Impact of Initial Chest CT Findings on the Clinical Course and Hospitalization in Patients With Acute Drug Poisoning

Introduction: In patients with acute drug poisoning, aspiration pneumonia complicated by respiratory failure is associated with prolonged hospitalization and increased mortality. However, the association between imaging findings at presentation and subsequent clinical course has not been fully evaluated. We investigated the association between lung injury findings on initial chest computed tomography (CT)-defined as peribronchial ground-glass opacities and/or consolidation-and clinical course and health care costs in patients with acute drug poisoning. Methods: Among 83 patients transported to our emergency department for intentional overdose or acute drug poisoning between January and August 2023, we retrospectively analyzed 57 patients who underwent chest CT at initial presentation. Patients were divided into CT-positive and CT-negative groups according to the presence of lung injury findings on initial CT. We compared patient characteristics, clinical findings, laboratory findings, clinical course, and fee-for-service costs between groups. We also performed multivariable analyses to identify factors associated with prolonged duration of intubation, prolonged length of stay, and increased medical costs. Results: The median age was 43.5 (IQR, 27.2-57.0) years, and 17 patients were men. Lung injury findings were observed on chest CT in 16 patients (28.1%). Compared with the CT-negative group, the CT-positive group had a significantly higher proportion of patients requiring mechanical ventilation (81.2% vs 29.2%, p < 0.01), longer duration of intubation (2.0 vs 0 days, p < 0.01), longer hospital stay (6.0 vs 3.0 days, p < 0.01), and higher fee-for-service costs (Japanese yen (¥) 875,000 vs ¥487,000, p < 0.01). In multivariable analyses, CT positivity was significantly associated with prolonged duration of intubation (p < 0.01) and increased fee-for-service costs (p = 0.01). Conclusions: Approximately one-third of patients transported for acute drug poisoning who underwent chest CT at initial presentation had lung injury findings. These CT findings were significantly associated with prolonged duration of intubation and increased fee-for-service costs. However, because this was an exploratory retrospective analysis restricted to CT-imaged patients and residual confounding is likely, the results should be interpreted cautiously. Larger studies are needed to assess external validity.