Alcohol consumption in emergency room patients and the general population: a population-based study

Our purpose was to obtain epidemiological measures of the association between habitual alcohol consumption, alcohol consumption before the event and alcohol abuse/dependence, and emergency room (ER) attendance compared to the general population in Pachuca-Hidalgo, a city located in the central area of Mexico. The study was a population based case-control design. Data consisted of breath samples to estimated blood alcohol concentration, as well as an interviewer-administered questionnaire, collected on a 24-hr basis, during the entire week, in each of the three main ERs of Pachuca. Cases were all patients who visited the three main hospitals ERs during the study period, classified according to their status as an injured or noninjured (medically ill) patient (n = 1511). The general population sample (n = 920) serves as a comparison group for both types of patients. Injured patients in the ER sample were significantly more likely to report high frequency/high quantity of drinking during the last 12 months than the general population [odds ratio and 95% confidence intervals = 5.55 (1.72-17.97)] and to report drinking within 6 hr before the injury. These relationships did not hold for noninjured patients. Both types of patients were more likely to report high frequency of drunkenness during the preceding 12 months, to be positive for alcohol dependence and to report drug use. We found in the city of Pachuca, a large relationship between habitual alcohol consumption and ER injuries. These findings support associations of alcohol consumption and admission to an emergency room found in ER and general population studies in other countries. Due to the increases in the risk found for abuse/dependent in both injured and noninjured patients, they both would benefit with a brief intervention strategy for reducing their alcohol consumption.

Performance of screening instruments for identifying alcohol dependence in the general population, compared with clinical populations

Screening instruments for problem drinking have been developed in clinical populations, and little is known of their performance in the general population. Sensitivity and specificity of the CAGE and the TWEAK for ICD-10 and/or DSM-IV criteria for alcohol dependence are compared among those sampled from the southern region in the 1995 National Alcohol Survey (n = 776), and from emergency room (ER) (n = 1327) and primary care clinic (n = 767) samples in Jackson, MS. Sensitivity of the CAGE was higher in both the ER (85%) and primary care (82%) samples than in the general population (75%), although differences were not significant, and this held for males and females alike. Sensitivity of the TWEAK was lower in the general population sample (83%) than in the ER sample (89%), but higher than in the primary care sample (75%). In the general population, sensitivity of both screeners was better (although not significantly so) among those making an ER or primary care visit during the last year than among those not doing so, with the largest difference found for the CAGE (85% vs. 65%, respectively). In a merged sample of the three sites, the interaction of site by screening instrument was not a significant predictor of alcohol dependence for either the CAGE or TWEAK. Data suggest that screening instruments may not perform as well in the general population as in some clinical populations, with more variation apparent across groups for some screeners than for others. Although further analysis is necessary to explore this issue further, attention should be given to selection of the best instrument for use in a given population.

Differences in performance of screening instruments for problem drinking among blacks, whites and Hispanics in an emergency room population

OBJECTIVE

The purpose of this study was to compare the performance of a number of standard screening instruments for alcohol dependence and harmful drinking/abuse by ethnicity (black, Hispanic and white) and by ethnicity and gender in an emergency room setting.

METHOD

A probability sample of patients (N = 1,429) was breath analyzed and interviewed at the Santa Clara Valley Medical Center in San Jose, California. Sensitivity and specificity were analyzed among current drinkers (n = 857) for the CAGE, Brief MAST, AUDIT, TWEAK, RAPS and other items against combined ICD- 10 or DSM-IV criteria for alcohol dependence and separately for alcohol dependence or harmful drinking or abuse.

RESULTS

Screening measures were not found to perform equally well by ethnicity or gender, with lower sensitivity found for women compared to men. Consistency in sensitivity of measures was found to vary considerably across ethnic and gender groups, with some measures (most notably the RAPS and the AUDIT) showing consistently high sensitivity across subgroups. None of the instruments performed nearly as well for identifying alcohol dependence or harmful drinking or abuse combined as for alcohol dependence alone.

CONCLUSIONS

Analyses suggest that, while the RAPS may hold promise for identifying problem drinkers across ethnic and gender subgroups, it and other screening instruments currently in use require additional evaluation in a variety of settings to determine their usefulness for identifying those who could benefit from a brief intervention or referral for problem drinking.

Alcohol consumption, sensation seeking and ski injury: a case-control study

OBJECTIVE

Alcohol consumption is known to be associated with both risk of accidental injury and with sensation seeking, and sensation seeking has been found to be common among those engaging in such high-risk activities as skiing. However, few studies have examined the joint association of alcohol consumption and sensation seeking on injury.

METHOD

Alcohol consumption prior to injury and sensation-seeking disposition are analyzed on 389 injured skiers (clinic sample) and 899 randomly selected uninjured skiers (trailside sample) at a Northeastern ski resort. Cases and controls were asked questions pertaining to drinking within 24 hours, amount consumed, time lapsed between the last drink and the event, skiing ability, and sensation seeking.

RESULTS

The clinic sample was more likely to be female, to have less skiing experience, to score lower on sensation seeking and to have been drinking within 24 hours compared to the trailside sample. However, they were less likely to have had six or more drinks within 24 hours and were more likely to report a greater time lapse between the last drink and injury or interview. A larger proportion of those who reported drinking in both samples scored high on sensation seeking compared to those who reported not drinking. Logistic regression analysis found the following variables predictive of ski injury: female, low on sensation seeking, amount of alcohol consumed prior to the event, a longer time lapsed between drinking and the event, time of day (later) and day of the week (weekend).

CONCLUSIONS

The data suggest that, while drinking within 24 hours is positively associated with sensation seeking, drinking and not sensation seeking is positively predictive of injury. Drinking at least 12 hours prior to skiing, not drinking in close proximity to skiing, may increase risk for accidental injury, possibly due to a hangover or residual alcohol effect in which fatigue may play a part.

Male drinking and violence-related injury in the emergency room

AIMS

To present epidemiological measures of associations between violence-related injuries (assaults and fights), alcohol consumption prior to the event, and drinking patterns among males attending hospital emergency rooms (ERs) in Mexico City.

DESIGN

All patients were interviewed and breath tested for alcohol consumption. The data were analyzed using a case-control design.

SETTING

Eight ERs in Mexico City that were representative of the types of emergency care systems available in that city (from public, private and social security systems hospitals).

PARTICIPANTS

Cases were males patients (n = 445) admitted to the ER because of a fight or an assault. The control group was comprised of patients (n = 320) admitted to the ER because of accidents that are less frequently reported a alcohol-related (i.e. work-place accidents, animal bites or recreational accidents excluding near drowning).

MEASUREMENTS

A breath sample to estimate BAG, as well as an interviewer-administered questionnaire were used.

FINDINGS

Alcohol consumption prior to injury was found to be a more important risk factor than usual drinking for injuries resulting from violence, while quantity of usual alcohol consumption was more predictive of violence-related injuries than frequency of drinking.

CONCLUSIONS

These data suggest the importance of using more appropriate control groups when estimating associations of alcohol and violence-related injuries so that associations will not be underestimated. More research is needed to establish unbiased estimates of alcohol-related violence.

Comparison of screening instruments for alcohol problems between black and white emergency room patients from two regions of the country

A number of brief screening instruments to identify alcohol dependence exist, but the validity of these instruments across ethnic groups or regions of the country is not well established. The sensitivity and specificity of a number of standard screening instruments (CAGE, brief MAST, AUDIT, TWEAK, and RAPS), as well as other measures (History of Trauma Scale, breathalyzer reading, self-reported drinking before the event, and consuming five or more drinks at a sitting at least monthly) are compared against ICD-10 and DSM-IV criteria for alcohol dependence between probability samples of Black and White emergency room patients in Santa Clara County, CA (n = 716) and in Jackson, MS (n = 1330). Variability in the sensitivity of screening instruments among current drinkers was found to be greater between samples for both Blacks and Whites, than for Blacks compared with Whites within the same sample. The AUDIT, TWEAK, and RAPS seemed to perform well by gender and injury status for both Blacks and Whites in the two samples, and no significant differences were found in the performance of these instruments across sample sites. To evaluate the influence of regional differences in alcohol dependence on differences found in the performance of screening instruments, using logistic regression with the simultaneous entry of demographic variables (age, gender, ethnicity, injury status, and site) and drinking variables (breathalyzer reading, self-reported drinking before the event, and drinking five or more drinks at a sitting at least monthly) to predict alcohol dependence in a merged sample of these patients (Jackson vs. Santa Clara) site was not found to be significant. Data suggest that, whereas region of the country may not be important in predicting alcohol dependence in emergency room populations, regional differences in the performance of screening instruments for alcohol dependence may exist, even when ethnicity is taken into account. Given distinct regional differences in drinking patterns and problems in the U.S., further research on commonly used screening instruments is needed to determine those screeners most efficient for identifying problem drinking.

Alcohol and injury: a comparison of three emergency room samples in two regions

OBJECTIVE

Alcohol's involvement in injury has been found to vary greatly depending on the type and location of emergency room (ER), and associations may also vary by regional variations in drinking patterns. Similar data on alcohol and injury are compared in patients from three distinctly different ER types (trauma center vs county/ community and HMO) in two regions of the country (Mississippi and California).

METHOD

Representative samples of injured ER patients from the University of Mississippi Medical Center in Jackson (n = 356), San Francisco General Hospital (SFGH) (n = 555) and Contra Costa County, California, (n = 1,630) were breath analyzed and interviewed at the time of ER admission.

RESULTS

Men in the Jackson sample were less likely than those in SFGH, but more likely than those in Contra Costa, to be positive on the breath analyzer and to report drinking prior to the event, while women in Jackson were less likely to be positive than those in the other two samples. Similar rates of heavy problem drinking were found for those in Jackson and Contra Costa and both rates were lower than those in SFGH. Subjects in Jackson were more likely to be drinking in their own home, to be drinking an alcoholic beverage other than wine and to report a shorter time lapse between the last drink and the event, compared to the other two samples. Quantity-frequency of drinking was found to be predictive of injury in addition to breath analyzer reading and reporting drinking prior to the event, and significant interaction terms were found for drinking variables by site.

CONCLUSIONS

The data suggest that breath analyzer readings may be closely associated with type of ER, urbanicity of the area and socio-demographic characteristics of the clientele, while drinking prior to the injury may be closely associated with regional variations in drinking. Drinking variables appear to be more important predictors of injury in the Jackson sample than in Contra Costa or SFGH.

Alcohol and injuries resulting from violence: a comparison of emergency room samples from two regions of the U.S

Data on representative samples of emergency room patients from a wet region of the U.S. (Contra Costa County, California) and a dry region (Jackson, Mississippi) were analyzed to explore the influence of drinking patterns, rates of abstinence, and per capita consumption with respect to alcohol's role in injuries involving violence. In both samples those with violence-related injuries were more likely to have a positive breathalyzer reading, to report drinking within six hours prior to the event and to report drunkenness and alcohol-related problems compared to those with other injuries. A larger proportion of those with violence-related injuries in the Jackson sample reported consuming more drinks prior to injury and a shorter time lapse between drinking and the event than those in Contra Costa. They were no more likely, however, to report feeling drunk at the time or to attribute a causal association between drinking and the event. The data suggest there may be a closer association of alcohol with violence in the Jackson sample compared to Contra Costa.

Alcohol and violence-related injuries in the emergency room

This chapter reviews data on estimated blood alcohol concentration (BAC), self-reported consumption, and drinking patterns and problems from emergency room (ER) studies of alcohol and violence-related injury. These studies used probability samples of all injured patients that were representative of the population served by the ER where the data were collected. Those with violence-related injuries were more likely to be admitted to the ER with a positive BAC, to report drinking prior to the event, and to report more frequent heavy drinking and alcohol-related problems than those admitted to the same ER during the same time period with injuries from other causes. Limitations to these ER studies, including representativeness of samples, alcohol's presence and role in violence perpetration compared to violence victimization, the presence of other psychoactive substances, and the actual risk at which alcohol places the individual for injuries resulting from violence are discussed.

Alcohol-related health services use and identification of patients in the emergency department

STUDY OBJECTIVE

To determine the relationship between alcohol-related emergency department visits and alcohol-related outpatient visits and the extent of identification and referral of these ED patients for alcohol treatment.

METHODS

A representative sample of ED patients in three medical centers of a large northern California health maintenance organization were interviewed and given breath alcohol tests, and their medical records were reviewed. An alcohol-related ED visit was defined as a visit meeting one or more of the following criteria: positive breath alcohol test result (.01 mg/dL or more), report of drinking in the 6 hours before the presenting injury or illness, ED visit for an alcohol-related problem, and a medical record notation of excessive alcohol use or an alcohol problem.

RESULTS

Among 988 ED patients, 91 were found to have an alcohol-related ED visit. Of the 91, 6 made an alcohol-related outpatient visit in the 12 months before the ED visit, and 10 made such a visit in the following 6 months. Among the 91 patients, 10 were identified as having an alcohol problem by the ED staff, and 1 was referred for alcohol treatment.

CONCLUSION

The ED is an important point for the early identification and referral for treatment of alcohol-dependent and problem drinkers. The patient may make an alcohol-related ED visit relatively early in the pattern of alcohol-related health care use.

Drinking patterns and problems and drinking in the event: an analysis of injury by cause among casualty patients

The association of alcohol and injury might be expected to vary by the specific cause of injury, but few studies have examined such associations across all causes of injury coming from the same population, largely because of the lack of a sufficient number of cases. This study examines the association of drinking patterns and problems and drinking-in-the-injury-event for six mutually exclusive causes of injury (falls, penetrating trauma, motor vehicle accidents, fires, violence, and other causes) in a merged sample of 3109 patients from four emergency room/trauma center studies that used identical study methodology. The predictive value of drinking and demographic variables are examined separately for each cause of injury, and variables predictive of reporting drinking before the event, feeling drunk at the time of injury, and attributing a causal association of drinking and the injury. Injuries sustained from violence and falls had the greatest association with drinking variables, with those with positive breathalyzer readings, and those who reported drinking before injury, frequent heavy drinking, and frequent drunkenness overrepresented in these two causes. Those who reported a larger number of drinks consumed before injury and those who reported feeling drunk at the time were also overrepresented among those with injuries related to violence and falls. A larger proportion than expected of those who attributed a causal association of drinking with the event sustained injuries related to violence, whereas a smaller proportion sustained injuries from falls. Demographic characteristics were more predictive than drinking characteristics of each cause of injury, whereas drinking characteristics, particularly positive breathalyzer readings, were more predictive of drinking before specific causes of injury. These data provide information that may be useful in developing brief interventions for the prevention of alcohol-related injuries in the emergency room or trauma center setting.

Regional differences in alcohol and fatal injury: a comparison of data from two county coroners

OBJECTIVE

While alcohol has been found to be associated with fatal injury, this association may vary in different regions of the United States where drinking patterns and problems are known to vary. The purpose of this study was to analyze alcohol in injury fatalities in a "dry" area of the country (Hinds County, Miss.) compared to a "wet" area (Contra Costa County, Calif.).

METHOD

Data on all unnatural causes of death during a 1-year period among those 18 years and older were abstracted from county coroner records in Hinds County, Miss. (n = 222) and Contra Costa County, Calif. (n = 304).

RESULTS

Across all causes of death, those in Hinds County were more likely to be alcohol-involved (57%) compared to those in Contra Costa (40%). Those in Hinds County were twice as likely as those in Contra Costa to have died from homicide (32% vs 17%), but the proportion of homicides which was alcohol positive did not differ between the two regions (51% vs 46%). Using logistic regression, gender (male) and region (South) were predictive of a positive blood alcohol concentration across all causes of fatality combined. Age (younger) and ethnicity (black) were predictive of homicide. Ethnicity (non-black), a negative blood alcohol concentration and a positive drug screen were predictive of suicide, while age (younger), ethnicity (non-black), a positive blood alcohol concentration and a negative drug screen were predictive of motor vehicle accidents.

CONCLUSIONS

These data suggest that regional variations in alcohol's association with fatal injury do exist, and vary by demographic characteristics and cause of death. In addition, areas of the country that have relatively low rates of per capita consumption may have higher rates of alcohol-related injury fatalities than areas with greater per capita consumption.

Alcohol in fatal and nonfatal injuries: a comparison of coroner and emergency room data from the same county

Although alcohol is thought to be associated with severity of injury, relatively little data are available that compares alcohol's involvement in injury cases treated in the emergency room (ER) with coroner cases of injury fatality, both coming from the same county. Data from a probability sample of casualty patients 18 years and older treated at the University of Mississippi Medical Center ER in Jackson during a 6-month period (n = 275) are compared with data from coroner reports of all fatalities from unnatural causes among those 18 and older in the same county during a 1-year period surrounding the 6 months of data collection in the ER (n = 222). The two samples are compared on demographic characteristics, cause of injury, place of injury, and alcohol use before the event. A significantly larger proportion of the coroner sample was positive for alcohol (57%) and intoxicated (36%), compared with the proportion of those in the ER sample breathalyzed within 6 hr of injury, and reporting no drinking after the event who were positive (15%) and intoxicated (6%). Differences were most pronounced for motor vehicle accidents and fires. Violence-related injuries were more likely in the coroner sample (32%) than in the ER sample (16%), and they were more likely to involve alcohol at levels of intoxication. Those in the coroner sample were also more likely to be alcohol-positive for injuries occurring in all places except the home of another and the workplace. Using logistic regression, gender (male) and site (coroner) were predictive of a positive blood alcohol across all causes of injury combined. Gender (female), being alcohol-positive and site (coroner) were significantly predictive of motor vehicle accidents. Alcohol was not found to be a significant predictor for falls, other accidents, or injuries resulting from violence. Data suggest that alcohol's association with severity of injury varies by cause of injury.

Alcohol use and medical care utilization among health maintenance organization patients in the emergency department

OBJECTIVE

To determine the association of an alcohol-related ED visit with medical care utilization during a two-year period surrounding the ED visit in an HMO.

METHODS

A probability sample of ED patients were interviewed and underwent breath analysis in a large HMO in a Northern California county. Based on recent alcohol intake or documentation of an alcohol-related ED visit, the patients were assigned to an alcohol group (n = 91) or a non-alcohol group (n = 897). A 10% random sample of the health plan membership of the same county (n = 19,968) served as a comparison group. Utilization data were obtained from computerized files. Multiple linear regression was used to determine differences in subsequent outpatient visit rates between the alcohol and the non-alcohol groups. Logistic regression was used to compare the risks of hospitalization in the two groups.

RESULTS

Annual outpatient visit rates were 7.8 in the alcohol group and 8.3 in the non-alcohol group (p = 0.65), controlling for gender, age, and injury status, and were significantly different from the visit rate of 5.5 for the random health plan sample (p = 0.0001). No difference was found between the alcohol and the non-alcohol groups for risk of hospitalization; however, those in the health plan sample were less than half as likely to be hospitalized as were those in the non-alcohol group (odds ratio 0.44, p = 0.002).

CONCLUSIONS

No difference was found in utilization of medical services between the alcohol and the non-alcohol groups in this predominantly white, well-educated HMO ED population. However, both groups used significantly more inpatient and outpatient services than did the general HMO membership.

Screening for alcohol problems in the emergency room: a rapid alcohol problems screen

This paper compares the sensitivity and specificity of a five-item Rapid Alcohol Problems Screen (RAPS) optimized in this sample with the CAGE, brief MAST, AUDIT, TWEAK, History of Trauma Scale and breathalyzer reading against ICD-10 criteria for alcohol dependence or harmful drinking, by gender, ethnicity and injury status in a probability sample of emergency room patients (n = 1330) from the University of Mississippi Medical Center. The RAPS performed better than all other screening instruments for the total sample of current drinkers who reported ever having had three or more drinks at one time (sensitivity of 90%, specificity of 78%), and performed consistently better across all subgroups than any other single instrument, even at alternate cut points. The Rapid Alcohol Problems Screen may hold promise for use in clinical settings in identifying those who could benefit from a brief intervention or referral for problem drinking, particularly since the instrument is short and patients need not be asked additional questions after screening positive on one of the five items. Further research is necessary to analyze and compare the performance of the RAPS with other screening instruments across demographic subgroups in other emergency room and primary care settings.

Analysis of cut points for screening instruments for alcohol problems in the emergency room

OBJECTIVE

The purpose of this study is to evaluate the performance of a number of alcohol screening instruments (CAGE, Brief MAST, AUDIT, TWEAK), in an emergency room population, against ICD-10 criteria for harmful drinking and for alcohol dependence from the CIDI, by gender, race and injury status.

METHOD

A probability sample of patients were interviewed (N = 1,330) at the University of Mississippi Medical Center. Analyses were carried out on only current drinkers (n = 771; 58% of the sample). Instruments were compared on sensitivity, specificity and area under the curve using receiver operating characteristic (ROC) analysis to determine optimum cut points.

RESULTS

Overall the TWEAK and AUDIT performed best (in relation to sensitivity and area under the ROC curve) at standard cut points (3 and 8, respectively) for both harmful drinking and alcohol dependence. These instruments did not perform equally well across all subgroups, however, particularly among women, and among whites where the CAGE, with a cut point of 1, outperformed both the TWEAK and AUDIT at standard cut points. The TWEAK at a cut point of 2 also did as well as the CAGE at a cut point of 1 among women.

CONCLUSION

These data suggest that standard screening instruments do not perform equally well across ethnic and gender subgroups and that consideration of alternative cut points may be appropriate in some populations.

Alcohol and non-fatal injury in the U.S. general population: a risk function analysis

This paper reports a risk function analysis of average daily volume of alcohol consumed and the frequency of consuming 5 or more drinks during a single day with reporting an injury in a probability sample of the U.S. adult household population living in the 48 contiguous states. The data are from the 1990 National Alcohol Survey on a weighted sample of 1150 respondents, 748 of whom were current drinkers. Risk of injury was found to increase with an average daily volume of 1 drink for both males and females and for those 30 and younger and those over 30, and to increase with a frequency of consuming 5 or more drinks on one day more often than twice a year. These data suggest that risk for injury may be increased at relatively low levels of consumption and, if so, that preventive efforts aimed at more moderate drinkers may have a greater impact on the reduction of alcohol-related accidents than efforts focused on heavier drinkers who are fewer in number.

Screening for alcohol problems in the emergency department

STUDY OBJECTIVE

To evaluate the sensitivity and specificity of several alcohol screening instruments (CAGE, brief MAST, AUDIT, TWEAK, History of Trauma Scale) and other measures (breath alcohol analyzer reading and reporting of drinking before the event), in an emergency department population, against International Classification of Disease, revision 10 (ICD-10) criteria for harmful drinking and for alcohol dependence from the Composite International Diagnostic Interview (CIDI) by gender, race, and injury status.

DESIGN

A probability sample of patients was subjected to breath alcohol analysis and interviewed (N = 1,330.)

SETTING

University of Mississippi Medical Center.

RESULTS

Overall, the TWEAK and AUDIT methods were the most sensitive, identifying 84% and 81%, respectively, of patients who were positive for alcohol dependence. Sensitivity was not as high for females, whites, or the noninjured. Sensitivities for the breath alcohol analysis and self-reported drinking were 20% and 29%, respectively.

CONCLUSION

These data suggest that the effectiveness of screening instruments varies by gender, race, and injury status and that positive breath alcohol analysis readings and reporting of drinking before the event are not good indicators of alcohol dependence in this population.

Ethnic differences in performance of screening instruments for identifying harmful drinking and alcohol dependence in the emergency room

This study examines sensitivity and specificity figures associated with screens used to predict harmful drinking and alcohol dependence among current drinkers. The study population comes from a probability sample of emergency room patients in Jackson, MS. Data are presented by gender and injury status (injured versus noninjured) for Blacks and for Whites. The Composite International Diagnostic Interview was used to assess ICD-10 criteria for harmful drinking and alcohol dependence, which were taken as standards. Predictors include screening instruments (CAGE, AUDIT, brief MAST, TWEAK, and History of Trauma Scale), breathalyzer reading, self-reported consumption before the injury or noninjury event, quantity and frequency of drinking, and an abbreviated alcohol dependence experiences measure used in general population surveys. Single items from these screening instruments were also tested as predictors. Overall, the TWEAK and the AUDIT performed best in terms of sensitivity and specificity, but variation across subgroups suggests that the search for a good screening instrument for general use must be continued.

Alcohol use among HMO patients in the emergency room, primary care and the general population

OBJECTIVE

Although heavy drinking and alcohol-related problems are overpresented among patients seen in some primary care settings compared to the general population, it is not known whether those seen for noninjury problems in emergency rooms (ERs) are similar in demographic and drinking characteristics to those seen in primary care clinics. Nor do we know whether alcohol-related problems are over-represented in both of these settings compared to the general population when equal access to health care services is provided, as by membership in the same HMO. Reported here are data from a single northern California health maintenance organization (HMO).

METHOD

Probability samples of noninjured patients seen in the ERs of the HMO (n = 579) are compared on demographic characteristics and drinking patterns and problems to those seen in the primary care clinics of the same HMO (n = 295) and to those in the general population of the same county who reported membership in the HMO (n = 737).

RESULTS

No differences in drinking patterns, alcohol-related problems or gender or age distribution were found between the clinic patients and the noninjured ER patients. Both the noninjured ER patients and the clinic patients were less likely to report heavy and problem drinking, or treatment for an alcohol-related problem during the last year, as compared to those in the general population.

CONCLUSIONS

The data from this HMO study suggest that noninjured patients seen in these particular emergency rooms resemble those seen in primary care, and that, contrary to the commonly held belief that alcohol-related problems are overrepresented in primary care, primary care patients in this HMO population may be less likely to be problem drinkers than those in the general population from which they come.

Alcohol and casualties: comparison of county-wide emergency room data with the county general population

A representative sample of patients in hospital emergency rooms (ERs) in a Northern California county (n = 3731) were compared with a household probability sample of those living in the same county (n = 2101). The injured in the ER sample were more likely to be black and under 30 than those in the general population sample who reported an injury during the last year which was treated in the ER. ER injured were more likely to be abstainers than injured in the general population and among drinkers, they were also more likely to report social consequences of drinking, but were no more likely to report experiences associated with alcohol dependence. Similar differences were found between the injured and the non-injured in the two samples, with the injured more likely to be male, younger, never married and to report heavy drinking, drunkenness, social consequences of drinking and alcohol dependence experiences. The data suggest that associations of alcohol and injury found in representative samples of the ER population may be generalizable to the injured in the general population from which these patients come, with differences which do exist most likely attributable to characteristics associated with emergency room usage.

Alcohol and injury in the general population: data from two household samples

OBJECTIVE

While a large literature exists on the association of alcohol and injury, coming largely from studies carried out in hospital emergency rooms (ERs), it is not known how representative ER patients are of those who are injured and treated elsewhere, or of those who are injured and receive no treatment. This article reports data on alcohol, injury and ER treatment in the general population.

METHOD

Data were collected in two household probability samples: a national sample (N = 1,144) and a California county sample (N = 3,065).

RESULTS

In the national sample those treated in the ER for an injury were more likely to be younger, black and heavier drinkers, and were more likely to report experiences associated with alcohol dependence compared to those with other injuries, treated or untreated. In the county sample, those treated in the ER were more likely to have been drinking prior to the injury event, to be injured on the street and to report the event to be related to violence compared either to those whose injuries were treated elsewhere or to those who received no treatment for their injuries.

CONCLUSIONS

These data support the contention that findings on associations of alcohol and injury obtained from ER studies cannot be generalized to other injuries in the same population or to other populations.

Alcohol use among primary care patients: comparing an HMO with county clinics and the general population

A probability sample of all patients seen in the four health maintenance organization (HMO) primary care clinics in one Northern California county (N = 314) are compared to patients from all five of the county-operated primary care clinics in the same county (N = 394) and to the general population of the county (N = 3069) on demographic characteristics, drinking patterns and alcohol-related problems. The HMO clinic patients were less likely to report frequent, heavy drinking, drunkenness or alcohol-related problems during the last year compared to those in the county clinics sample, and they were also less likely to report heavy and problem drinking compared to those in the general population. These data suggest problem drinking may not be over-represented in primary care practice in general, but rather may be more closely associated with characteristics of clientele served by a primary care practice than with those characteristics associated with a need for medical attention.

Injury and the role of alcohol: county-wide emergency room data

The purpose of this study is to describe variables associated with injury in an emergency room (ER) sample that is representative of an entire U.S. county. A probability sample (n = 3717) of ER patients from the county hospital, 3 of the 6 community hospitals, and the three health maintenance organization hospitals in a single Northern California county were breath-analyzed and interviewed at the time of the ER visit. Injured were most likely to consume only 1 or 2 drinks within < 1 hr of injury occurrence. Twenty-three percent reported feeling drunk at the time of the event, and of these, 45% felt the event would not have happened if they had not been drinking. Breathalyzer reading, feeling drunk at the time of the event, and quantity-frequency (Q-F) of usual drinking were found to be predictive of admission to the ER with an injury, whereas breathalyzer reading, Q-F, and being injured in someone's home were predictive of reporting drinking prior to injury. Although feeling drunk at the time of the event and usual drinking patterns are predictive of injury occurrence, drinking prior to the event may not entail large quantities of alcohol consumed, but relatively small amounts consumed in close proximity to the injury event. These alcohol consumption variables may vary, however, depending on the type, cause, and severity of injury.