SESSION TITLE: Critical Care 2 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2018 01:00 PM - 02:00 PM PURPOSE: Patients presenting with substance overdose (recreational or prescription) are often admitted to the Intensive Care Unit (ICU). While ICU-level interventions are needed for some, many admitted to the ICU do not require these. To balance patient safety and judicious use of ICU resources, we studied the accuracy of a set of clinical criteria in identifying patients who may require ICU-level interventions. METHODS: We conducted an IRB-approved retrospective study at a large, academic medical center. Through electronic chart review, we identified all adult patients presenting with substance overdose over 1 year (7/1/16 – 6/30/17). Based on prior literature, cutoffs were set as follows for each of the key clinical criteria: respiratory rate (≤8 or ≥30 per minute), oxygen saturation (<90%), systolic blood pressure (<90 or >200 mmHg), Glasgow Coma Scale (GCS) score (<14) and QRS duration on electrocardiogram (>120 millisecond). ICU admission was said to be indicated if any of the above criteria were met. We recorded ICU-level interventions performed for patients, including mechanical ventilation, central venous access, hemodynamic infusions, cardiac pacing or arrhythmia management, or continuous renal replacement therapy. RESULTS: A total of 179 patients were identified with a median age of 42 years. 87 were men and 92 were female. Of these, 146 patients (81%) had one or more abnormal clinical criteria. Of the 179 patients, 36 (20%) received ICU-level interventions. Using these data, sensitivity of the criteria in identifying patients needing ICU care was 94.4%. The specificity was 21.6%. 99 patients were actually admitted to the ICU, of which 66 did not require any ICU-level intervention. Of these, the criteria would have accurately predicted that 11 (16.7%) did not need ICU admission. CONCLUSIONS: We found that a composite tool using multiple clinical criteria can be very sensitive in identifying patients who may benefit from ICU-level care. Of the patients actually admitted to the ICU, two-thirds did not require ICU-level interventions. Of these, this tool would have appropriately reduced 16.7% of ICU admissions, in a safe manner.Our results are similar to the sensitivity and specificity reported in the literature using composite variables to create a triaging tool for patients with substance overdose. CLINICAL IMPLICATIONS: While ICU care is potentially life-saving, it is resource-intensive. This study is an important step in the development of a tool to help triage patients with substance overdose or poisoning to the appropriate level of care. The tool used in this study is sensitive enough to safely screen patients in or out of the ICU. Once patients are screened using this tool, additional clinical judgment can then be used to decide whether ICU admission is warranted. This approach would reduce the number of ICU admissions without compromising patient safety. DISCLOSURES: No relevant relationships by Sumedh Hoskote, source=Web Response No relevant relationships by Shaun Noronha, source=Web Response No relevant relationships by Swathi Sangli, source=Web Response