recorded demographics, clinical symptoms, imaging diagnosis, history of OP, and dates of death. Sixty-five percent of the patients were male and 78% were white. The exams were categorized by imaging diagnosis, modality, and specialty.

There were 1,673 exams performed: 779 X-rays, 544 CT, 292 MRI, and 58 US, for one to 13 exams per patient, accounting for 0.2% (1,673/854,299) of all ER studies in the same period. A total of 52% of patients had one or more studies with IV-SUDs complications. The rates of positive imaging per imaging specialty were:

• GI 77% (113/146)

• MSK 52% (419/802)

• Vascular 48% (77/162)

• Neuro 47% (97/206)

• Chest 25% (90/356)

The most frequent clinical symptoms were:

• Local complications of injections (27%, 450/1673)

• Respiratory (15%, 251/1673)

• Back pain (13.4%, 224/1673)

A history of OP before the first imaging was present in 30% (310/1031) of cases (mean of 10 prescriptions per patient), significantly more often in women (37%, 128/348), than men (27%, 182/673).

The mean time from OP to first imaging was 51 months and this was significantly shorter among men (45 months) compared with women (51 months). Overall death was recorded in 11.7% (121/1031) of patients, and was significantly higher in patients with positive imaging diagnosis of IV-SUDs complications (14%, 73/534) than in those without (10%, 48/449).

In addition, the five-year mortality rates were higher among patients with prior OP at 9% (29/310) while only 7% overall (73/1031) and 6% (44/721) among patients without. It was also higher in patients with imaging complications (6%, 33/534) than in those without (4%, 21/427).

The researchers concluded there is a high prevalence of multisystem IV-SUDs imaging complications among patients presenting to the ER and radiologists can play a role in recognizing this and helping patients towards recovery. “Radiology is central to patient care in the Emergency Department setting,” Flores said in the release. “We need to be actively advocating for these patients and giving them an opportunity to take steps into recovery.”

37-year-old man with history of broken needle proximal to the right elbow while injecting heroin. Anterior-posterior X-ray view of the right humerus shows three linear hyperdensities in the soft tissues of the arm (arrows). ©RSNA 2017

 
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