Incidence and Correlates of Cannabinoid-Related Psychiatric Emergency Care: A Retrospective, Multiyear Cohort Study
Bibliographic record
Abstract
ABSTRACTRésumé Background: In October 2018, Canada legalized recreational cannabis use. To date, only a few studies have reviewed shifts in emergency department (ED) utilization for cannabis-related psychiatric presentations. Aims: To describe the characteristics of patients seeking ED care for cannabis-related psychiatric presentations, and to identify demographic and clinical characteristics that were associated with psychiatric inpatient admission for such presentations. Methods: Retrospective cohort study with multivariate logistic regression. Findings: Over a 4-year period, 715 cannabis-related presentations were recorded (50% female, mean age 27.1 years). Time trend analysis showed a significant increase in the number of visits by fiscal year. The most common reason for ED presentation was harmful use of cannabis (60%). 8% of all visits required psychiatric admission; predictors of psychiatric admission were arrival by police (adjusted odds ratio [AOR] = 14.5; 95% confidence interval [CI] = 6.0–35.0), arrival by ambulance (AOR = 2.6; 95% CI = 1.4–4.9), and triage score (AOR = 0.4; 95% CI = 0.3–0.6). Length of stay, sex, age, and service provider (e.g., psychiatry, medicine, surgery) were not associated with disposition in the ED. Admissions was more likely for cannabis-induced psychosis or cannabis-related mental and behavioural disorders. Conclusion: EDs are serving increasing numbers of patients in psychiatric crisis related to cannabinoid-use before the legalization of recreational cannabis in Canada. A decision support tool could be developed and validated in the future to provide reliable, clinically relevant information to providers and case managers relevant to cannabis-related ED presentations. Contexte: En octobre 2018, le Canada a légalisé la consommation récréative de cannabis. À ce jour, seules quelques études ont examiné les changements dans l’utilisation des services d’urgence (DE) pour les présentations psychiatriques liées au cannabis. Objectifs: Décrire les caractéristiques des patients qui demandent des soins d’urgence pour des présentations psychiatriques liées au cannabis et identifier les caractéristiques démographiques et cliniques associées à l’admission en psychiatrie pour ces présentations. Méthodes: Étude de cohorte rétrospective avec régression logistique multi-variée. Résultats: Sur une période de quatre ans, 715 présentations liées au cannabis ont été enregistrées (50% de femmes, âge moyen 27,1 ans). L’analyse des tendances temporelles a montré une augmentation significative du nombre de visites par année fiscale. La raison la plus courante de la présentation à l’urgence était l’usage nocif du cannabis (60%). 8% de toutes les visites ont nécessité une admission psychiatrique; les signes prédictifs de l’admission en psychiatrie étaient l’arrivée de policiers (rapport de cotes ajusté [AOR] = 14,5; intervalle de confiance à 95% [IC] = 6,0–35,0), l’arrivée par ambulance (AOR = 2,6; IC à 95% = 1,4–4,9) et score de triage (AOR = 0,4; IC à 95% = 0,3–0,6). La durée du séjour, le sexe, l’âge et le fournisseur de services (p. Ex., Psychiatrie, médecine, chirurgie) n’étaient pas associés à la décision prise à l’urgence. Les admis étaient plus susceptibles de souffrir de psychose induite par le cannabis ou de troubles mentaux et comportementaux liés au cannabis. Conclusion: Les services d’urgence desservent un nombre croissant de patients en crise psychiatrique liés à l’utilisation de cannabinoïdes avant la légalisation du cannabis récréatif au Canada. Un outil d’aide à la décision pourrait être développé et validé à l’avenir afin de fournir des informations fiables et cliniquement pertinentes aux prestataires et aux gestionnaires de cas concernant les présentations au SU liées au cannabis.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".