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Lee S, Oh H. Triage and length of stay in emergency department visits due to alcohol intoxication: A retrospective chart review. Australas Emerg Care 2023; 26:90-95. [PMID: 36028432 DOI: 10.1016/j.auec.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 08/07/2022] [Accepted: 08/08/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Patients with alcohol intoxication are screened and treated at emergency departments (EDs), at the cost of alcohol-related ED visit resource consumption. The purposes of this study were to identify characteristics of patients with alcohol intoxication, in terms of triage, blood alcohol concentration (BAC), and ED length of stay (LOS) and to compare these characteristics by homelessness status. METHODS We conducted a retrospective chart review of all visits and referrals to one drunken center in an ED between January and December 2019. Adults aged over 18 years admitted to the drunken center with a blood alcohol concentration (BAC) of 100 mg/dl or higher were included. RESULTS Approximately 89 % were male, around 30.4 % of the patients with acute alcohol intoxication were homeless. Approximately 46 % of patients were Medicaid or non-insured. Approximately 74.2 % of the patients were classified as KTAS 4 (less urgent) and 5 (nonurgency) upon initial KTAS evaluation. Both BAC and ED LOS were significantly higher in the homeless group. CONCLUSIONS About half of alcohol intoxicated patients who visited ED were vulnerable, and they visited the ED due to the problem of less urgent or non-urgent status of triage. Sobering places, not ED, and connecting patients with social work programs is important.
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Affiliation(s)
- Sunmi Lee
- National Emergency Medical Center, National Medical Center, Seoul, South Korea
| | - Hyunjin Oh
- Gachon University, Incheon, South Korea.
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2
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Shenvi CL, Weaver MA, Biese KJ, Wang Y, Revankar R, Fatade Y, Aylward A, Busby‐Whitehead J, Platts‐Mills TF, D'Onofrio G. Identification and characterization of older emergency department patients with high-risk alcohol use. J Am Coll Emerg Physicians Open 2020; 1:804-811. [PMID: 33145524 PMCID: PMC7593462 DOI: 10.1002/emp2.12196] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/31/2020] [Accepted: 07/01/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND High-risk alcohol use in the elderly is a common but underrecognized problem. We tested a brief screening instrument to identify high-risk individuals. METHODS This was a prospective, cross-sectional study conducted at a single emergency department. High-risk alcohol use was defined by National Institute on Alcohol Abuse and Alcoholism (NIAAA) guidelines as >7 drinks/week or >3 drinks/occasion. We assessed alcohol use in patients aged ≥ 65 years using the timeline follow back (TLFB) method as a reference standard and a new, 2-question screener based on NIAAA guidelines. The Alcohol Use Disorders Identification Test (AUDIT) and Cut down, Annoyed, Guilty, Eye-opener (CAGE) screens were used for comparison. We collected demographic information from a convenience sample of high- and low-risk drinkers. RESULTS We screened 2250 older adults and 180 (8%) met criteria for high-risk use. Ninety-eight high-risk and 124 low-risk individuals were enrolled. The 2-question screener had sensitivity of 98% (95% CI, 93%-100%) and specificity of 87% (95% CI, 80%-92%) using TLFB as the reference. It had higher sensitivity than the AUDIT or CAGE tools. The high-risk group was predominantly male (65% vs 35%, P < 0.001). They drank a median of 14 drinks per week across all ages from 65 to 92. They had higher rates of prior substance use treatment (17% vs 2%, P < 0.001) and current tobacco use (24% vs 9%, P = 0.004). CONCLUSION A rapid, 2-question screener can identify high-risk drinkers with higher sensitivity than AUDIT or CAGE screening. It could be used in concert with more specific questionnaires to guide treatment.
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Affiliation(s)
- Christina L. Shenvi
- Department of Emergency MedicineUniversity of North Carolina‐Chapel HillChapel HillNorth CarolinaUSA
| | - Mark A. Weaver
- Department of Mathematics and StatisticsElon UniversityElonNorth CarolinaUSA
| | - Kevin J. Biese
- Department of Emergency MedicineUniversity of North Carolina‐Chapel HillChapel HillNorth CarolinaUSA
| | - Yushan Wang
- Wake Forest School of MedicineWinston SalemNorth CarolinaUSA
| | | | - Yetunde Fatade
- Department of Internal MedicineEmory UniversityAtlantaGeorgiaUSA
| | - Aileen Aylward
- Department of Emergency MedicineUniversity of North Carolina‐Chapel HillChapel HillNorth CarolinaUSA
| | - Jan Busby‐Whitehead
- Division of GeriatricsUniversity of North Carolina‐Chapel HillChapel HillNorth CarolinaUSA
| | - Timothy F. Platts‐Mills
- Department of Emergency MedicineUniversity of North Carolina‐Chapel HillChapel HillNorth CarolinaUSA
| | - Gail D'Onofrio
- Department of Emergency MedicineYale School of MedicineNew HavenConnecticutUSA
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3
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Forson PK, Oduro G, Bonney J, Cobbold S, Sarfo-Frimpong J, Boyd C, Maio R. Emergency department admissions Kumasi, Ghana: Prevalence of alcohol and substance use, and associated trauma. J Addict Dis 2020; 38:520-528. [PMID: 32664825 DOI: 10.1080/10550887.2020.1791378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Alcohol and substance use (ASU) are significant contributors to global morbidity, mortality, and health resource utilization. We sought to describe the frequency of ASU use among adult injured patients presenting to the Komfo Anokye Teaching Hospital Emergency Department (KATH ED) and to describe injury mechanism and site among injured patients. METHODS A cross-sectional study was carried out for six months in 2016 involving all trauma patients and altered mental status patients presenting to the ED in Kumasi, Ghana. Blood alcohol concentration was evaluated with SureScreen Alcometer Breathalyzer, which provided a numeric breath alcohol concentration in mg/L units (BAC). Substance presence was evaluated using saliva strips with Micro-Distribution STATSWAB 6 panel oral fluid devices. Medical charts were reviewed retrospectively for details of history after testing was done at triage. RESULTS The total number of patients tested for substance use was 171 comprising 146 trauma patients and 25 non-trauma patients with altered mental statuses. Twenty-four percent (41) of patients tested positive for drugs. Of these 41, 29 tested positive for marijuana, six tested for opiates, two tested for oxycodone, two tested positive for cocaine, one tested positive for benzodiazepines, and one tested positive for methamphetamines. About a third (29%) of the patients tested positive for alcohol. Eleven patients (6.4%) tested positive for ASU. Road traffic injuries were the commonest mechanism of injury. Lower limb (42.1%), upper limb (29.2%), and head injuries constituted the most common injuries. CONCLUSION ASU may be a preventable cause of injuries among adults presenting to KATH ED.
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Affiliation(s)
- Paa Kobina Forson
- Department of Emergency Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana.,Emergency Medicine Research Office, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - George Oduro
- Department of Emergency Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana.,Emergency Medicine Research Office, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Joseph Bonney
- Department of Emergency Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana.,Emergency Medicine Research Office, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Sonia Cobbold
- Emergency Medicine Research Office, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | - Carol Boyd
- Centre for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, Ann Arbor, Michigan, USA.,Injury Prevention Centre, University of Michigan, Ann Arbor, Michigan, USA
| | - Ronald Maio
- Injury Prevention Centre, University of Michigan, Ann Arbor, Michigan, USA.,Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Gribben JL, Ilonzo N, Neifert S, Hubert M, Leitman IM. Characteristics and Outcomes of Abdominal and Pelvic Trauma Patients With Psychiatric Illness. J Surg Res 2019; 243:440-446. [PMID: 31279984 DOI: 10.1016/j.jss.2019.05.051] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 04/15/2019] [Accepted: 05/30/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The association between psychiatric illness and outcomes in trauma patients in general has only recently been investigated. The aim of this study was to describe the unique characteristics, risk factors, and outcomes of patients with comorbid psychiatric illness and penetrating abdominal and pelvic injuries. MATERIALS AND METHODS This was a retrospective review of trauma patients with open injuries to the abdomen and pelvis identified in the 2010-2015 the American College of Surgeons Trauma Quality Improvement Program database. Baseline variables extracted included demographics, comorbidities, including a discrete "psychiatric illness" variable that preexisted in the database, and injury information. Outcome variables collected included in-hospital mortality, length of stay and intensive care unit stay, and complications. Categorical variables were analyzed using chi-square and Fisher's exact test. Logistic regression was used to assess independent predictors for mortality with odds ratios (ORs) and 95% confidence intervals (CIs) constructed about group differences. RESULTS There were 22,053 patients identified, 6.1% of whom were diagnosed with a psychiatric comorbidity. Patients with psychiatric illnesses were more likely to be aged ≥65 y (5.4% versus 3.2%, P < 0.0001), female (25.4% versus 12.4%, P < 0.0001), and have other comorbidities. Their injuries were more likely to be self-inflicted (34.9% versus 4.9%) and of a cut or piercing mechanism (33.7% versus 24.1%). Psychiatric comorbidity was an independent predictor of intensive care unit admission (OR 1.32, 95% CI 1.14-1.53) and was independently associated with decreased odds of mortality (OR 0.42, 95% CI 0.32-0.55) despite increased complication rates. CONCLUSIONS The presence of a psychiatric comorbidity may be independently associated with trauma patients' complications and outcomes. Patients with psychiatric comorbidities have a unique set of risk factors and health needs that must be recognized and addressed by multidisciplinary care teams.
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Affiliation(s)
- Jeanie L Gribben
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Nicole Ilonzo
- Department of Surgery, Mount Sinai St. Luke's, New York, New York
| | - Sean Neifert
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Maya Hubert
- Department of Psychiatry, Mount Sinai St. Luke's, New York, New York
| | - I Michael Leitman
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York.
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Lingamanaicker K, Geelhoed E, Fatovich DM, Egerton‐Warburton D, Gosbell A, Wadsworth A, Moore K, Richardson D, Fatovich D. Direct cost of alcohol‐related presentations to Royal Perth Hospital emergency department. Emerg Med Australas 2019; 31:1045-1052. [DOI: 10.1111/1742-6723.13307] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 03/11/2019] [Accepted: 04/09/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Kausalya Lingamanaicker
- Emergency DepartmentRoyal Perth Hospital, The University of Western Australia Perth Western Australia Australia
| | - Elizabeth Geelhoed
- Health EconomicsThe University of Western Australia Perth Western Australia Australia
| | - Daniel M Fatovich
- Emergency MedicineRoyal Perth Hospital, The University of Western Australia Perth Western Australia Australia
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Tsai YC, Wu SC, Huang JF, Kuo SCH, Rau CS, Chien PC, Hsieh HY, Hsieh CH. The effect of lowering the legal blood alcohol concentration limit on driving under the influence (DUI) in southern Taiwan: a cross-sectional retrospective analysis. BMJ Open 2019; 9:e026481. [PMID: 31005931 PMCID: PMC6528014 DOI: 10.1136/bmjopen-2018-026481] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES We aimed to profile the epidemiological changes of driving under the influence (DUI) in southern Taiwan after the legal blood alcohol concentration (BAC) limit was lowered from 50 to 30 mg/dL in 2013. SETTING Level 1 trauma medical centre in southern Taiwan. PARTICIPANTS Data from 7447 patients (4375 males and 3072 females) were retrieved from the trauma registry system of a single trauma centre to examine patient characteristics (gender, age and BAC), clinical outcome variables (Abbreviated Injury Score, Injury Severity Score and mortality) and vehicular crash-related factors (vehicle type, airbag use in car crashes, helmet use in motorcycle crashes and time of crash) before and after the BAC limit change. RESULTS Our results indicated that the percentage of DUI patients significantly declined from 10.99% (n=373) to 6.64% (n=269) after the BAC limit was lowered. Airbag use in car crashes (OR: 0.30, 95% CI 0.10 to 0.88, p=0.007) and helmet use in motorcycle crashes (OR: 0.20, 95% CI 0.15 to 0.26, p<0.001) was lower in DUI patients compared with non-DUI patients after the BAC limit change, with significant negative correlation. DUI behaviour increased crash mortality risk before the BAC limit change (OR: 4.33, 95% CI 2.20 to 8.54), and even more so after (OR: 5.60, 95% CI 3.16 to 9.93). The difference in ORs for mortality before and after the change in the BAC legal limit was not significant (p=0.568). CONCLUSION This study revealed that lowering the BAC limit to 30 mg/dL significantly reduced the number of DUI events, but failed to result in a significant reduction in mortality in these trauma patients.
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Affiliation(s)
- Yu-Chin Tsai
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shao-Chun Wu
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Jin-Fu Huang
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Spencer C H Kuo
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Cheng-Shyuan Rau
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Peng-Chen Chien
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsiao-Yun Hsieh
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ching-Hua Hsieh
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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7
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Park JH, Park JO, Ro YS, Shin SD. Effect of alcohol use on emergency department length of stay among minimally injured patients based on mechanism of injury: multicenter observational study. Clin Exp Emerg Med 2018; 5:7-13. [PMID: 29618187 PMCID: PMC5891740 DOI: 10.15441/ceem.16.180] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 01/23/2018] [Accepted: 02/01/2018] [Indexed: 11/23/2022] Open
Abstract
Objective This study aimed to evaluate the effect of alcohol use on emergency department (ED) length of stay (LOS) among minimally injured patients by mechanism of injury. Methods This was a retrospective study of injury surveillance data for injured patients (except poisoning), aged over 18 years, discharged home from the ED, and treated at seven academic EDs in Korea during 2008 to 2012. Patients were divided into alcohol-related and alcohol-unrelated groups based on self-report. We used multivariable quantile regression models for the analysis and adjusted covariates including age, sex, consciousness status, severity of injury, emergency medical service use, the season, day and time of visit, and hospital. To determine if there were different effects of alcohol use across mechanism of injury, all analyses were stratified by each mechanism. Results Among 192,200 patients, 95,807 patients were analyzed. The number of participants in the alcohol-related group was 16,249 (17.0%). In the multivariable quantile regression model, the alcohol-related group had significantly longer ED LOS at the 10th (7 minutes; 95% confidence interval [CI], 6 to 8), 50th (21 minutes; 95% CI, 19 to 23), and 90th (81 minutes; 95% CI, 74 to 87) percentiles when compared to the alcohol-unrelated group. The effect of alcohol use on increased ED LOS was most prominent in motor vehicle injuries. Conclusion We found that alcohol use was associated with increased emergency ED LOS. Furthermore, if we limited our attention to the effect of alcohol use on the number of patients, the burden of alcohol use on the ED would have been underestimated.
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Affiliation(s)
- Jeong Ho Park
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.,Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ju Ok Park
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.,Department of Emergency Medicine, Hallym Univertisy Dongtan Sacred Hospital, Hwaseong, Korea
| | - Young Sun Ro
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Sang Do Shin
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.,Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
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8
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Gogeascoechea-Trejo MDC, Blázquez-Morales MSL, Pavón León P, De San Jorge Cárdenas X. Factores asociados con la hospitalización por lesiones en pacientes atendidos en los servicios de urgencias. Rev Salud Publica (Bogota) 2018; 20:237-242. [DOI: 10.15446/rsap.v20n2.60641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 01/16/2018] [Indexed: 11/09/2022] Open
Abstract
Objetivo Identificar los factores asociados con la hospitalización por lesiones en pacientes atendidos en el servicio de urgencias de dos hospitales.Métodos Estudio transversal, en lesionados mayores de 15 años que solicitaron atención en el servicio de urgencias de dos hospitales de Xalapa, Veracruz, México. Se realizó un análisis bivariado y un análisis de regresión logística para estimar los riesgos mediante Odds Ratio (OR) e identificar los factores asociados con la probabilidad de hospitalización.Resultados De los 505 lesionados, 10,7% requirieron ser hospitalizados. El riesgo de hospitalización se asoció con el sexo masculino (OR=2,7, IC95% 1,2-6,1), la edad de 46 años o más (OR=2,3, IC95% 1,2-4,5), el consumo de alcohol antes de la lesión (OR=2,3, IC95% 1,2-4,6), la violencia (OR=2,3, IC95% 1,1-4,9). En cuanto al tipo de lesión, mostraron mayor riesgo las fracturas (OR=7,4, IC95% 3,0-17,8).Conclusión Los resultados de esta investigación mostraron que algunos factores presentan mayor riesgo de hospitalización por lesiones. Dicha información puede utilizarse para proponer estrategias y desarrollar intervenciones que puedan incidir en la prevención de factores de riesgo que den como resultado lesiones graves que ameriten hospitalización.
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Peng SH, Hsu SY, Kuo PJ, Rau CS, Cheng YA, Hsieh CH. Influence of alcohol use on mortality and expenditure during hospital admission: a cross-sectional study. BMJ Open 2016; 6:e013176. [PMID: 27803110 PMCID: PMC5128992 DOI: 10.1136/bmjopen-2016-013176] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVES This study was designed to investigate the effect of alcohol intoxication on clinical presentation of hospitalised adult trauma patients at a Level I trauma centre using propensity score matching. DESIGN Cross-sectional study. SETTING Taiwan. PARTICIPANTS Detailed data of 929 hospitalised adult trauma patients with alcohol intoxication, aged 20-65 years, and 10 104 corresponding patients without alcohol intoxication were retrieved from the Trauma Registry System between 1 January 2009 and 31 December 2014. Alcohol intoxication was defined as a blood alcohol concentration (BAC) ≥50 mg/dL. MAIN OUTCOME MEASURES In-hospital mortality and expenditure. RESULTS Patients with alcohol intoxication presented with significantly higher short-term mortality (OR: 3.0, 95% CI 2.0 to 4.4; p<0.001) than patients without alcohol intoxication. However, on comparison with propensity score-matched patients with respect to sex, age, comorbidity, Glasgow Coma Scale (GCS), injury region based on Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS), alcohol intoxication did not significantly influence mortality (OR: 0.8, 95% CI 0.5 to 1.4; p=0.563). This implied that the higher mortality of alcohol-intoxicated patients was attributable to patient characteristics such as a higher injury severity rather than alcohol intoxication. Even on comparison with sex-matched, age-matched and comorbidity-matched patients without alcohol intoxication, patients with alcohol intoxication still had significantly higher total expenditure (17.4% higher), cost of operation (40.3% higher), cost of examination (52.8% higher) and cost of pharmaceuticals (38.3% higher). CONCLUSIONS The associated higher mortality of adult trauma patients with alcohol intoxication was completely attributable to other patient characteristics and associated injury severity rather than the effects of alcohol. However, patients with alcohol intoxication incurred significantly higher expenditure than patients without alcohol intoxication, even on comparison with sex-matched, age-matched and comorbidity-matched patients without alcohol intoxication.
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Affiliation(s)
- Shu-Hui Peng
- Executive Master Program, Department of Healthcare Administration, I-Shou University, Kaohsiung, Taiwan
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shiun-Yuan Hsu
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Pao-Jen Kuo
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Cheng-Shyuan Rau
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ya-Ai Cheng
- Executive Master Program, Department of Healthcare Administration, I-Shou University, Kaohsiung, Taiwan
| | - Ching-Hua Hsieh
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Green RS, Kureshi N, Erdogan M. Legal consequences for alcohol-impaired drivers injured in motor vehicle collisions: A systematic review. ACCIDENT; ANALYSIS AND PREVENTION 2015; 80:106-116. [PMID: 25899058 DOI: 10.1016/j.aap.2015.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 04/01/2015] [Accepted: 04/06/2015] [Indexed: 06/04/2023]
Abstract
The treatment of alcohol-impaired drivers injured in a motor vehicle collision (MVC) is a complex public health issue. We conducted a systematic review to describe the legal consequences for alcohol-impaired drivers injured in a MVC and taken to a hospital or trauma center. Methods We searched MEDLINE, Embase, and CINAHL databases from inception until August 2014. We included studies that reported legal consequences including charges or convictions of injured drivers taken to a hospital or trauma center after a MVC with a blood alcohol concentration (BAC) exceeding the legal limit.Results Twenty-six studies met inclusion criteria; twenty studies were conducted in the USA, five in Canada, and one in Sweden. All were cohort studies (23 retrospective, 3 prospective) and included 11,409 patients overall. A total of 5,127 drivers had a BAC exceeding the legal limit, with legal consequences reported in 4937 cases. The median overall DUI/DWI conviction rate was 13% (range 0-85%). The median percentage of drivers with a previous conviction on their record for driving under the influence (DUI) or driving while intoxicated (DWI) was 15.5% (range 6-40%). The median percentage of drivers convicted again for DUI/DWI during the study period was 3.5% (range 2-10%). Heterogeneity between study designs, legal jurisdictions, institutional procedures and policies for obtaining a legally admissible BAC measurement precluded a meta-analysis. Conclusions The majority of intoxicated drivers injured in MVCs and seen in the emergency department are never charged or convicted. A substantial proportion of injured intoxicated drivers had more than one conviction for DUI/DWI on their police record.
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Affiliation(s)
- Robert S Green
- Department of Critical Care Medicine, Dalhousie University, Halifax, NS, Canada; Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada; Trauma Nova Scotia, Halifax, NS, Canada.
| | - Nelofar Kureshi
- Division of Neurosurgery, Dalhousie University, Halifax, NS, Canada.
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11
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Asante LS, Newell M, Yun M, Yun-Welch S, Chun S. Comparative study of the impact of intoxication on injuries in china and Korea. Osong Public Health Res Perspect 2015; 6:27-33. [PMID: 25737828 PMCID: PMC4346591 DOI: 10.1016/j.phrp.2015.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 12/15/2014] [Accepted: 12/16/2014] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVES Alcohol misuse has been widely studied as a substantial contributor to injured patients' visits to emergency departments. The current research studied differences in alcohol-related injury variables in China and Korea. METHODS Data were collected from a sample of 4,509 patients (2,862 males and 1,667 females) reporting at emergency departments in China and Korea using the World Health Organization collaborative study on alcohol and injuries protocol. RESULTS More injuries were reported by men, young people aged 25-34 years, employed individuals, and persons who had at least a high-school education. The proportion of injury cases among intoxicated patients was 14% for Chinese and 20% for Koreans. The odds of intentional injuries to intoxicated patients increased significantly when the perpetrator had been drinking, especially for severely intoxicated victims in both countries. The odds of injuries for intoxicated persons in both countries were high during sports and leisure activities; odds ratio (OR) = 3.93, 95% confidence interval (CI) = 2.76-5.59 for Chinese and OR = 10.97, 95% CI = 6.06-19.85 for Koreans. CONCLUSION These findings are a contribution to research in the two Asian countries about the effect of intoxication on injuries especially when both victim and perpetrator are intoxicated.
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Affiliation(s)
- Lydia Sarponmaa Asante
- Department of Health-Bio Convergence Science, Sahmyook University, Seoul, Korea ; Korean Institute on Alcohol Problems, Sahmyook University, Seoul, Korea
| | - Maxine Newell
- Department of Health Management, Sahmyook University, Seoul, Korea ; Korean Institute on Alcohol Problems, Sahmyook University, Seoul, Korea
| | - Mieun Yun
- Korean Institute on Alcohol Problems, Sahmyook University, Seoul, Korea ; Department of Public Health, Sahmyook University, Seoul, Korea
| | - Sunmee Yun-Welch
- Korean Institute on Alcohol Problems, Sahmyook University, Seoul, Korea ; Department of Public Health, Sahmyook University, Seoul, Korea
| | - Sungsoo Chun
- Department of Health-Bio Convergence Science, Sahmyook University, Seoul, Korea ; Department of Health Management, Sahmyook University, Seoul, Korea ; Korean Institute on Alcohol Problems, Sahmyook University, Seoul, Korea ; Department of Public Health, Sahmyook University, Seoul, Korea
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12
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Rhodes KV, Rodgers M, Sommers M, Hanlon A, Crits-Christoph P. The Social Health Intervention Project (SHIP): protocol for a randomized controlled clinical trial assessing the effectiveness of a brief motivational intervention for problem drinking and intimate partner violence in an urban emergency department. BMC Emerg Med 2014; 14:10. [PMID: 24742322 PMCID: PMC4101846 DOI: 10.1186/1471-227x-14-10] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 03/14/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND There is a strong reciprocal association between two highly prevalent public health problems: intimate partner violence and heavy drinking, both of which remain major sources of morbidity and mortality. Brief interventions in the Emergency Department setting have been found to be effective in reducing alcohol-related injury but neither classic intimate partner violence nor substance abuse interventions have adequately integrated assessment and treatment for these co-occurring conditions. The overall goal of this study is to determine whether a motivational intervention delivered at the time of an Emergency Department visit will reduce heavy drinking and improve the safety of women experiencing intimate partner violence. METHODS AND DESIGN We are completing data collection for a randomized controlled trial enrolling 600 female patients, age 18-64, presenting to one of two urban Emergency Departments, who self-disclose both problem drinking and intimate partner violence. Eligible patients are randomized to a brief manual-guided motivational intervention, and a phone booster at 10 days. The intervention, which is delivered by masters-level therapists during the Emergency Department visit, is recorded and monitored for fidelity. Primary outcomes are episodes of heavy drinking and incidents of intimate partner violence, assessed weekly by Interactive Voice Response System for 12 weeks and at 3, 6 and 12 months by interviewers blinded to group assignment. To identify the impact of assessment alone, we included a no-contact control group assessed only once at 3 months. Secondary outcomes include violence severity, changes in the Composite Abuse Scale and alcohol quantity/frequency, along with other health-related behaviors. The analysis will also explore the impact of likely mediators and moderators of the intervention. DISCUSSION While screening and intervention for intimate partner violence is now recommended for women of child bearing age in health care settings, there is a need for rigorous evaluations of what works for whom. Upon completion, we will have high-quality evidence regarding the effectiveness of a low-intensity, brief motivational intervention, delivered by social workers in the Emergency Department setting, for decreasing episodes of heavy drinking and intimate partner violence. Ultimately, this is a model could be generalizable to other acute health care settings. TRIAL REGISTRATION ClinicalTrials.gov REGISTRATION NUMBER NCT01207258.
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Affiliation(s)
- Karin V Rhodes
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
- Center for Emergency Care Policy Research, Department of Emergency Medicine 1st Floor Ravdin, HUP, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Melissa Rodgers
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Marilyn Sommers
- School of Nursing, University of Pennsylvania, Philadelphia, USA
| | - Alexandra Hanlon
- School of Nursing, University of Pennsylvania, Philadelphia, USA
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