176 Multicenter assessment of the revisit risk for a further drug-related problem in the emergency department in cocaine users (MARRIED-cocaine study) MIGUEL GALICIA 1,2 , SANTIAGO NOGUÉ 2,3 , XAVIER CASAÑAS 4 , Mª LUISA IGLESIAS 4 , JORDI PUIGURIGUER 5 , AUGUST SUPERVÍA 6 , ALFONS AGUIRRE 6 , CARLOS CLEMENTE 6 , ISABEL PUENTE 6 , JOSE LUIS ECHARTE 6 , CARMEN GARCÍA-PÉREZ 7 , GUILLERMO BURILLO-PUTZE 7 , ARANCHA BERNAL 8 , PABLO BUSCA 8 , EVA GIL 9 , and ÒSCAR MIRÓ 1,2 1 Emergency Department, Hospital Clìnic, Barcelona, Spain 2 Emergency Medicine Investigation Group: Emergency Care: processes and diseases. IDIBAPS, Barcelona, Spain 3 Clinical Toxicology Unit, Hospital Clínic, Barcelona, Spain 4 Emergency Department, Hospital Parc Tauli, Sabadell, Spain 5 Emergency Department and Toxicology Unit, Hospital Son Espases, Palma de Mallorca, Spain 6 Emergency Department, Parc de Salut del Mar, Barcelona, Spain 7 Emergency Department, Hospital Universitario de Canarias, Tenerife, Spain 8 Emergency Department, Hospital Donostia, San Sebastian, Spain 9 Uniied Laboratory, Hospital Donostia, San Sebastian, Spain Introduction and objectives. Emergency departments (EDs) in Spanish hospitals daily attend a large number of patients for adverse reactions or clinical complications resulting from cocaine use. After discharge, some of these patients revisit the ED for the same reason within a year. The objective of the present study was to quantify the rate of such revisits and identify the factors associated with them. Method. We performed a retrospective, multicenter study with cohort follow-up and without a control group, conducted in the EDs of six Spanish hospitals during 12 months (January–December 2009). We included all ED patients attended for cocaine-related symptoms who reported recent cocaine use and those with cocaine-positive urine analysis by immunoassay without declared consumption. Twelve independent variables assessed for each hospital ED were collected: sex, age, place of consumption, month, day, and time of consumption, mode of arrival at the ED, discharge diagnosis, psychiatric assessment on the ED episode, concomitant drugs, destination on discharge, and history of previous ED visits related with drug use and alcohol use. The dependent variable was a subsequent visit to the ED associated with drug use, identiied using the computerized hospital admissions system. Results. The study included 807 patients, of whom 6.7% revisited the ED within 30 days, 11.9% within 3 months and 18.9% within 1 year. The variables signiicantly associated with ED revisits were: presence of clinical manifestations directly related to cocaine (p  0.05), ED attendance on a working day (p  0.05), history of ED visits related with the consumption of alcohol (p  0.001) or drugs (p  0.001), and the need for urgent consultation with a psychiatrist (p  0.001), although only the last four were independent predictors in multivariate analysis. We derived a score based on these variables to predict risk of revisits (MARRIED-score, ranging from 0 to 400 points), which had a reasonably good predictive value for revisit (area under ROC of 0.75; 95% CI 0.71–0.79). Keywords Cocaine, Emergency department revisiting, Street drugs Introduction Cocaine is currently the second most commonly used illicit drug in Europe after cannabis, where an estimated 14 mil- lion people have taken cocaine at least once. By age groups, an estimated 4.1% of the population aged 15–64 years and 5.9% of young adults (15–34 years) have tried cocaine. Spain tops the list of European countries with the highest number of cocaine users per capita. An estimated 11.8% of Spanish youth (15–34 years) have taken it at least once in their lifetime. 1 Of all illicit drugs, cocaine is also associ- ated with the greatest number of visits to the emergency department (ED). According to different series, cocaine use is involved in 28.6–66% of ED visits generated by illicit drug use. 2,3 The acute effects of cocaine are varied and well known; they include behavioral disorder, cardiovascular, neurologi- cal, and other organ system manifestations that have been extensively described in the literature and sometimes are severe enough to generate a visit to the ED. 4–10 The clinical Clinical Toxicology (2012), 50, 176–182 Copyright © 2012 Informa Healthcare USA, Inc. ISSN: 1556-3650 print / 1556-9519 online DOI: 10.3109/15563650.2012.658917 RESEARCH ARTICLE Received 23 October 2011; accepted 15 January 2012. Address correspondence to Dr. Oscar Miró, Emergency Department, Hospital Clinic, Barcelona, Spain. E-mail: omiro@clinic.ub.es Clinical Toxicology Downloaded from informahealthcare.com by 2.139.78.235 on 02/29/12 For personal use only.