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JournalFeed PubMetric Report

Analysis Source: PDF full text + PubMed metadata

JournalFeed PubMetric Score

11

High Confidence

PubMetric Score Breakdown

Relevance 2/2

Addresses a common and challenging clinical scenario in emergency medicine.

Design & Methods 1/2

Retrospective cohort design limits causal inference.

Bias Risk 1/2

Potential selection bias due to retrospective design and ECG availability.

Results 2/2

Statistically significant improvement in COWS scores and no serious cardiac events.

Certainty & Consistency 1/2

First study of its kind; results need further validation.

Applicability 2/2

Protocol can be implemented in standard ED settings.

Transparency 2/2

Funding present; COI disclosure present.

Critical Appraisal

Study Identification

Title: Assessing the Cardiac Safety of a Multimodal Protocol for ‘Tranq Dope’ Withdrawal: A Retrospective QTc Analysis
Authors: Kory S. London, Emily Deschler, Sabrina Butt, Steven Graver, Jake Figaniak, Nathan Hersh, Ariana Rucker, Bogdan Popa, Jenna R. Hoopes, Jennifer Kahoud, Behzad Pavri
Journal: The American journal of emergency medicine
Year: 2026
DOI: https://doi.org/10.1016/j.ajem.2025.10.033
Trial Registration: Not reported
Country / Region: United States
Setting: Two urban hospitals in Philadelphia, PA

Background

The emergence of 'tranq dope', a combination of fentanyl and xylazine, complicates opioid withdrawal management due to severe symptoms and potential QT interval prolongation.

Study Question

Is the multimodal protocol for 'tranq dope' withdrawal associated with QTc prolongation or serious cardiac events?

Study Design & Conduct

Study Design: Retrospective cohort study
Prospective / Retrospective: Retrospective
Multicenter: Yes
Unit of Allocation: Not applicable
Unit of Analysis: Patients
Randomization Method: Not applicable
Allocation Concealment: Not applicable
Blinding: Not applicable
Follow-up Duration: Not reported

Population

Inclusion Criteria:
  • Adult ED patients
  • Suspected fentanyl/xylazine exposure
  • Treated using the novel protocol
  • Pre- and post-treatment ECGs available
Exclusion Criteria:
  • Received medications before initial ECG
  • No second ECG during hospital stay
  • Under 18 years of age
  • Pregnant
  • Suffered ventricular dysrhythmia prior to treatment
Number Screened: 1375
Number Enrolled: 284
Number Analyzed: 284
Key Baseline Characteristics
Age: Mean 39 years
Sex: 62.3% male
Disease Severity: Not reported
Care Setting Distribution: Emergency departments
Additional Baseline Characteristics
  • 98.5% positive for fentanyl
  • 63.8% positive for cocaine

Exposures / Interventions

Primary Exposure / Intervention
Description: Multimodal protocol for 'tranq dope' withdrawal
Definition / Dose: Concurrent use of short-acting opioids, ketamine, dopamine antagonists, and alpha-2 agonists
Timing: During ED visit
Classification Method: Protocolized
Protocolized / Discretionary: Protocolized
Comparator / Reference
Description: Not applicable
Definition: Not applicable

Outcomes & Results

Primary Outcomes
Change in QTc interval
Definition: Difference in QTc interval pre- and post-treatment
Time Point: During ED stay
Measurement Method: ECG
Results: Mean QTc changed from 457 ms pre-treatment to 456 ms post-treatment
Secondary Outcomes
Symptom improvement
Definition: Change in Clinical Opiate Withdrawal Scale (COWS) scores
Time Point: During ED stay
Measurement Method: COWS
Results: Mean reduction 10 points, p < 0.001
Medication-specific QTc effects
Definition: Association of individual medications with QTc change
Time Point: During ED stay
Measurement Method: ECG
Results: Vancomycin (+13 ms), ondansetron (+16 ms), and methadone (+15 ms) associated with QTc increase
Adverse events
Definition: Incidence of life-threatening arrhythmias
Time Point: During ED stay
Measurement Method: Clinical observation
Results: No life-threatening arrhythmias observed

Risk of Bias

Risk of Bias - ROBINS-I
  • Confounding (Some concerns): Potential confounders not fully controlled due to retrospective design.
  • Selection of participants (Some concerns): Selection bias possible due to inclusion of patients with available ECGs.
  • Classification of interventions (Low): Interventions clearly defined and protocolized.
  • Deviations from intended interventions (Low): Interventions were applied as per protocol.
  • Missing data (Some concerns): Missing ECG data for some patients.
  • Measurement of outcomes (Low): Outcomes measured consistently with ECGs.
  • Selection of the reported result (Low): All relevant outcomes reported.
Transparency
Funding Disclosed: TRUE
COI Statement Present: TRUE

PubMetric Brief

Take-Home Message
A multimodal protocol for 'tranq dope' withdrawal showed no significant QTc prolongation or serious cardiac events.

Study Summary
This retrospective cohort study evaluated the cardiac safety of a multimodal protocol for withdrawal from 'tranq dope'—a combination of fentanyl and xylazine—across two urban EDs in Philadelphia. Among 1375 patients treated, 284 had pre- and post-treatment ECGs. The primary outcome was the change in QTc interval, which showed a mean change from 457 ms pre-treatment to 456 ms post-treatment. No protocol medication was linked to QTc prolongation. Secondary outcomes included significant improvement in Clinical Opiate Withdrawal Scale (COWS) scores and no life-threatening arrhythmias. The study suggests the protocol is safe for patients at risk of QTc prolongation, though further research is needed.

Citation
Assessing the Cardiac Safety of a Multimodal Protocol for ‘Tranq Dope’ Withdrawal: A Retrospective QTc Analysis . The American journal of emergency medicine. 2026;99:313-324. PMID: 41151217