Seizure Prediction Model in Acute Tramadol Poisoning; a Derivation and Validation study
Archives of Academic Emergency Medicine,
Vol. 8 No. 1 (2020),
7 January 2020
Introduction: Seizure is a common complication of tramadol poisoning and predicting it will help clinicians in preventing seizure and better management of patients. This study aimed to develop and validate a prediction model to assess the risk of seizure in acute tramadol poisoning.
Methods: This retrospective observational study was conducted on 909 patients with acute tramadol poisoning in Baharloo Hospital, Tehran, Iran, (2015-2019). Several available demographic, clinical, and para-clinical characteristics were considered as potential predictors of seizure and extracted from clinical records. The data were split into derivation and validation sets (70/30 split) via random sampling. Derivation set was used to develop a multivariable logistic regression model. The model was tested on the validation set and its performance was assessed with receiver operating characteristic (ROC) curve.
Results: The mean (standard deviation (SD)) of patientsâ€™ age was 23.75 (7.47) years and 683 (75.1%) of them were male. Seizures occurred in 541 (60%) patients.Â Univariate analysis indicated that sex, pulse rate (PR), arterial blood Carbone dioxide pressure (PCO2), Glasgow Coma Scale (GCS), blood bicarbonate level, pH, and serum sodium level could predict the chance of seizure in acute tramadol poisoning. The final model in derivation set consisted of sex, PR, GCS, pH, and blood bicarbonate level. The model showed good accuracy on the validation set with an area under the ROC curve of 0.77 (95% CI: 0.67â€“0.87).
Conclusion: Representation of this model as a decision tree could help clinicians to identify high-risk patients with tramadol poisoning-induced seizure and in decision-making at triage of emergency departments in hospitals.
- Clinical decision-making
How to Cite
Rostam-Abadi Y, Gholami J, Amin-Esmaeili M, Safarcherati A, Mojtabai R, Ghadirzadeh MR, et al. Tramadol use and public health consequences in Iran: a systematic review and meta-analysis. Addiction. 2020.
Minami K, Ogata J, Uezono Y. What is the main mechanism of tramadol? Naunyn Schmiedebergs Arch Pharmacol. 2015;388(10):999-1007.
Hafezi Moghadam P, Zarei N, Farsi D, Abbasi S, Mofidi M, Rezai M, et al. Electrocardiographic changes in patients with tramadol-induced idiosyncratic seizures. Turk J Emerg Med. 2016;16(4):151-4.
Okazi A, Taghaddosinejad N, Mazrouei N, Forouzesh M, Barzegar A, F F. Occurrence and Recurrence of Seizures and Related Factors in Patients with Tramadol Ingestion. IJMTFM. 2018;8(3):101-8.
Shokrzadeh M, Hajimohammadi A, Delaram A, Y S. Characteristics of patients hospitalized with Tramadol intoxication in Gorgan, Iran, 2008- 2015. J Mazandaran Univ Med Sci. 2017;26(146):185-90.
Taghaddosinejad F, Mehrpour O, Afshari R, Seghatoleslami A, Abdollahi M, Dart RC. Factors related to seizure in tramadol poisoning and its blood concentration. J Med Toxicol. 2011;7(3):183-8.
Rehni AK, Singh I, Kumar M. Tramadol-induced seizurogenic effect: a possible role of opioid-dependent gamma-aminobutyric acid inhibitory pathway. Basic Clin Pharmacol Toxicol. 2008;103(3):262-6.
Sun C, Mtchedlishvili Z, Erisir A, Kapur J. Diminished neurosteroid sensitivity of synaptic inhibition and altered location of the alpha4 subunit of GABA(A) receptors in an animal model of epilepsy. J Neurosci. 2007;27(46):12641-50.
Baldo BA. Opioid analgesic drugs and serotonin toxicity (syndrome): mechanisms, animal models, and links to clinical effects. Arch Toxicol. 2018;92(8):2457-73.
Koushesh HR, Afshari R, Afshari R. A new illicit opioid dependence outbreak, evidence for a combination of opioids and steroids. Drug Chem Toxicol. 2009;32(2):114-9.
Afshari R, Majdzadeh R, Balali-Mood M. Pattern of acute poisonings in Mashhad, Iran 1993-2000. J Toxicol Clin Toxicol. 2004;42(7):965-75.
Ahmadimanesh M, Shadnia S, Rouini MR, Sheikholeslami B, Ahsani Nasab S, Ghazi-Khansari M. Correlation between plasma concentrations of tramadol and its metabolites and the incidence of seizure in tramadol-intoxicated patients. Drug Metab Pers Ther. 2018;33(2):75-83.
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