Socioeconomic factors, hazardous alcohol consumption, and smoking in patients with minor trauma in an inner-city emergency department

On-Premise Alcohol Establishments and Ambulance Calls for Trauma, Assault, and Intoxication

Alcohol contributes to intentional and unintentional injury. We explored on-premise licensed alcohol establishments (LAEs) and emergency medical service (EMS) ambulance calls.We completed a retrospective population-based study in the Region of Peel, Ontario, 2005 to 2014, where alcohol sales are tightly regulated and healthcare is universally available. We included participants age ≥ 19 years. Longitude-latitude coordinates of all 696 LAEs and all 267,477 EMS ambulance calls were ascertained, and then assigned to 1 of 1568 dissemination areas (DA) in Peel. Relative risks (RRs) described the association between density of on-premise LAEs (by DA deciles) and the rate of EMS calls, adjusted for material deprivation, and density of beer/liquor stores in each DA.There was a curvilinear relation between LAE density and EMS calls for trauma, rising from 45.3 per 1000 in DAs with no LAEs to 381.0 per 1000 in decile-10 (adjusted RR 7.83, 95% confidence interval [CI] 6.15-9.97). This relation was more pronounced for alcohol-focused LAEs, and highest among younger males. Calls for assault (RR 2.67, 95% CI 1.26-5.65) and intoxication (RR 4.00, 95% CI 1.41-11.38) were more likely on the last day of the month and the day thereafter, compared to 1 week prior. At 02:00 hours, when LAEs must stop selling alcohol, there was a considerable rise in assault-related calls in DAs with LAE but not in DAs without LAEs.On-premise LAEs contribute to EMS calls for trauma and assault, especially among young males, around last call, and when monthly pay cheques are cashed.

Past blood alcohol concentration and injury in trauma center: propensity scoring

BACKGROUND

Evidence linking alcohol use to injury outcomes remains inconclusive, with prehospital and police department-based studies showing negative effects and hospital-based studies showing no effect or better outcomes.

OBJECTIVE

The purpose of this study was to examine the relationship of blood alcohol concentration (BAC) with injury characteristics and outcomes among trauma patients admitted to a major teaching hospital. In an effort to mitigate selection and confounding bias, propensity scoring methodology was applied, by which trauma patients were randomly assigned to high- and low-BAC groups.

METHODS

Electronic medical records were retrospectively reviewed for a period of 8 months. Of 1057 patients whose BAC was determined, 667 had BAC ≤ 0.08 g/dL and 390 had BAC > 0.08 g/dL. Injury characteristics were defined as injury type, injury location, and trauma level. Injury outcomes were defined as hospitalization, length of hospital stay, and in-hospital death. Adjusted odds ratios (aOR) and their 95% confidence intervals (CI) were calculated using multivariate logistic regression models and propensity scoring was applied.

RESULTS

A positive relationship was observed between BAC and unintentional injury (aOR = 1.08; 95% CI 1.01-1.17). Although injuries of the extremities were less likely to occur in patients with high BAC (aOR = 0.88; 95% CI 0.80-0.98), head injury was positively associated with high BAC (aOR = 1.27; 95% CI 1.14-1.42). Also, Level I trauma patients had nearly 60% greater odds of having a high BAC than Level II trauma patients.

CONCLUSIONS

A high alcohol level in the blood appears to be predictive of more unintentional injury, head injury, and Level I trauma activation and less injuries in extremities.

The impact of alcohol in pedestrian trauma

Across the globe, alcohol plays a major role in traffic-related injuries. It impairs the motor and cognitive coordination of drivers leading to motor vehicle collisions, which severely or fatally injure individuals across cultures and socioeconomic spectra. Although most public health initiatives have focused on driver intoxication, there is a high prevalence of alcohol use among pedestrians who are struck by motor vehicles, especially in collisions involving pedestrian fatalities. Alcohol use by pedestrians impairs judgment and coordination leading to risky street-crossing behaviors. Intoxication influences medical management by disrupting the reliability of the physical examination often necessitating expensive imaging modalities to rule out injuries. Alcohol abuse continues to impede traffic safety injury prevention efforts. This article reviews alcohol’s notorious role in traffic safety and pedestrian trauma.

Predictors of repeated emergency department visits among persons treated for addiction

BACKGROUND/AIMS

To determine whether frequent emergency department (ED) users who enter specialized treatment programs for alcohol and/or drug problems have any characteristics that predict their future ED use.

METHODS

Adult patients (783 alcohol users, 405 illicit drug users) were interviewed. Data from the medical database on utilization of ED and the emergency departments' specific units for addictive diseases (EDAD) 12 months before and 12 months after the interview were linked with patient characteristics in logistic regression models.

RESULTS

Among alcohol users, prior ED/EDAD visits predicted repeat future visits to these sites (OR 11.6; 95% CI 6.5-20.5). Prior inpatient hospital care with addiction diagnosis was a predictor of future multiple visits to the EDAD only (OR 3.1; 95% CI 1.5-6.5). Among drug users, predictors of future ED/EDAD visits were use of heroin (OR 2.7; 95% CI 1.4-5.4) and prior ED/EDAD visits (OR 27.3; 95% CI 12.7-58.4). Drug users' EDAD utilization was also predicted by inpatient hospital care with addiction diagnosis.

CONCLUSION

The strongest predictive factors of visiting ED repeatedly were previous repeat emergency care use and hospitalization with addiction diagnosis. Entering regular addiction treatment does not appear to alter the pattern of ED utilization.

Will emergency and surgical patients participate in and complete alcohol interventions? A systematic review

BACKGROUND

In the everyday surgical life, staff may experience that patients with Alcohol Use Disorders (AUDs) seem reluctant to participate in alcohol intervention programs. The objective was therefore to assess acceptance of screening and intervention as well as adherence to the intervention program among emergency department (ED) and surgical patients with AUDs.

METHODS

A systematic literature search was followed by extraction of acceptance and adherence rates in ED and surgical patients. Numbers needed to screen (NNS) were calculated. Subgroup analyses were carried out based on different study characteristics.

RESULTS

The literature search revealed 33 relevant studies. Of these, 31 were randomized trials, 28 were conducted in EDs and 31 evaluated the effect of brief alcohol intervention. Follow-up was mainly conducted after six and/or twelve months.Four in five ED patients accepted alcohol screening and two in three accepted participation in intervention. In surgical patients, two in three accepted screening and the intervention acceptance rate was almost 100%. The adherence rate was above 60% for up to twelve months in both ED and surgical patients. The NNS to identify one eligible AUD patient and to get one eligible patient to accept participation in alcohol intervention varied from a few up to 70 patients.The rates did not differ between randomized and non-randomized trials, brief and intensive interventions or validated and self-reported alcohol consumption. Adherence rates were not affected by patients' group allocation and type of follow-up.

CONCLUSIONS

Most emergency and surgical patients with AUD accept participation in alcohol screening and interventions and complete the intervention program.

Will emergency and surgical patients participate in and complete alcohol interventions? A systematic review

Background

In the everyday surgical life, staff may experience that patients with Alcohol Use Disorders (AUDs) seem reluctant to participate in alcohol intervention programs. The objective was therefore to assess acceptance of screening and intervention as well as adherence to the intervention program among emergency department (ED) and surgical patients with AUDs.

Methods

A systematic literature search was followed by extraction of acceptance and adherence rates in ED and surgical patients. Numbers needed to screen (NNS) were calculated. Subgroup analyses were carried out based on different study characteristics.

Results

The literature search revealed 33 relevant studies. Of these, 31 were randomized trials, 28 were conducted in EDs and 31 evaluated the effect of brief alcohol intervention. Follow-up was mainly conducted after six and/or twelve months.

Four in five ED patients accepted alcohol screening and two in three accepted participation in intervention. In surgical patients, two in three accepted screening and the intervention acceptance rate was almost 100%. The adherence rate was above 60% for up to twelve months in both ED and surgical patients. The NNS to identify one eligible AUD patient and to get one eligible patient to accept participation in alcohol intervention varied from a few up to 70 patients.

The rates did not differ between randomized and non-randomized trials, brief and intensive interventions or validated and self-reported alcohol consumption. Adherence rates were not affected by patients' group allocation and type of follow-up.

Conclusions

Most emergency and surgical patients with AUD accept participation in alcohol screening and interventions and complete the intervention program.

Dose-related effect of smoking on mortality in critically ill patients: a multicentre cohort study

PURPOSE

It is uncertain whether smoking has an independent dose-related adverse effect on mortality in critically ill patients. This study assessed whether the intensity of smoking history, measured in pack-years, has a dose-related effect on mortality in critically ill patients.

METHODS

In this multicentre cohort study data were collected from six tertiary intensive care units (ICU) in Australia and New Zealand.

RESULTS

Of the 8,962 patients considered in the study, data on patients' smoking status and smoking history were available from 5,063 and 2,865 patients, respectively. Male gender, and chronic respiratory, liver and cardiovascular diseases were over-represented among smokers compared to non-smokers. Smokers had a higher risk of requiring mechanical ventilation and dying in hospital than non-smokers (10.7% vs. 6.7%, p=0.001), particularly after emergency admission. Smokers also had a longer ICU stay than non-smokers (mean 3.2 days, interquartile range 0.8-3.2 vs. 2.8 days, interquartile range 0.8-2.9; p=0.024). After adjusting for age, gender, elective surgical admission, severity of acute illness, and severe chronic illnesses, the intensity of smoking history remained significantly associated with the risk of dying in hospital. This was in a relatively linear fashion (odds ratio 1.08 per 10 pack-years increment, 95% confidence interval 1.02-1.15; p=0.02). Further grouping of smokers into active smokers and ex-smokers, or including patients with unknown smoking status in the sensitivity analyses did not change the association between the intensity of smoking history and mortality.

CONCLUSIONS

Smoking has a dose-related adverse effect on mortality of critically ill patients after adjusting for other confounders.