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Forbes SM, Schwartz N, Fu SH, Hobin E, Smith BT. The association between off- and on-premise alcohol outlet density and 100% alcohol-attributable emergency department visits by neighbourhood-level socioeconomic status in Ontario, Canada. Health Place 2024; 89:103284. [PMID: 38875963 DOI: 10.1016/j.healthplace.2024.103284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 05/17/2024] [Accepted: 05/31/2024] [Indexed: 06/16/2024]
Abstract
Alcohol availability is positively associated with alcohol use and harms, but the influence of socioeconomic status (SES) on these associations is not well established. This population-based cross-sectional study examined neighbourhood-level associations between physical alcohol availability (measured as off- and on-premise alcohol outlet density) and 100% alcohol-attributable emergency department (ED) visits by neighbourhood SES in Ontario, Canada from 2017 to 2019 (n = 19,740). A Bayesian spatial modelling approach was used to assess associations and account for spatial autocorrelation, which produced risk ratios (RRs) and 95% credible intervals (95% CrI). Each additional off-premise alcohol outlet in a neighbourhood was associated with a 3% increased risk of alcohol-attributable ED visits in both men (RR = 1.03, 95%CrI: 1.02-1.04) and women (RR = 1.03, 95% CrI: 1.02-1.04). Positive associations were also observed between on-premise alcohol outlet density and alcohol-attributable ED visits, although effect sizes were small. A disproportionately greater association with ED visits was observed with increasing alcohol outlet density in the lowest compared to higher SES neighbourhoods. Reducing physical alcohol availability may be an important policy lever for reducing alcohol harm and alcohol-attributable health inequities.
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Affiliation(s)
- Samantha M Forbes
- Public Health Ontario, 661 University Ave, Toronto, Ontario, Canada, M5G 1M1.
| | - Naomi Schwartz
- Public Health Ontario, 661 University Ave, Toronto, Ontario, Canada, M5G 1M1.
| | - Sze Hang Fu
- Public Health Ontario, 661 University Ave, Toronto, Ontario, Canada, M5G 1M1.
| | - Erin Hobin
- Public Health Ontario, 661 University Ave, Toronto, Ontario, Canada, M5G 1M1; Dalla Lana School of Public Health, University of Toronto, 1 55 College St, Toronto, Canada, M5T 3M7.
| | - Brendan T Smith
- Public Health Ontario, 661 University Ave, Toronto, Ontario, Canada, M5G 1M1; Dalla Lana School of Public Health, University of Toronto, 1 55 College St, Toronto, Canada, M5T 3M7.
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Myran DT, Friesen E, Talarico R, Gaudreault A, Taljaard M, Hobin E, Smith BT, Schwartz N, Giesbrecht N, Crépault JF, Tanuseputro P, Manuel DG. The association between alcohol retail access and health care visits attributable to alcohol for individuals with and without a history of alcohol-related health-care use. Addiction 2024. [PMID: 38804474 DOI: 10.1111/add.16566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 04/22/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND AND AIMS Alcohol retail access is associated with alcohol use and related harms. This study measured whether this association differs for people with and without heavy and disordered patterns of alcohol use. DESIGN The study used a repeated cross-sectional analysis of health administrative databases. SETTING, PARTICIPANTS/CASES All residents of Ontario, Canada aged 10-105 years with universal health coverage (n = 10 677 604 in 2013) were included in the analysis. MEASUREMENTS Quarterly rates of emergency department (ED) and outpatient visits attributable to alcohol in 464 geographic regions between 2013 and 2019 were measured. Quarterly off-premises alcohol retail access scores were calculated (average drive to the closest seven stores) for each geographic region. Mixed-effect linear regression models adjusted for area-level socio-demographic covariates were used to examine associations between deciles of alcohol retail access and health-care visits attributable to alcohol. Stratified analyses were run for individuals with and without prior alcohol-attributable health-care use in the past 2 years. FINDINGS We included 437 707 ED visits and 505 271 outpatient visits attributable to alcohol. After adjustment, rates of ED visits were 39% higher [rate ratio (RR) = 1.39, 95% confidence interval (CI) = 1.20-1.61] and rates of outpatient visits were 49% higher (RR = 1.49, 95% CI = 1.26-1.75) in the highest versus lowest decile of alcohol access. There was a positive association between alcohol access and outpatient visits attributable to alcohol for individuals without prior health-care attributable to alcohol (RR = 1.65, 95% CI = 1.39-1.95 for the highest to lowest decile of alcohol access) but not for individuals with prior health-care attributable to alcohol (RR = 1.08, 95% CI = 0.90-1.30). There was a positive association between alcohol access and ED visits attributable to alcohol for individuals with and without prior health-care for alcohol for ED visits. CONCLUSION In Ontario, Canada, greater alcohol retail access appears to be associated with higher rates of emergency department (ED) and outpatient health-care visits attributable to alcohol. Individuals without prior health-care for alcohol may be more susceptible to greater alcohol retail access for outpatient but not ED visits attributable to alcohol.
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Affiliation(s)
- Daniel T Myran
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Erik Friesen
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Robert Talarico
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Adrienne Gaudreault
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Erin Hobin
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Brendan T Smith
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Naomi Schwartz
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, Ontario, Canada
| | - Norman Giesbrecht
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Jean-François Crépault
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Peter Tanuseputro
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Douglas G Manuel
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
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Lee CM, Dillon DG, Tahir PM, Murphy CE. Phenobarbital treatment of alcohol withdrawal in the emergency department: A systematic review and meta-analysis. Acad Emerg Med 2024; 31:515-524. [PMID: 37923363 PMCID: PMC11065966 DOI: 10.1111/acem.14825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 10/14/2023] [Accepted: 10/17/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE Despite frequent treatment of alcohol withdrawal syndrome (AWS) in the emergency department (ED), evidence for phenobarbital (PB) as an ED alternative therapy is mixed. We conducted a systematic review and meta-analysis comparing safety and efficacy of PB to benzodiazepines (BZDs) for treatment of AWS in the ED. METHODS We searched articles and references published in English in PubMed, Web of Science, and Embase from inception through May 2022. We included randomized trials and cohort studies comparing treatment with PB to BZD controls and excluded studies focused on non-AWS conditions. Review was conducted by two blinded investigators and a third author; eight of 59 (13.6%) abstracts met inclusion criteria for review and meta-analysis using a random-effects model. Treatment superiority was evaluated through utilization, pharmacologic, and clinical outcomes. Primary outcomes for meta-analysis were the proportion of patients (1) admitted to the intensive care unit (ICU), (2) admitted to the hospital, (3) readmitted to the ED after discharge, and (4) who experienced adverse events. RESULTS Eight studies (two randomized controlled trials, six retrospective cohorts) comprised data from 1507 patients in 2012 treatment encounters for AWS. All studies were included in meta-analysis for adverse events, seven for hospital admission, five for ICU admission, and three for readmission to the ED after discharge. Overall methodological quality was low-moderate, risk of bias moderate-high, and statistical heterogeneity moderate. Pooled relative risk of ICU admission for those treated with PB versus BZD was 0.92 (95% confidence interval [CI] 0.54-1.55). Risk for admission to the hospital was 0.98 (95% CI 0.89-1.07) and for any adverse event was 1.1 (95% CI 0.78-1.57); heterogeneity prevented meta-analysis for ED readmission. CONCLUSIONS The current literature base does not show that treatment with PB significantly reduces ICU admissions, hospital admissions, ED readmissions, or adverse events in ED patients with AWS compared with BZDs alone.
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Affiliation(s)
- Carmen M Lee
- Department of Emergency Medicine, Highland Hospital, Alameda Health System, Oakland, California
| | - David G Dillon
- Emergency Medicine at the University of California, Davis School of Medicine, Sacramento, California
| | - Peggy M Tahir
- Research and Copyright Librarian at the University of California, San Francisco Library, San Francisco, California
| | - Charles E Murphy
- Associate Physician Diplomate in Emergency Medicine at the University of California, San Francisco School of Medicine, San Francisco, California
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Makutonin M, Ramdin C, Meltzer A, Mazer-Amirshahi M, Nelson L. Concurrent Alcohol and Opioid Intoxication in Emergency Department Patients Leads to Greater Resource Utilization. Subst Use Misuse 2024; 59:616-621. [PMID: 38192231 DOI: 10.1080/10826084.2023.2294963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
Background: Concurrent alcohol intoxication can complicate emergency department (ED) presentations for opioid-related adverse events. We sought to determine if there was a difference in resource utilization among patients who presented to the ED with concurrent opioid and alcohol intoxication compared to opioid intoxication alone. Methods: Using linked state-wide databases from the Maryland Healthcare Cost and Utilization Project (HCUP), we identified patients with a diagnosis of opioid intoxication treated in the ED from 2016 to 2018. We measured healthcare utilization for each patient in the ED settings for one year after the initial ED visit and estimated direct costs. We performed logistic regression comparing patients presented with co-intoxication to those without. Results: Of 12,295 patients who presented to the ED for opioid intoxication during the study period, 703 (5.7%) had concurrent alcohol intoxication. Patients with co-intoxication had more recurrent ED visits (340 vs 247.4 per 1000 patients, p < 0.05), higher index ED visit admission rates (26.9% vs 19.4%, p < 0.001), but similar overall costs ($3736 vs $2861, p < 0.05) at one year. Co-intoxication was associated with suicidal ideation (OR = 1.58, 95% CI 1.51-1.65), high zip code income (OR = 1.16, 95% CI 1.12-1.21), and higher rates of intoxication with all classes of drugs analyzed (p < 0.001). Conclusion: Our study demonstrated that mental health disorders, socioeconomic status, and increased ED utilization are associated with co-intoxication of opioids and alcohol presenting to the ED. Further research is needed to elucidate factors responsible for the increased resource use in this population.
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Affiliation(s)
- Michael Makutonin
- Department of Emergency Medicine, George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Christine Ramdin
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Andrew Meltzer
- Department of Emergency Medicine, George Washington University School of Medicine, Washington, District of Columbia, USA
| | | | - Lewis Nelson
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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Farkas A, Mandich M, Sherman K. Emergency department visits at Veterans Health Administration hospitals related to alcohol intoxication: A ten-year retrospective. Alcohol 2023; 119:23-27. [PMID: 38048965 DOI: 10.1016/j.alcohol.2023.12.001] [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: 08/02/2023] [Revised: 11/10/2023] [Accepted: 12/01/2023] [Indexed: 12/06/2023]
Abstract
We sought to quantify and describe the volume of emergency department visits related to alcohol intoxication at the Veterans Health Administration (VHA), the largest healthcare system in the United States. This is a retrospective cohort study of patients with VHA emergency department visits for alcohol intoxication from 2010 to 2019 as identified via ICD-9/10 code and/or serum ethanol concentration >50 mg/dL. Encounters were identified and demographic and clinical data were acquired by automated query of the VHA Corporate Data Warehouse. Descriptive statistics and univariate analysis were performed. We identified 95,123 patients with a total of 251,310 emergency department visits. The annual number of visits increased over the study period, reaching 32,333 in 2019. Men aged 40-60 were the most common demographic group in the cohort (48% of all patients), and men made up a higher proportion of patients in the database (94%) than the VHA population overall (90%). A disproportionate number of visits (32%) came from the top 4.4% of most frequent visitors. Most of the emergency department visits in the database (68%) were associated with medical or psychiatric admission, or interfacility transfer for admission elsewhere. Patients in the cohort accounted for 1.3% of all VHA emergency department visits during the study period, a proportion that is somewhat smaller than what has been reported at non-VHA facilities, despite the high prevalence of addiction disorders in the VHA patient population. We submit that this lower-than-expected proportion of alcohol-related emergency department visits may be due to the access to primary and mental care which is afforded by VHA patient benefits.
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Affiliation(s)
- Andrew Farkas
- Department of Emergency Medicine, Medical College of Wisconsin, Hub For Collaborative Medicine, 8701 Watertown Plank Rd., Milwaukee, Wisconsin 53226, United States; Clement J. Zablocki VA Medical Center, 5000 W. National Ave, Milwaukee, Wisconsin 53295, United States.
| | - Madalyn Mandich
- Department of Emergency Medicine, Medical College of Wisconsin, Hub For Collaborative Medicine, 8701 Watertown Plank Rd., Milwaukee, Wisconsin 53226, United States
| | - Katherine Sherman
- Clement J. Zablocki VA Medical Center, 5000 W. National Ave, Milwaukee, Wisconsin 53295, United States
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Gaume J, Blanc S, Magill M, McCambridge J, Bertholet N, Hugli O, Daeppen JB. Who benefits from brief motivational intervention among young adults presenting to the emergency department with alcohol intoxication: A latent-class moderation analysis. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:1614-1623. [PMID: 37515697 DOI: 10.1111/acer.15128] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 05/23/2023] [Accepted: 06/01/2023] [Indexed: 07/31/2023]
Abstract
BACKGROUND Research has not identified which patients optimally benefit from brief Motivational Interviewing (bMI) for heavy drinking when delivered to young adults in the Emergency Department (ED). METHODS We conducted secondary analyses of data from a randomized controlled trial in which 344 young adults (18-35 years) presenting to the ED with alcohol intoxication received either bMI or Brief Advice (BA, control group). We used Latent Class Analysis to derive participants' profiles from baseline characteristics (i.e., sex, age, severity of alcohol use disorder, attribution of ED admission to alcohol use, importance, and confidence to change, cognitive discrepancy, anxiety, depression, and trait reactance). We then conducted a moderation analysis to assess the number of heavy drinking days at short-term (1-month) and long-term (12-month) follow-up using negative binomial regressions with interactions between the intervention and derived classes. RESULTS Fit statistics indicated that a 4-class solution best fit the data. Class 3 (high severity, importance and discrepancy, and low confidence and anxiety) benefitted more from bMI than BA at short- and long-term follow-up than Class 1 (younger; lowest severity, importance, discrepancy, reactance, anxiety and depression, and highest confidence). Class 2 (older; highest severity, importance, discrepancy, reactance, anxiety and depression, and lowest confidence) also benefitted more from bMI than BA than did Class 1 at short-term follow-up. In these significant contrasts, Class 1 benefitted more from BA than bMI. There were no significant interactions involving Class 4 (more likely to be women; low severity; high levels of anxiety, depression, and reactance). CONCLUSIONS This study identified the patient profiles that benefitted more from bMI than BA among nontreatment-seeking young adults who present intoxicated to the ED. The findings have implications for intervention design and argue for the importance of research aimed at developing intervention content tailored to patient profiles.
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Affiliation(s)
- Jacques Gaume
- Department of Psychiatry - Addiction Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Stéphanie Blanc
- Department of Psychiatry - Addiction Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Molly Magill
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island, USA
| | | | - Nicolas Bertholet
- Department of Psychiatry - Addiction Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Olivier Hugli
- Emergency Department, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jean-Bernard Daeppen
- Department of Psychiatry - Addiction Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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7
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Schwegler E, Bachmann M, Kube F, Eriksson U. Gender-specific differences in comorbidities, in-hospital complications and outcomes in emergency patients with ethanol intoxication with and without multisubstance use. Swiss Med Wkly 2023; 153:40061. [PMID: 37155832 DOI: 10.57187/smw.2023.40061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
AIMS OF THE STUDY To analyse gender-specific differences in comorbidities, multisubstance abuse, in-hospital complications, intensive care unit transfers and referrals to psychiatric wards of emergency department patients with ethanol intoxication. Several lines of evidence suggest an influence of gender differences on diagnostic and therapeutic approaches to various diseases. METHODS Over a period of 7 years, all patients with signs or symptoms of ethanol intoxication and a positive blood ethanol test admitted for the first time to the emergency department of a Swiss regional tertiary referral hospital were prospectively enrolled. Patients were categorised into two subgroups: patients without additional drug use were considered ethanol-only cases, whereas patients who had also ingested other substances (as determined from bystanders, physicians and urine drug screening) were considered multisubstance cases. A retrospective analysis of this database evaluated gender-specific differences in comorbidities, multisubstance abuse, in-hospital complications, intensive care unit transfers and referrals to psychiatric wards within these two subgroups. Statistical analysis included Fisher's exact test for categorical data and Wilcoxon rank sum test for continuous data. RESULTS Of 409 enrolled patients, 236 cases were ethanol-only and 173 were multisubstance cases. The three most common comorbidities in multisubstance patients showed significant gender differences: psychiatric disorders (43% males vs 61% females; p = 0.022), chronic ethanol abuse (55% males vs 32% females; p = 0.002) and drug addiction (44% males vs 17% females; p = 0.001). Gender differences were also found for the most frequently co-ingested substances: benzodiazepines (35% males vs 43% females; p = 0.014), cannabis (45% males vs 24% females; p = 0.006) and cocaine (24% males vs 6% females; p = 0.001). Male and female ethanol-only patients were transferred to the intensive care unit in 8% of cases. In multisubstance cases, 32% of male and 43% of female patients were transferred to the intensive care unit (no significant gender difference). The psychiatric ward referral rate in male (30%) and female (48%) patients with multisubstance abuse was significantly different (p = 0.028). No significant gender difference in psychiatric ward referral rates was observed for ethanol-only patients (12% males, 17% females). CONCLUSION Among emergency department patients admitted with ethanol intoxication, gender differences in comorbidities, substance use and psychiatric ward referrals were highly significant among patients who presented with multisubstance abuse. Rates of intensive care unit transfer for patients with ethanol intoxication are substantial for both genders, reflecting relevant disease burden and resource demand, as well as the need for further preventive efforts.
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Affiliation(s)
- Eric Schwegler
- Department of Medicine, GZO Regional Health Center, Wetzikon, Switzerland
| | - Marta Bachmann
- Department of Medicine, GZO Regional Health Center, Wetzikon, Switzerland
| | - Frank Kube
- Emergency Department, GZO Regional Health Center, Wetzikon, Switzerland
| | - Urs Eriksson
- Department of Medicine, GZO Regional Health Center, Wetzikon, Switzerland
- University of Zurich, Zürich, Switzerland
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Strayer RJ, Friedman BW, Haroz R, Ketcham E, Klein L, LaPietra AM, Motov S, Repanshek Z, Taylor S, Weiner SG, Nelson LS. Emergency Department Management of Patients With Alcohol Intoxication, Alcohol Withdrawal, and Alcohol Use Disorder: A White Paper Prepared for the American Academy of Emergency Medicine. J Emerg Med 2023; 64:517-540. [PMID: 36997435 DOI: 10.1016/j.jemermed.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/06/2023] [Indexed: 03/30/2023]
Affiliation(s)
- Reuben J Strayer
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, New York.
| | - Benjamin W Friedman
- Department of Emergency Medicine, Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Rachel Haroz
- Cooper Medical School of Rowan University, Cooper University Healthcare, Camden, New Jersey
| | - Eric Ketcham
- Department of Emergency Medicine, Department of Behavioral Health, Addiction Medicine, Presbyterian Healthcare System, Santa Fe & Española, New Mexico
| | - Lauren Klein
- Department of Emergency Medicine, Good Samaritan Hospital, West Islip, New York
| | - Alexis M LaPietra
- Department of Emergency Medicine, Saint Joseph's Regional Medical Center, Paterson, New Jersey
| | - Sergey Motov
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, New York
| | - Zachary Repanshek
- Department of Emergency Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Scott Taylor
- Department of Emergency Medicine, Royal Melbourne Hospital, Melbourne, Australia
| | - Scott G Weiner
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lewis S Nelson
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
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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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10
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Incidence of Intoxications in the Emergency Department of Galati Hospital with Examples of Cardiovascular Effects of MDMA Intoxication. Diagnostics (Basel) 2023; 13:diagnostics13050940. [PMID: 36900084 PMCID: PMC10001041 DOI: 10.3390/diagnostics13050940] [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: 01/03/2023] [Revised: 02/21/2023] [Accepted: 02/23/2023] [Indexed: 03/06/2023] Open
Abstract
MDMA (3,4-methylenedioxymethamphetamine; commonly referred to as "Molly" or "ecstasy") is a synthetic compound, structurally and pharmacologically similar to both amphetamines and mescaline. MDMA differs somewhat from traditional amphetamines in that it is not structurally similar to serotonin. Cocaine is rare and cannabis is consumed less frequently than in Western Europe. Heroin is the drug of choice for the poor in Bucharest, Romania's capital of two million people, and alcoholism is common in villages where more than a third of the population lives in poverty. By far, the most popular drugs are Legal Highs (Romanians call them "ethnobotanics"). All of these drugs have significant effects on cardiovascular function that contribute significantly to adverse events. Most adverse cardiac events occur in young adults and are potentially reversible. Poisoning among patients aged 17 years and over was commonly seen in the Emergency Departments of a large tertiary hospital in the city centre, accounting for 3.2% of all patients. In a third of the poisonings, more than one substance was used. Intoxication with ethnobotanicals was the most frequently observed, followed by use of drugs from the amphetamine group. The majority of patients presenting to the Emergency Department were male. Therefore, this study suggests further research on hazardous alcohol consumption and drug abuse.
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Smith BT, Schoer N, Sherk A, Thielman J, McKnight A, Hobin E. Trends in alcohol-attributable hospitalisations and emergency department visits by age, sex, drinking group and health condition in Ontario, Canada. Drug Alcohol Rev 2023; 42:926-937. [PMID: 36843065 DOI: 10.1111/dar.13629] [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: 07/18/2022] [Revised: 12/20/2022] [Accepted: 01/26/2023] [Indexed: 02/28/2023]
Abstract
INTRODUCTION Alcohol-attributable harms are increasing in Canada. We described trends in alcohol-attributable hospitalisations and emergency department (ED) visits by age, sex, drinking group, attribution and health condition. METHODS Hospitalisation and ED visits for partially or wholly alcohol-attributable health conditions by age and sex were obtained from population-based health administrative data for individuals aged 15+ in Ontario, Canada. Population-level alcohol exposure was estimated using per capita alcohol sales and alcohol use data. We estimated the number and rate of alcohol-attributable hospitalisations (2008-2018) and ED visits (2008-2019) using the International Model of Alcohol Harms and Policies (InterMAHP). RESULTS Over the study period, the modelled rates of alcohol-attributable health-care encounters were higher in males, but increased faster in females. Specifically, rates of alcohol-attributable hospitalisations and ED visits increased by 300% (19-76 per 100,000) and 37% (774-1,064 per 100,000) in females, compared to 20% (322-386 per 100,000) and 2% (2563-2626 per 100,000) in males, respectively. Alcohol-attributable ED visit rates were highest among individuals aged 15-34, however, increased faster among individuals aged 65+ (females: 266%; males: 44%) than 15-34 years (females:+17%; males: -16%). High-volume drinkers had the highest rates of alcohol-attributable health-care encounters; yet, low-/medium-volume drinkers contributed substantial hospitalisations (11%) and ED visits (36%), with increasing rates of ED visits in females drinking low/medium volumes. DISCUSSION AND CONCLUSIONS Alcohol-attributable health-care encounters increased overall, and faster among females, adults aged 65+ and low-/medium-volume drinkers. Monitoring trends across subpopulations is imperative to inform equitable interventions to mitigate alcohol-attributable harms.
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Affiliation(s)
- Brendan T Smith
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Nicole Schoer
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, Canada
| | - Adam Sherk
- Canadian Institute for Substance Use Research, University of Victoria, Technology Enterprise Facility, Victoria, Canada
| | - Justin Thielman
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, Canada
| | - Anthony McKnight
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Erin Hobin
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Canadian Institute for Substance Use Research, University of Victoria, Technology Enterprise Facility, Victoria, Canada
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12
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Meng Y, Wang J, Jiang N, Gong Y, Ye F, Li J, Zhou P, Yin X. Occurrence and correlated factors of physical and verbal violence among emergency physicians in China. J Glob Health 2023; 13:04013. [PMID: 36655917 PMCID: PMC9850876 DOI: 10.7189/jogh.13.04013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background Workplace violence against emergency physicians is a global concern. However, there was relatively little research on the incidence and correlated factors of workplace violence among emergency physicians in China. We aimed to investigate the occurrence and correlated factors of physical and verbal violence among emergency physicians in China. Methods We conducted a nationwide cross-sectional study from July 2018 to August 2018. We included a total of 10 457 emergency physicians from 31 provinces across China in the analysis. The questionnaire covered socio-demographic characteristics, work-related factors, psychological characteristics, and workplace violence. We applied binary logistic regression to examine the correlated factors of physical and verbal violence among emergency physicians. Results The prevalence of physical and verbal violence among emergency physicians in China was 27.63% and 81.81%, respectively. Regarding socio-demographic factors, male emergency physicians with bachelor's degrees or higher, poor sleep quality, and unfavorable health conditions were more likely to experience workplace violence. Concerning work-related factors, emergency physicians who had longer years of service, worked a higher frequency of night shifts per month and served more patients per day had a greater prevalence of workplace violence. As for individual psychological characteristics, negative affect was positively correlated with workplace violence, while self-efficacy and positive affect were negatively correlated with workplace violence. Conclusions The situation of physical and verbal violence against emergency physicians in China is severe, especially verbal violence. Hospital administrators should pay more attention to the workplace violence of emergency physicians and take measures to decrease the occurrence of workplace violence efficiently, such as reducing their workload and cultivating their positive affect and self-efficacy.
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13
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Verheij C, Haagsma JA, Koch BCP, Segers AEM, Schuit SCE, Rood PPM. Screening for hazardous alcohol use in the Emergency Department: Comparison of phosphatidylethanol with the Alcohol Use Disorders Identification Test and the Timeline Follow-back. Alcohol Clin Exp Res 2022; 46:2225-2235. [PMID: 36520053 PMCID: PMC10107187 DOI: 10.1111/acer.14958] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 09/10/2022] [Accepted: 10/07/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Up to 15% of all visits to the Emergency Department (ED) are alcohol related. Identification of problematic alcohol use is important in this setting because it allows for intervention and prevention efforts. This study investigated the correlation between the objective phosphatidylethanol (PEth) marker and the subjective Alcohol Use Disorders Identification Test (AUDIT) and Timeline Followback Questionnaire (TLFB) as screening methods for hazardous alcohol use in the general ED population. METHODS This prospective cohort study included 301 ED patients (57% male) who were seen in the ED and required to give a blood sample. The correlation between the values of PEth (PEth 16:0/18:1 and PEth 16:0/18:2) and the scores on the AUDIT and TLFB were analyzed using Spearman's rank correlation coefficient. Differences between risk categories of PEth and AUDIT were also examined. RESULTS The Spearman correlation coefficients between PEth 16:0/18:1|PEth 16:0/18:2 values and the AUDIT scores were moderate (PEth 16:0/18:1: 0.67, p < 0.001; PEth 16:0/18:2: 0.67, p < 0.001). Of the patients who scored 'low risk drinking/abstinence' according to the AUDIT questionnaire, respectively 1% and 4% had PEth 16:0/18:1|PEth 16:0/18:2 values indicating excessive alcohol use, and another 10% and 12% had PEth 16:0/18:1|PEth 16:0/18:2 values indicating moderate alcohol consumption. Of the 12 (PEth 16:0/18:1) and 25 (PEth 16:0/18:2) patients with high-risk values, respectively 25% and 40% scored in the lowest risk category on the AUDIT questionnaire. Spearman correlation coefficients between PEth 16:0/18:1|PEth 16:0/18:2 values and TLFB two-week scores were high (PEth 16:0/18:1: 0.74, p < 0.001; PEth 16:0/18:2: 0.82, p < 0.001). CONCLUSIONS AUDIT scores were moderately correlated with PEth values in the general ED population. In almost all cases where there was not a good correlation, patients had high PEth values with low AUDIT scores. We conclude that PEth identifies patients with problematic alcohol use who are missed by the AUDIT questionnaire and therefore PEth could be used as an additional screening method for hazardous alcohol use in this population.
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Affiliation(s)
- Carolien Verheij
- Department of Emergency Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Juanita A Haagsma
- Department of Emergency Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Birgit C P Koch
- Department of Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Anne E M Segers
- Department of Emergency Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Stephanie C E Schuit
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Board of Directors, University Medical Center Groningen, Groningen, The Netherlands
| | - Pleunie P M Rood
- Department of Emergency Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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14
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Jolkovsky EL, Fernandez‐Penny FE, Alexis M, Benson LN, Wang BH, Abella BS. Impact of acute intoxication on quantitative pupillometry assessment in the emergency department. J Am Coll Emerg Physicians Open 2022; 3:e12825. [PMID: 36311337 PMCID: PMC9601771 DOI: 10.1002/emp2.12825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 08/24/2022] [Accepted: 09/02/2022] [Indexed: 11/11/2022] Open
Abstract
Study Hypothesis/Objective This prospective cohort study aimed to assess whether and to what extent different quantitative pupillometry (QP) metrics are associated with different intoxicant drug classes as well as investigate the potential benefit of QP as a tool in the rapid assessment of clinically intoxicated patients in the emergency department (ED). Methods Between February 25, 2019 and April 24, 2021, 325 patients were enrolled in the EDs of the Hospital of the University of Pennsylvania (HUP) and Penn Presbyterian Medical Center (PPMC). Patients deemed clinically intoxicated or in withdrawal by an attending emergency physician were considered for eligibility. Patients <18 years old, with a chief complaint indicative of head trauma or stroke or without a urine drug screen (UDS) positive for drugs of abuse were excluded. QP data were also collected from a cohort of 82 healthy control subjects. Results Neurological Pupil index (NPi) values did not vary significantly between control and study groups nor between study group patients with a UDS positive for opioids. With exception of latency of constriction, all other QP metrics for the study group were depressed relative to controls (P < 0.005). Conclusions This work demonstrated the feasibility of QP measurement in the ED, finding that NPi remains unaffected by clinical intoxication and therefore can potentially be used for ED patient evaluation without risk of confounding by key intoxicants of abuse. Future work will evaluate the value of QP as a means of rapid and reproducible neurological assessment to identify various pathologies.
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Affiliation(s)
- Eliana L. Jolkovsky
- David Geffen School of MedicineUniversity of CaliforniaLos AngelesLos AngelesCaliforniaUSA
| | - Felix E. Fernandez‐Penny
- Department of Emergency MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA,Penn Acute Research CollaborationUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Maya Alexis
- Department of Emergency MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Lauren N. Benson
- Department of Emergency MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Bo Hwan Wang
- Department of Emergency MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Benjamin S. Abella
- Department of Emergency MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA,Penn Acute Research CollaborationUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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15
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Gaume J, Bertholet N, McCambridge J, Magill M, Adam A, Hugli O, Daeppen JB. Effect of a Novel Brief Motivational Intervention for Alcohol-Intoxicated Young Adults in the Emergency Department: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2237563. [PMID: 36269355 PMCID: PMC9587483 DOI: 10.1001/jamanetworkopen.2022.37563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
IMPORTANCE Heavy drinking among young adults is a major public health concern. Brief motivational interventions in the emergency department have shown promising but inconsistent results. OBJECTIVE To test whether young adults receiving a newly developed brief motivational intervention reduce their number of heavy drinking days and alcohol-related problems over 1 year compared with participants receiving brief advice. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial was conducted at an emergency department of a tertiary care university hospital in Lausanne, Switzerland. Recruitment ran from December 2016 to August 2019. Follow-up was conducted after 1, 3, 6, and 12 months. All adults aged 18 to 35 years presenting for any cause and presenting with alcohol intoxication were eligible (N = 2108); 1764 were excluded or refused participation. Follow-up rate was 79% at 12 months and 89% of participants provided follow-up data at least once and were included in the primary analyses. Statistical analysis was performed from September 2020 to January 2021. INTERVENTIONS The novel intervention was based on motivational interviewing and comprised in-person discussion in the emergency department and up to 3 booster telephone calls. The control group received brief advice. MAIN OUTCOMES AND MEASURES Primary outcomes were the number of heavy drinking days (at least 60 g of ethanol) over the previous month and the total score on the Short Inventory of Problems (0-45, higher scores indicating more problems) over the previous 3 months. Hypotheses tested were formulated before data collection. RESULTS There were 344 young adults included (median [IQR] age: 23 [20-28] years; 84 women [24.4%]). Among the 306 participants providing at least 1 follow-up point, a statistically significant time × group interaction was observed (β = -0.03; 95% CI, -0.05 to 0.00; P = .02), and simple slopes indicated an increase of heavy drinking days over time in the control (β = 0.04; 95% CI, 0.02 to 0.05; P < .001) but not in the intervention group (β = 0.01; 95% CI, -0.01 to 0.03; P = .24). There was no effect on the Short Inventory of Problems score (β = -0.01; 95% CI, -0.03 to 0.02; P = .71). CONCLUSIONS AND RELEVANCE This randomized clinical trial found that a brief motivational intervention implemented in the emergency department provided beneficial effects on heavy drinking, which accounts for a substantial portion of mortality and disease burden among young adults. TRIAL REGISTRATION ISRCTN registry: 13832949.
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Affiliation(s)
- Jacques Gaume
- Department of Psychiatry—Addiction Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Nicolas Bertholet
- Department of Psychiatry—Addiction Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jim McCambridge
- Department of Health Sciences, University of York, York, United Kingdom
| | - Molly Magill
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island
| | - Angéline Adam
- Department of Psychiatry—Addiction Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Olivier Hugli
- Emergency Department, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jean-Bernard Daeppen
- Department of Psychiatry—Addiction Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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16
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Suen LW, Makam AN, Snyder HR, Repplinger D, Kushel MB, Martin M, Nguyen OK. National Prevalence of Alcohol and Other Substance Use Disorders Among Emergency Department Visits and Hospitalizations: NHAMCS 2014-2018. J Gen Intern Med 2022; 37:2420-2428. [PMID: 34518978 PMCID: PMC8436853 DOI: 10.1007/s11606-021-07069-w] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 07/21/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Acute healthcare utilization attributed to alcohol use disorders (AUD) and other substance use disorders (SUD) is rising. OBJECTIVE To describe the prevalence and characteristics of emergency department (ED) visits and hospitalizations made by adults with AUD or SUD. DESIGN, SETTING, AND PARTICIPANTS Observational study with retrospective analysis of the National Hospital Ambulatory Medical Care Survey (2014 to 2018), a nationally representative survey of acute care visits with information on the presence of AUD or SUD abstracted from the medical chart. MAIN MEASURES Outcome measured as the presence of AUD or SUD. KEY RESULTS From 2014 to 2018, the annual average prevalence of AUD or SUD was 9.4% of ED visits (9.3 million visits) and 11.9% hospitalizations (1.4 million hospitalizations). Both estimates increased over time (30% and 57% relative increase for ED visits and hospitalizations, respectively, from 2014 to 2018). ED visits and hospitalizations from individuals with AUD or SUD, compared to individuals with neither AUD nor SUD, had higher percentages of Medicaid insurance (ED visits: AUD: 33.1%, SUD: 35.0%, neither: 24.4%; hospitalizations: AUD: 30.7%, SUD: 36.3%, neither: 14.8%); homelessness (ED visits: AUD: 6.2%, SUD 4.4%, neither 0.4%; hospitalizations: AUD: 5.9%, SUD 7.3%, neither: 0.4%); coexisting depression (ED visits: AUD: 26.3%, SUD 24.7%, neither 10.5%; hospitalizations: AUD: 33.5%, SUD 35.3%, neither: 13.9%); and injury/trauma (ED visits: AUD: 51.3%, SUD 36.3%, neither: 26.4%; hospitalizations: AUD: 31.8%, SUD: 23.8%, neither: 15.0%). CONCLUSIONS In this nationally representative study, 1 in 11 ED visits and 1 in 9 hospitalizations were made by adults with AUD or SUD, and both increased over time. These estimates are higher or similar than previous national estimates using claims data. This highlights the importance of identifying opportunities to address AUD and SUD in acute care settings in tandem with other medical concerns, particularly among visits presenting with injury, trauma, or coexisting depression.
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Affiliation(s)
- Leslie W Suen
- National Clinician Scholars Program, Philip R. Lee Institute of Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA. .,San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA.
| | - Anil N Makam
- Division of Hospital Medicine, Department of Medicine, San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, USA.,University of California, San Francisco Center for Vulnerable Populations, San Francisco, CA, USA.,Philip R. Lee Institute of Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA
| | - Hannah R Snyder
- Department of Family and Community Medicine, San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, USA
| | - Daniel Repplinger
- Department of Emergency Medicine, San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, USA
| | - Margot B Kushel
- University of California, San Francisco Center for Vulnerable Populations, San Francisco, CA, USA
| | - Marlene Martin
- Division of Hospital Medicine, Department of Medicine, San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, USA
| | - Oanh Kieu Nguyen
- Division of Hospital Medicine, Department of Medicine, San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, USA.,University of California, San Francisco Center for Vulnerable Populations, San Francisco, CA, USA
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17
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Alpert HR, Slater ME, Yoon YH, Chen CM, Winstanley N, Esser MB. Alcohol Consumption and 15 Causes of Fatal Injuries: A Systematic Review and Meta-Analysis. Am J Prev Med 2022; 63:286-300. [PMID: 35581102 PMCID: PMC9347063 DOI: 10.1016/j.amepre.2022.03.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 03/21/2022] [Accepted: 03/24/2022] [Indexed: 11/01/2022]
Abstract
INTRODUCTION The proportion of fatal nontraffic injuries that involve high levels of alcohol use or alcohol intoxication was assessed by cause of injury to generate alcohol-attributable fractions. Updated alcohol-attributable fractions can contribute to improved estimates of the public health impact of excessive alcohol use. METHODS Peer-reviewed and gray literature for 1995-2019 on 15 causes of fatal nontraffic injuries in the U.S., Canada, or Mexico were systematically reviewed, and state data systems were queried for available estimates of fatalities with recorded blood alcohol concentration levels and proportions of decedents with blood alcohol concentrations ≥0.10 g/dL by cause of injury. For each injury cause, alcohol-attributable fractions across studies were synthesized by meta-analysis of single proportions using generalized linear mixed models. RESULTS In total, 60 published studies and 40 additional population-level data points from 6 state data systems were included. The meta-analyzed alcohol-attributable fractions by cause of injury are as follows: air-space transport (0.03), aspiration (0.24), child maltreatment (0.09), drowning (0.31), fall injuries (0.37), fire injuries (0.34), firearm injuries (0.24), homicide (0.29), hypothermia (0.29), motor vehicle nontraffic crashes (0.42), occupational and machine injuries (0.08), other road vehicle crashes (railroad trespasser injuries) (0.63), poisoning (not alcohol) (0.20), suicide (0.21), and water transport (0.27), yielding an overall median alcohol-attributable fraction of 0.27. DISCUSSION Excessive alcohol use is associated with substantial proportions of violent and nonviolent injury deaths. These findings can improve the data used for estimating alcohol-attributable injury deaths and inform the planning and implementation of evidence-based strategies (e.g., increasing alcohol taxes, regulating alcohol outlet density) to prevent them.
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Affiliation(s)
| | | | | | | | | | - Marissa B Esser
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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18
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Myran D, Hsu A, Kunkel E, Rhodes E, Imsirovic H, Tanuseputro P. Socioeconomic and Geographic Disparities in Emergency Department Visits due to Alcohol in Ontario: A Retrospective Population-level Study from 2003 to 2017. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 67:534-543. [PMID: 34254563 PMCID: PMC9234901 DOI: 10.1177/07067437211027321] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE While the overall health system burden of alcohol is large and increasing in Canada, little is known about how this burden differs by sociodemographic factors. The objectives of this study were to assess sociodemographic patterns and temporal trends in emergency department (ED) visits due to alcohol to identify emerging and at-risk subgroups. METHODS We conducted a retrospective population-level cohort study of all individuals aged 10 to 105 living in Ontario, Canada. We identified ED visits due to alcohol between 2003 and 2017 using defined International Classification of Diseases, 10th edition, codes from a pre-existing indicator. We calculated annual age- and sex-standardized, and age- and sex-specific rates of ED visits and compared overall patterns and changes over time between urban and rural settings and income quintiles. RESULTS There were 829,662 ED visits due to alcohol over 15 years. Rates of ED visits due to alcohol were greater for individual living in the lowest- compared to the highest-income quintile neighbourhoods, and disparities (rate ratio lowest to highest quintile) increased with age from 1.22 (95% CI, 1.19 to 1.25) in 15- to 18-year-olds to 4.17 (95% CI, 4.07 to 4.28) in 55- to 59-year-olds. Rates of ED visits due to alcohol were significantly greater in rural settings (56.0 per 10,000 individuals, 95% CI, 55.7 to 56.4) compared to urban settings (44.8 per 10,000 individuals, 95% CI, 44.7 to 44.9), particularly for young adults. Increases in rates of visits between 2003 and 2017 were greater in rural versus urban settings (82 vs. 68% increase in age- and sex-standardized rates) and varied across sociodemographic subgroups with the largest annual increases in rates of visits in young (15 to 29) low-income women (6.9%, 95%CI, 6.7 to 7.3) and the smallest increase in older (45 to 59) high-income men (2.7, 95%CI, 2.4 to 3.0). CONCLUSION Alcohol harms display unique patterns with the highest burden in rural and lower-income populations. Rural-urban and income-based disparities differ by age and sex and have increased over time, which offers an imperative and opportunity for further interventions by clinicians and policy makers.
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Affiliation(s)
- Daniel Myran
- 10055The Ottawa Hospital Research Institute, Ontario, Canada.,Department of Family Medicine, University of Ottawa, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - Amy Hsu
- 10055The Ottawa Hospital Research Institute, Ontario, Canada.,Department of Family Medicine, University of Ottawa, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | | | - Emily Rhodes
- 10055The Ottawa Hospital Research Institute, Ontario, Canada
| | | | - Peter Tanuseputro
- Department of Family Medicine, University of Ottawa, Ontario, Canada.,Bruyère Research Institute, Ottawa, Ontario, Canada.,Department of Medicine, University of Ottawa, Ontario, Canada
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19
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Hsu HE, Chen PY, Chang HM, Pan CH, Su SS, Tsai SY, Chen CC, Kuo CJ. Incidence of and risk factors for alcohol dependence in bipolar disorder: A population-based cohort and nested case-control study. Aust N Z J Psychiatry 2022; 57:725-735. [PMID: 35642594 DOI: 10.1177/00048674221100153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Although alcohol dependence is highly prevalent in patients with bipolar disorder, the causal relationship is not yet well-established. This study estimated the incidence of alcohol dependence in a nationwide bipolar disorder cohort and examined risk factors for alcohol dependence. METHODS Patients aged 15-65 years with consistent bipolar disorder who had their first psychiatric admission between 1999 and 2012 (n = 21,791) were enrolled from the National Health Insurance Research Database in Taiwan. We calculated the adjusted incidence rate ratio of alcohol dependence in the bipolar cohort relative to the general population after stratification by age and sex. In the nested case-control study, we included patients with incident alcohol dependence as cases and four age- and sex-matched controls for each case to analyze health care utilization, comorbidities and concomitant medications between them. RESULTS We identified 1261 patients with bipolar disorder with incident alcohol dependence. Relative to the general population, the adjusted incidence rate ratio of alcohol dependence was 9.20 in the bipolar cohort. All adjusted incidence rate ratios were high across all age subgroups. Cases had higher psychiatric and nonpsychiatric health care utilization than did controls. Multivariate analysis revealed that cases tended to have cardiovascular disease, diabetes mellitus, chronic hepatic disease, pneumonia and delirium before alcohol dependence diagnosis. Cases had higher psychiatric comorbidities, namely drug-induced mental disorders, anxiety disorder, personality disorder, adjustment disorder and sleep disorder. CONCLUSION The bipolar cohort had a higher incidence of alcohol dependence. We identified specific groups with a high risk of alcohol dependence. Additional strategies for early detection, treatment and intervention for alcohol dependence should be developed.
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Affiliation(s)
- Haw-En Hsu
- Department of General Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei
| | - Po-Yu Chen
- Department of General Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei
| | - Hu-Ming Chang
- Department of General Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei
| | - Chun-Hung Pan
- Department of General Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei.,Department of Psychology, National Chengchi University, Taipei
| | - Sheng-Shiang Su
- Department of General Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei
| | - Shang-Ying Tsai
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei.,Psychiatric Research Center, Taipei Medical University Hospital, Taipei
| | - Chiao-Chicy Chen
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei.,Department of Psychiatry, Mackay Memorial Hospital, Taipei.,Department of Psychiatry, Mackay Medical College, Taipei
| | - Chian-Jue Kuo
- Department of General Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei.,Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei.,Psychiatric Research Center, Taipei Medical University Hospital, Taipei
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20
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Philippine T, Forsgren E, DeWitt C, Carter I, McCollough M, Taira BR. Provider perspectives on emergency department initiation of medication assisted treatment for alcohol use disorder. BMC Health Serv Res 2022; 22:456. [PMID: 35392901 PMCID: PMC8988541 DOI: 10.1186/s12913-022-07862-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 03/29/2022] [Indexed: 11/10/2022] Open
Abstract
Background Alcohol use disorder (AUD) is ubiquitous and its sequelae contribute to high levels of healthcare utilization, yet AUD remains undertreated. The ED encounter represents a missed opportunity to initiate medication assisted treatment (MAT) for patients with AUD. The aims of this study are to identify barriers and facilitators to the treatment of AUD in the ED, and to design interventions to address identified barriers. Methods Using an implementation science approach based on the Behavior Change Wheel framework, we conducted qualitative interviews with staff to interrogate their perspectives on ED initiation of AUD treatment. Subjects included physicians, nurses, nurse practitioners, clinical social workers, and pharmacists. Interviews were thematically coded using both inductive and deductive approaches and constant comparative analysis. Themes were further categorized as relating to providers’ capabilities, opportunities, or motivations. Barriers were then mapped to corresponding intervention functions. Results Facilitators at our institution included time allotted for continuing education, the availability of clinical social workers, and favorable opinions of MAT based on previous experiences implementing buprenorphine for opioid use disorder. Capability barriers included limited familiarity with naltrexone and difficulty determining which patients are candidates for therapy. Opportunity barriers included the limited supply of naltrexone and a lack of clarity as to who should introduce naltrexone and assess readiness for change. Motivation barriers included a sense of futility in treating patients with AUD and stigmas associated with alcohol use. Evidence-based interventions included multi-modal provider education, a standardized treatment algorithm and order set, selection of clinical champions, and clarification of roles among providers on the team. Conclusions A large evidence-practice gap exists for the treatment of AUD with Naltrexone, and the ED visit is a missed opportunity for intervention. ED providers are optimistic about implementing AUD treatment in the ED but described many barriers, especially related to knowledge, clarification of roles, and stigma associated with AUD. Applying a formal implementation science approach guided by the Behavior Change Wheel allowed us to transform qualitative interview data into evidence-based interventions for the implementation of an ED-based program for the treatment of AUD. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07862-1.
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Affiliation(s)
| | - Ethan Forsgren
- Department of Emergency Medicine, Olive View-UCLA Medical Center, Sylmar, California, USA
| | | | - Inanna Carter
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Maureen McCollough
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Department of Emergency Medicine, Olive View-UCLA Medical Center, Sylmar, California, USA
| | - Breena R Taira
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Department of Emergency Medicine, Olive View-UCLA Medical Center, Sylmar, California, USA
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21
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Kissee JL, Huang Y, Dayal P, Yellowlees P, Sigal I, Marcin JP. Association Between Insurance and the Transfer of Children With Mental Health Emergencies. Pediatr Emerg Care 2021; 37:e1026-e1032. [PMID: 31274825 DOI: 10.1097/pec.0000000000001881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study sought to investigate the association between a patient's insurance coverage and a hospital's decision to admit or transfer pediatric patients presenting to the emergency department (ED) with a mental health disorder. METHODS This is a cross-sectional study of pediatric mental health ED admission and transfer events using the Healthcare Cost and Utilization Project 2014 Nationwide Emergency Department Sample. Children presenting to an ED with a primary mental health disorder who were either admitted locally or transferred to another hospital were included. Multivariable logistic regression models were used to adjust for confounders. RESULTS Nineteem thousand eighty-one acute mental health ED events among children were included in the analyses. The odds of transfer relative to admission were higher for children without insurance (odds ratio, 3.30; 95% confidence interval, 1.73-6.31) compared with patients with private insurance. The odds of transfer were similar for children with Medicaid compared with children with private insurance (odds ratio, 1.23; 95% confidence interval, 0.80-1.88). Transfer rates also varied across mental health diagnostic categories. Patients without insurance had higher odds of transfer compared with those with private insurance when they presented with depressive disorder, bipolar disorder, attention-deficit/conduct disorders, and schizophrenia. CONCLUSIONS Children presenting to an ED with a mental health emergency who do not have insurance are more likely to be transferred to another hospital than to be admitted and treated locally compared with those with private insurance. Future studies are needed to determine factors that may protect patients without insurance from disparities in access to care.
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Schimmel J, Vargas‐Torres C, Genes N, Probst MA, Manini AF. Changes in alcohol-related hospital visits during COVID-19 in New York City. Addiction 2021; 116:3525-3530. [PMID: 34060168 PMCID: PMC8212089 DOI: 10.1111/add.15589] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/07/2020] [Accepted: 05/19/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIMS Increased alcohol consumption has been proposed as a potential consequence of the coronavirus disease 2019 (COVID-19) pandemic. There has been little scrutiny of alcohol use behaviors resulting in hospital visits, which is essential to guide pandemic public policy. We aimed to determine whether COVID-19 peak restrictions were associated with increased hospital visits for alcohol use or withdrawal. Secondary objectives were to describe differences based on age, sex and race, and to examine alcohol-related complication incidence. DESIGN Multi-center, retrospective, pre-post study. SETTING New York City health system with five participating hospitals. PARTICIPANTS Adult emergency department encounters for alcohol use, alcoholic gastritis or pancreatitis or hepatitis, alcohol withdrawal syndrome, withdrawal seizure or delirium tremens. MEASUREMENTS Age, sex, race, site and encounter diagnosis. Encounters were compared between 2019 and 2020 for 1 March to 31 May. FINDINGS There were 2790 alcohol-related visits during the 2019 study period and 1793 in 2020, with a decrease in total hospital visits. Of 4583 alcohol-related visits, median age was 47 years, with 22.3% females. In 2020 there was an increase in percentage of visits for alcohol withdrawal [adjusted odds ratio (aOR) = 1.34, 95% confidence interval (CI) = 1.07-1.67] and withdrawal with complications (aOR = 1.40, 95% CI = 1.14-1.72), and a decline in percentage of hospital visits for alcohol use (aOR = 0.70, 95% CI = 0.59-0.85) and use with complications (aOR = 0.71, 95% CI = 0.58-0.88). It is unknown whether use visit changes mirror declines in other chief complaints. The age groups 18-29 and 60-69 years were associated with increased visits for use and decreased visits for withdrawal, as were non-white race groups. Sex was not associated with alcohol-related visit changes despite male predominance. CONCLUSIONS In New York City during the initial COVID-19 peak (1 March to 31 May 2020), hospital visits for alcohol withdrawal increased while those for alcohol use decreased.
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Affiliation(s)
- Jonathan Schimmel
- Department of Emergency MedicineIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | - Carmen Vargas‐Torres
- Department of Emergency MedicineIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | - Nicholas Genes
- Department of Emergency MedicineIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | - Marc A. Probst
- Department of Emergency MedicineIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | - Alex F. Manini
- Division of Medical Toxicology, Department of Emergency Medicine, Icahn School of Medicine at Mount SinaiElmhurst Hospital CenterNew YorkNYUSA
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Vuong KA, Manzanero S, Ungerer JPJ, Mitchell G, McWhinney B, Vallmuur K, Warren J, McCreanor V, Howell T, Pollard C, Schuetz M, Zournazi A, Cameron CM. Prevalence of Alcohol Consumption in Emergency department presentations (PACE) in Queensland, Australia, using alcohol biomarkers ethanol and phosphatidylethanol: an observational study protocol. BMJ Open 2021; 11:e047887. [PMID: 34753753 PMCID: PMC8578965 DOI: 10.1136/bmjopen-2020-047887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Alcohol use in patients presenting to the emergency department (ED) is a significant problem in many countries. There is a need for valid and reliable surveillance of the prevalence of alcohol use in patients presenting to the ED, to provide a more complete picture of the risk factors and inform targeted public health interventions. This PACE study will use two biomarkers, blood ethanol and phosphatidylethanol (PEth), to determine the patterns, presence and level of alcohol use in patients presenting to an Australian ED. METHODS AND ANALYSIS This is an observational prevalence study involving the secondary use of routinely collected blood samples from patients presenting to the Royal Brisbane and Women's Hospital (RBWH) Emergency and Trauma Centre (ETC). Samples will be tested for acute and medium-term alcohol intake using the two biomarkers blood ethanol and PEth respectively, over one collection period of 10-12 days. Descriptive statistics such as frequencies, percentages, means, SD, medians and IQRs, will be used to describe the prevalence, pattern and distribution of acute and medium-term alcohol intake in the study sample. The correlation between acute and medium-term alcohol intake levels will also be examined. ETHICS AND DISSEMINATION This study has been approved by the RBWH Human Research Ethics Committee (reference, LNR/2019/QRBW/56859). Findings will be disseminated to key stakeholders such as RBWH ETC, Australasian College for Emergency Medicine, Royal Australasian College of Surgeons, Statewide Clinical Networks, and used to inform clinicians and hospital services. Findings will be submitted for publication in peer-reviewed journals and presentation at appropriate conferences.
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Affiliation(s)
- Kim A Vuong
- Australian Centre for Health Services Innovation (AusHSI), Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
- Centre for Accident Research and Road Safety - Queensland (CARRS-Q), Queensland University of Technology, Brisbane, Queensland, Australia
| | - Silvia Manzanero
- Jamieson Trauma Institute, Royal Brisbane & Women's Hospital (RBWH), Metro North Health, Brisbane, Queensland, Australia
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Jacobus P J Ungerer
- Chemical Pathology, Pathology Queensland, Queensland Health, Royal Brisbane & Women's Hospital (RBWH), Metro North Health, Brisbane, Queensland, Australia
- Faculty of Biomedical Science, The University of Queensland, Brisbane, Queensland, Australia
| | - Gary Mitchell
- Royal Brisbane & Women's Hospital (RBWH), Metro North Health, Brisbane, Queensland, Australia
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Brett McWhinney
- Chemical Pathology, Pathology Queensland, Queensland Health, Royal Brisbane & Women's Hospital (RBWH), Metro North Health, Brisbane, Queensland, Australia
| | - Kirsten Vallmuur
- Australian Centre for Health Services Innovation (AusHSI), Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
- Jamieson Trauma Institute, Royal Brisbane & Women's Hospital (RBWH), Metro North Health, Brisbane, Queensland, Australia
| | - Jacelle Warren
- Australian Centre for Health Services Innovation (AusHSI), Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
- Jamieson Trauma Institute, Royal Brisbane & Women's Hospital (RBWH), Metro North Health, Brisbane, Queensland, Australia
| | - Victoria McCreanor
- Australian Centre for Health Services Innovation (AusHSI), Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
- Jamieson Trauma Institute, Royal Brisbane & Women's Hospital (RBWH), Metro North Health, Brisbane, Queensland, Australia
| | | | - Clifford Pollard
- Jamieson Trauma Institute, Royal Brisbane & Women's Hospital (RBWH), Metro North Health, Brisbane, Queensland, Australia
| | - Michael Schuetz
- Jamieson Trauma Institute, Royal Brisbane & Women's Hospital (RBWH), Metro North Health, Brisbane, Queensland, Australia
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Anna Zournazi
- Chemical Pathology, Pathology Queensland, Queensland Health, Royal Brisbane & Women's Hospital (RBWH), Metro North Health, Brisbane, Queensland, Australia
| | - Cate M Cameron
- Australian Centre for Health Services Innovation (AusHSI), Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
- Jamieson Trauma Institute, Royal Brisbane & Women's Hospital (RBWH), Metro North Health, Brisbane, Queensland, Australia
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Panken S, Wauters L, Gijbels R, Quintens H, Dorette AAA, Verelst S. The 12 -year evolution of emergency department alcohol-related admissions in a student city. Acta Clin Belg 2021; 77:742-747. [PMID: 34412571 DOI: 10.1080/17843286.2021.1966582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To investigate the trends in incidence of alcohol-intoxicated patients who present at the emergency department (ED), as well as the characteristics of these patients. METHODS Retrospective observational study based on data collected from 2008 until 2019 in two EDs in Leuven, Belgium. As a routine ED procedure, a blood alcohol concentration (BAC) test is ordered for all patients suspected of alcohol use as a primary presenting sign. Patients older than 10 years of age with a BAC ≥ 0.1 g/L were included. BAC levels, age, gender and proportion of repeat admissions were analysed. RESULTS The absolute number of patients with a positive BAC test increased from 1260 in 2008 to 1908 in 2019 (51.4%). Male-to-female ratio remained stable (2:1). In the University Hospital Leuven , the most represented age group shifted from 20-29 and 40-49 year olds (2008) to 50-59 year olds (2019). The most common age groups in Heilig Hart Leuven were 10-19 year olds and 20-29 year olds, which remained stable over the study period. The readmission rate was 18% within the entire study period with a range of 2 to 46 times. CONCLUSION Our study showed an annual increase in alcohol-related admissions. The highest rates of alcohol-related ED visits occurred in the age group 50-59. Patients with a repeat admission accounted for a large number of the total alcohol-related visits, placing a major burden on our healthcare system. It will be a challenge to timely detect patients at risk, regardless of their age, to prevent future ED admissions.
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Affiliation(s)
- Steffi Panken
- Department of Emergency Medicine, University Hospitals of Leuven, Leuven, Belgium
- Department of Public Health and Primary Care, Ku Leuven - University, Leuven, Belgium
| | - Lina Wauters
- Department of Emergency Medicine, University Hospitals of Leuven, Leuven, Belgium
- Department of Public Health and Primary Care, Ku Leuven - University, Leuven, Belgium
| | - Roos Gijbels
- Department of Emergency Medicine, University Hospitals of Leuven, Leuven, Belgium
- Department of Public Health and Primary Care, Ku Leuven - University, Leuven, Belgium
| | - Hilde Quintens
- Department of Emergency Medicine, Regionaal Ziekenhuis Heilig Hart Leuven, Leuven, Belgium
| | | | - Sandra Verelst
- Department of Emergency Medicine, University Hospitals of Leuven, Leuven, Belgium
- Department of Public Health and Primary Care, Ku Leuven - University, Leuven, Belgium
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Alcohol Medical Intervention Clinic: A Rapid Access Addiction Medicine Model Reduces Emergency Department Visits. J Addict Med 2021; 14:163-171. [PMID: 31403977 DOI: 10.1097/adm.0000000000000559] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Problematic alcohol use accounts for a large proportion of Emergency Department (ED) visits and revisits. We developed the Alcohol Medical Intervention Clinic (AMIC), a Rapid Access Addiction Medicine (RAAM) service, to reduce alcohol-related ED re-utilization and improve care for individuals with alcohol problems. This article describes the AMIC model and reports on an evaluation of its impact on patients and the ED system. METHODS Individuals presenting to The Ottawa Hospital Emergency Departments (TOH-ED) for an alcohol-related issue were referred to AMIC. Using data collected via medical chart review, and also self-report questionnaires, we assessed ED visits, revisits, and changes in alcohol use and mental health symptoms in patients before and after receiving services in AMIC. The incidence of alcohol-related ED visits and re-visits from 12-month periods before and after the introduction of AMIC were compared using data from TOH Data Warehouse. Connections made to additional services and patient satisfaction was also assessed. RESULTS For patients served by AMIC, from May 26, 2016 to June 30, 2017 (n = 194), there was an 82% reduction in 30-day visits and re-visits (P < 0.001). An 8.1% reduction in total alcohol-related 30-day TOH-ED revisit rates and a 10% reduction in total alcohol-related TOH-ED visits were found. After receiving AMIC services, clients reported reductions in alcohol use, depression, and anxiety (P < 0.001). CONCLUSIONS AMIC demonstrated positive impacts on patients and the healthcare system. AMIC reduced ED utilization, connected people with community services, and built system capacity to serve people with alcohol problems.
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Hulme J, Sheikh H, Xie E, Gatov E, Nagamuthu C, Kurdyak P. Mortality among patients with frequent emergency department use for alcohol-related reasons in Ontario: a population-based cohort study. CMAJ 2021; 192:E1522-E1531. [PMID: 33229348 DOI: 10.1503/cmaj.191730] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Little is known about the risk of death among people who visit emergency departments frequently for alcohol-related reasons, including whether mortality risk increases with increasing frequency of visits. Our primary objective was to describe the sociodemographic and clinical characteristics of this high-risk population and examine their 1-year overall mortality, premature mortality and cause of death as a function of emergency department visit frequency in Ontario, Canada. METHODS We conducted a population-based retrospective cohort study using linked health administrative data (Jan. 1, 2010, to Dec. 31, 2016) in Ontario for people aged 16-105 years who made at least 2 emergency department visits for mental or behavioural disorders due to alcohol within 1 year. We subdivided the cohort based on visit frequency (2, 3 or 4, or ≥ 5). The primary outcome was 1-year mortality, adjusted for age, sex, income, rural residence and presence of comorbidities. We examined premature mortality using years of potential life lost (YPLL). RESULTS Of the 25 813 people included in the cohort, 17 020 (65.9%) had 2 emergency department visits within 1 year, 5704 (22.1%) had 3 or 4 visits, and 3089 (12.0%) had 5 or more visits. Males, people aged 45-64 years, and those living in urban centres and lower-income neighbourhoods were more likely to have 3 or 4 visits, or 5 or more visits. The all-cause 1-year mortality rate was 5.4% overall, ranging from 4.7% among patients with 2 visits to 8.8% among those with 5 or more visits. Death due to external causes (e.g., suicide, accidents) was most common. The adjusted mortality rate was 38% higher for patients with 5 or more visits than for those with 2 visits (adjusted hazard ratio 1.38, 95% confidence interval 1.19-1.59). Among 25 298 people aged 16-74 years, this represented 30 607 YPLL. INTERPRETATION We observed a high mortality rate among relatively young, mostly urban, lower-income people with frequent emergency department visits for alcohol-related reasons. These visits are opportunities for intervention in a high-risk population to reduce a substantial mortality burden.
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Affiliation(s)
- Jennifer Hulme
- University Health Network (Hulme, Sheikh, Xie); Department of Family and Community Medicine (Hulme, Sheikh, Xie), University of Toronto; ICES (Gatov, Nagamuthu, Kurdyak); Institute for Mental Health Policy Research (Kurdyak), Centre for Addiction and Mental Health, Toronto, Ont
| | - Hasan Sheikh
- University Health Network (Hulme, Sheikh, Xie); Department of Family and Community Medicine (Hulme, Sheikh, Xie), University of Toronto; ICES (Gatov, Nagamuthu, Kurdyak); Institute for Mental Health Policy Research (Kurdyak), Centre for Addiction and Mental Health, Toronto, Ont
| | - Edward Xie
- University Health Network (Hulme, Sheikh, Xie); Department of Family and Community Medicine (Hulme, Sheikh, Xie), University of Toronto; ICES (Gatov, Nagamuthu, Kurdyak); Institute for Mental Health Policy Research (Kurdyak), Centre for Addiction and Mental Health, Toronto, Ont
| | - Evgenia Gatov
- University Health Network (Hulme, Sheikh, Xie); Department of Family and Community Medicine (Hulme, Sheikh, Xie), University of Toronto; ICES (Gatov, Nagamuthu, Kurdyak); Institute for Mental Health Policy Research (Kurdyak), Centre for Addiction and Mental Health, Toronto, Ont
| | - Chenthila Nagamuthu
- University Health Network (Hulme, Sheikh, Xie); Department of Family and Community Medicine (Hulme, Sheikh, Xie), University of Toronto; ICES (Gatov, Nagamuthu, Kurdyak); Institute for Mental Health Policy Research (Kurdyak), Centre for Addiction and Mental Health, Toronto, Ont
| | - Paul Kurdyak
- University Health Network (Hulme, Sheikh, Xie); Department of Family and Community Medicine (Hulme, Sheikh, Xie), University of Toronto; ICES (Gatov, Nagamuthu, Kurdyak); Institute for Mental Health Policy Research (Kurdyak), Centre for Addiction and Mental Health, Toronto, Ont.
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Personal Assessment of Ability to Drive Under the Influence of Alcohol vs. Objective Measurement. J Emerg Med 2021; 61:55-60. [PMID: 33785248 DOI: 10.1016/j.jemermed.2021.02.003] [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: 08/31/2020] [Revised: 10/04/2020] [Accepted: 02/06/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Alcohol intoxication often affects patient management in the emergency department. OBJECTIVE This study evaluates participants' subjective sense of impairment using ability to drive as a reference compared with measured breath alcohol concentrations (BrAC) and evaluate whether there is a gender difference. METHODS In this prospective study, 55 volunteers consumed one beer and estimated their BrAC and their ability to drive. BrAC was measured objectively and participants were blinded to the value until they reached a BrAC of 0.1 g/dL. Then they stopped drinking and estimated their BrAC and ability to drive every 30 min until objective BrAC reached 0.08 g/dL. RESULTS As BrAC increased, the association between estimated and perceived ability to drive was significantly different (p < 0.0001). At BrAC levels > 0.08 g/dL, 20.3% affirmed the ability to drive. At BrAC levels < 0.08 g/dL, 35.5% denied ability to drive. As BrAC decreased, the association between estimated and actual ability to drive was significantly different (p = 0.001). At BrAC values > 0.08 g/dL, 59.7% affirmed the ability to drive. At BrAC < 0.08 g/dL, 49.1% denied ability to drive. As BrAC increased, the correlations for men and women were strong and statistically significant (r = 0.80, p < 0.0001 and r = 0.79, p < 0.0001, respectively). As men's and women's BrAC decreased, the women's correlation was higher (r = 0.061 and r = 0.74, respectively; p < 0.0001). CONCLUSIONS Both genders can estimate their impaired ability to drive while drinking, but women are better at assessing their capacity to drive after drinking cessation.
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Stang JL, DeVries PA, Klein LR, Cole JB, Martel M, Reing ML, Raiter AM, Driver BE. Medical needs of emergency department patients presenting with acute alcohol and drug intoxication. Am J Emerg Med 2021; 42:38-42. [PMID: 33440329 DOI: 10.1016/j.ajem.2020.12.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/23/2020] [Accepted: 12/29/2020] [Indexed: 10/22/2022] Open
Abstract
STUDY OBJECTIVE Some contend that patients with acute alcohol or illicit substance intoxication should be treated in outpatient detoxification centers rather than in the ED. However, these patients often have underlying acute medical needs. We sought to determine the frequency of medical interventions required by ED patients with alcohol or illicit substance intoxication. METHODS This was a prospective observational study of consecutive ED patients presenting to an urban tertiary care ED with altered mental status due to alcohol or illicit substance use. We performed data collection for patients deemed to be low-risk for complications, as defined by receiving care in an intoxication observation unit. Trained staff observed and recorded all medical interventions, including medications administered, diagnostic testing, procedures performed, and airway interventions. The incidence of agitation was recorded using the Altered Mental Status Scale (AMSS, ordinal scale from -4 to +4, where +4 is most agitated). The data analysis is descriptive. RESULTS This analysis included 2685 encounters (1645 unique patients; median age 39; 73% male) from January to May 2019. Average breath alcohol concentration was 0.20 g/dL (range 0.00-0.47). There were 89% encounters with alcohol intoxication, and in 17% encounters the patient was suspected or known to have drug intoxication (either alone or in conjunction with alcohol use). On arrival to the ED, 372 (14%) had agitation (AMSS +1 or higher) and 32 (1%) were profoundly agitated (AMSS +4). In total, 1526 (56%) received at least one intervention that could not be provided by a local detoxification or sobering facility. Of the study population, 955 (36%) received a sedating medication, 903 (34%) required physical restraints for patients or staff safety, 575 (21%) underwent imaging studies, 318 (12%) underwent laboratory testing, 367 (13%) received another intervention (IV access, EKG, splinting, wound care, etc). Additionally, 111 (4%) patients received an airway intervention (19 intubation, 23 nasal airway, 85 supplemental oxygen) and 275 (10%) required repositioning to protect the airway. There were 168 (6%) patients admitted to the hospital. CONCLUSION In this population of relatively low-risk ED patients with drug and alcohol intoxication, a substantial proportion of patients received medical interventions.
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Affiliation(s)
- Jamie L Stang
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA.
| | - Paige A DeVries
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Lauren R Klein
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Jon B Cole
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Marc Martel
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Mackenzie L Reing
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Abagail M Raiter
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Brian E Driver
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA
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Marshall B, McGlynn E, King A. Sobering centers, emergency medical services, and emergency departments: A review of the literature. Am J Emerg Med 2020; 40:37-40. [PMID: 33340876 DOI: 10.1016/j.ajem.2020.11.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 11/14/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Acute alcohol intoxication accounts for a large proportion of potentially unnecessary emergency department visits and expenditure. Sobering centers are a cheaper alternative treatment option for alcohol intoxication and can provide an opportunity to treat the psychosocial aspects of alcohol use disorder. OBJECTIVE OF THE REVIEW The objective of this review is to analyze the existing literature regarding the use of sobering centers, EMS and their role in transporting to sobering centers, and the appropriate triage of the intoxicated patient. DISCUSSION Excessive alcohol consumption accounts for an estimated $24.6 billion in healthcare costs and patients are often referred to the emergency department for expensive care. Current literature suggests sobering centers are an alternative to acute hospitalization and are safe, relatively inexpensive, and may facilitate more aggressive connection to resources such as longitudinal rehabilitation programs for the acutely intoxicated patient. EMS plays a pivotal role in triage and transportation of intoxicated individuals, but demonstration of outcomes in lacking. CONCLUSIONS Sobering centers are a cost effective alternative to emergency department visits for acute alcohol intoxication and further research is required to identify safe, effective protocols for EMS to triage patients to appropriate treatment destinations.
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Affiliation(s)
- Brandon Marshall
- Department of Emergency Medicine, Detroit Receiving Hospital, 4201 St. Antoine Street, UHC Suite 6F, Detroit, MI 48201, USA.
| | - Erin McGlynn
- Department of Emergency Medicine, Detroit Receiving Hospital, 4201 St. Antoine Street, UHC Suite 6F, Detroit, MI 48201, USA.
| | - Andrew King
- Department of Emergency Medicine, Detroit Receiving Hospital, 4201 St. Antoine Street, UHC Suite 6F, Detroit, MI 48201, USA.
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Scheuermeyer FX, Miles I, Lane DJ, Grunau B, Grafstein E, Sljivic I, Duley S, Yan A, Chiu I, Kestler A, Barbic D, Moe J, Slaunwhite A, Nolan S, Ti L, Innes G. Lorazepam Versus Diazepam in the Management of Emergency Department Patients With Alcohol Withdrawal. Ann Emerg Med 2020; 76:774-781. [PMID: 32736932 DOI: 10.1016/j.annemergmed.2020.05.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/05/2020] [Accepted: 05/19/2020] [Indexed: 01/11/2023]
Affiliation(s)
- Frank X Scheuermeyer
- Department of Emergency Medicine, St Paul's Hospital and the University of British Columbia, Vancouver, British Columbia, Canada; Centre for Health Evaluation and Outcomes Sciences, St Paul's Hospital, Vancouver, British Columbia, Canada.
| | - Isabelle Miles
- Department of Emergency Medicine, St Paul's Hospital and the University of British Columbia, Vancouver, British Columbia, Canada; Centre for Health Evaluation and Outcomes Sciences, St Paul's Hospital, Vancouver, British Columbia, Canada; British Columbia Center for Substance Use, Vancouver, British Columbia, Canada
| | - Daniel J Lane
- Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Brian Grunau
- Department of Emergency Medicine, St Paul's Hospital and the University of British Columbia, Vancouver, British Columbia, Canada; Centre for Health Evaluation and Outcomes Sciences, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Eric Grafstein
- Department of Emergency Medicine, St Paul's Hospital and the University of British Columbia, Vancouver, British Columbia, Canada; Centre for Health Evaluation and Outcomes Sciences, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Igor Sljivic
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shayla Duley
- Department of Family Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alec Yan
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ivan Chiu
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew Kestler
- Department of Emergency Medicine, St Paul's Hospital and the University of British Columbia, Vancouver, British Columbia, Canada; Centre for Health Evaluation and Outcomes Sciences, St Paul's Hospital, Vancouver, British Columbia, Canada; British Columbia Center for Substance Use, Vancouver, British Columbia, Canada
| | - David Barbic
- Department of Emergency Medicine, St Paul's Hospital and the University of British Columbia, Vancouver, British Columbia, Canada; Centre for Health Evaluation and Outcomes Sciences, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Jessica Moe
- Department of Emergency Medicine, Vancouver General Hospital and the University of British Columbia, Vancouver, British Columbia, Canada; British Columbia Center for Disease Control, Vancouver, British Columbia, Canada
| | - Amanda Slaunwhite
- British Columbia Center for Disease Control, Vancouver, British Columbia, Canada
| | - Seonaid Nolan
- British Columbia Center for Substance Use, Vancouver, British Columbia, Canada
| | - Lianping Ti
- British Columbia Center for Substance Use, Vancouver, British Columbia, Canada
| | - Grant Innes
- Department of Emergency Medicine, Rockyview Hospital and the University of Calgary, Calgary, Alberta, Canada
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Vaca FE, Dziura J, Abujarad F, Pantalon MV, Hsiao A, Field CA, D'Onofrio G. Trial study design to test a bilingual digital health tool for alcohol use disorders among Latino emergency department patients. Contemp Clin Trials 2020; 97:106128. [PMID: 32950400 DOI: 10.1016/j.cct.2020.106128] [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
We describe an emergency department (ED)-based, Latino patient focused, unblinded, randomized controlled trial to empirically test if automated bilingual computerized alcohol screening and brief intervention (AB-CASI), a digital health tool, is superior to standard care (SC) on measures of alcohol consumption, alcohol-related negative behaviors and consequences, and 30-day treatment engagement. The trial design addresses the full spectrum of unhealthy drinking from high-risk drinking to severe alcohol use disorder (AUD). In an effort to surmount known ED-based alcohol screening, brief intervention, and referral to treatment process barriers, while addressing racial/ethnic alcohol-related health disparities among Latino groups, this trial will purposively use a digital health tool and seek enrollment of English and/or Spanish speaking self-identified adult Latino ED patients. Participants will be randomized (1:1) to AB-CASI or SC, stratified by AUD severity and preferred language (English vs. Spanish). The primary outcome will be the number of binge drinking days assessed using the 28-day timeline followback method at 12 months post-randomization. Secondary outcomes will include mean number of drinks/week and number of episodes of driving impaired, riding with an impaired driver, injuries, arrests, and tardiness and days absent from work/school. A sample size of 820 is necessary to provide 80% power to detect a 1.14 difference between AB-CASI and SC in the primary outcome. Showing efficacy of this promising bilingual ED-based brief intervention tool in Latino patients has the potential to widely and efficiently expand prevention efforts and facilitate meaningful contact with specialized treatment services.
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Affiliation(s)
- Federico E Vaca
- Yale School of Medicine, Department of Emergency Medicine, 464 Congress Avenue, Suite 260, New Haven, CT 06519, United States of America.
| | - James Dziura
- Yale School of Medicine, Department of Emergency Medicine, 464 Congress Avenue, Suite 260, New Haven, CT 06519, United States of America.
| | - Fuad Abujarad
- Yale School of Medicine, Department of Emergency Medicine, 464 Congress Avenue, Suite 260, New Haven, CT 06519, United States of America.
| | - Michael V Pantalon
- Yale School of Medicine, Department of Emergency Medicine, 464 Congress Avenue, Suite 260, New Haven, CT 06519, United States of America.
| | - Allen Hsiao
- Yale School of Medicine, Department of Emergency Medicine, 464 Congress Avenue, Suite 260, New Haven, CT 06519, United States of America; Yale School of Medicine, Department of Pediatrics, Section of Emergency Medicine, 100 York St, Suite 1F, New Haven, CT 06511, United States of America.
| | - Craig A Field
- University of Texas at El Paso, Latino Alcohol and Health Disparities Research Center (LAHDR), Psychology Building; Rooms 102 and 104, The University of Texas at El Paso, El Paso, TX 79968, United States of America.
| | - Gail D'Onofrio
- Yale School of Medicine, Department of Emergency Medicine, 464 Congress Avenue, Suite 260, New Haven, CT 06519, United States of America.
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Trial study design to test a bilingual digital health tool for alcohol use disorders among Latino emergency department patients. Contemp Clin Trials 2020; 96:106104. [PMID: 32777381 DOI: 10.1016/j.cct.2020.106104] [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: 04/20/2020] [Revised: 08/01/2020] [Accepted: 08/04/2020] [Indexed: 11/23/2022]
Abstract
We describe an emergency department (ED)-based, Latino patient focused, unblinded, randomized controlled trial to empirically test if automated bilingual computerized alcohol screening and brief intervention (AB-CASI), a digital health tool, is superior to standard care (SC) on measures of alcohol consumption, alcohol-related negative behaviors and consequences, and 30-day treatment engagement. The trial design addresses the full spectrum of unhealthy drinking from high-risk drinking to severe alcohol use disorder (AUD). In an effort to surmount known ED-based alcohol screening, brief intervention, and referral to treatment process barriers, while addressing racial/ethnic alcohol-related health disparities among Latino groups, this trial will purposively use a digital health tool and seek enrollment of English and/or Spanish speaking self-identified adult Latino ED patients. Participants will be randomized (1:1) to AB-CASI or SC, stratified by AUD severity and preferred language (English vs. Spanish). The primary outcome will be the number of binge drinking days assessed using the 28-day timeline followback method at 12 months post-randomization. Secondary outcomes will include mean number of drinks/week and number of episodes of driving impaired, riding with an impaired driver, injuries, arrests, and tardiness and days absent from work/school. A sample size of 820 is necessary to provide 80% power to detect a 1.14 difference between AB-CASI and SC in the primary outcome. Showing efficacy of this promising bilingual ED-based brief intervention tool in Latino patients has the potential to widely and efficiently expand prevention efforts and facilitate meaningful contact with specialized treatment services.
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Daya NR, Rebholz CM, Appel LJ, Selvin E, Lazo M. Alcohol Consumption and Risk of Hospitalizations and Mortality in the Atherosclerosis Risk in Communities Study. Alcohol Clin Exp Res 2020; 44:1646-1657. [PMID: 32524620 PMCID: PMC7484412 DOI: 10.1111/acer.14393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 06/03/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Public health recommendations on the benefits and harms of moderate alcohol intake require a thorough and unbiased understanding of all potential effects of various levels and patterns of alcohol consumption. We seek to evaluate the associations between patterns of current and past alcohol consumption with hospitalizations and mortality. METHODS Data came from a prospective cohort of 12,327 adults (56% women, 78% white, mean age 60 years) participating in the Atherosclerosis Risk in Communities study visit 3 (1993 to 1995). Current and past alcohol consumption was based on self-report. Hospitalizations and mortality were ascertained through December 31, 2017. Negative binomial and Cox proportional hazards regressions were used. RESULTS 24.8% of the study population reported never drinking, 48.3% reported currently drinking without a history of heavy drinking, 4.2% reported currently drinking with a history of heavy drinking, 19.2% reported being former drinkers without a history of heavy drinking, and 3.4% reported being former drinkers with a history of heavy drinking. Compared to those who reported drinking ≤1 to 7 drinks/wk, never drinkers (incident rate ratio [IRR]: 1.21 (95% confidence interval 1.13, 1.29) and former drinkers with (IRR: 1.43 [1.26, 1.63]) or without (IRR: 1.21 [1.13, 1.30]) a history of heavy drinking had a positive association with all-cause hospitalization (p < 0.001). Those who reported drinking ≤1 to 7 drinks/wk had the lowest all-cause mortality rate (19.2 per 1,000 person-years [18.4, 20.1]) and former drinkers with a history of heavy drinking had the highest (43.7 per 1,000 person-years [39.0, 49.1]). CONCLUSIONS The positive associations with hospitalization and mortality were stronger among never and former drinkers compared to those who consume ≤1 to 7 drinks/wk. Former drinkers with a history of heavy drinking had a stronger positive association with adverse health outcomes than former drinkers without a history of heavy drinking, highlighting the impact of this pattern of alcohol consumption.
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Affiliation(s)
- Natalie R Daya
- Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Casey M Rebholz
- Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Lawrence J Appel
- Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Elizabeth Selvin
- Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Mariana Lazo
- Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD
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Rönz K, Hirschi T, Becker S, Krummrey G, Exadaktylos AK, Sauter TC, Hautz WE, Müller M. Predictors of High Resource Consumption in Alcohol Intoxicated Patients in the Emergency Department. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17114122. [PMID: 32527025 PMCID: PMC7312041 DOI: 10.3390/ijerph17114122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/02/2020] [Accepted: 06/06/2020] [Indexed: 11/16/2022]
Abstract
Background: previous studies have reported that the incidence of alcohol-related visits to emergency departments (ED) has increased, but little is known about how the necessary resources per visit have changed, or about the predictors and reasons for resource consumption. Methods: a retrospective analysis was performed of all consultations with a primary or secondary diagnosis of acute alcohol intoxication admitted to the ED of Bern University Hospital, Switzerland, between 1 June 2012, and 31 May 2017. Clinical characteristics and resource consumption were extracted and analysed over time. Results: in all, 196,045 ED consultations included 2586 acute alcohol intoxications, corresponding to 1.3% of the total. The incidences of acute alcohol intoxications have tended to increase over the last five years, and a growing number of visits have consumed high resources (consultations above the 75th percentile for total resource consumption). High resource consumption was associated with greater age and the male gender (p < 0.001). The main predictors of resource consumption were fractures (Odds ratio (OR): 3.9, 95% CI 2.8–5.3, p < 0.001), dislocations (OR 3.7, 95%: 1.5–9.1, p < 0.001), and traumatic brain injury (3.5, 2.5–5.1, p < 0.001). Consultations consuming high resources mostly required radiology resources (45%); consultations consuming low or normal resources mostly required physicians’ work (45%) or nurses’ work (27%). Conclusions: the number of alcohol intoxications consuming high resources has increased over the last five years. Acute alcohol intoxication associated with trauma is resource intensive, especially with regard to radiology resources. This underlines the need for further efforts to prevent alcohol-related traffic accidents, for examples.
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Affiliation(s)
- Katharina Rönz
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.B.); (G.K.); (A.K.E.); (T.C.S.); (W.E.H.); (M.M.)
- Department of Emergency Medicine, Lindenhofspital, 3012 Bern, Switzerland
- Correspondence:
| | - Trevor Hirschi
- Department of Anaesthesiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland;
| | - Sebastian Becker
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.B.); (G.K.); (A.K.E.); (T.C.S.); (W.E.H.); (M.M.)
| | - Gert Krummrey
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.B.); (G.K.); (A.K.E.); (T.C.S.); (W.E.H.); (M.M.)
| | - Aristomenis K. Exadaktylos
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.B.); (G.K.); (A.K.E.); (T.C.S.); (W.E.H.); (M.M.)
| | - Thomas C. Sauter
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.B.); (G.K.); (A.K.E.); (T.C.S.); (W.E.H.); (M.M.)
- Medical Skills Lab, Universitätsmedizin Berlin, 12203 Charité Berlin, Germany
| | - Wolf E. Hautz
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.B.); (G.K.); (A.K.E.); (T.C.S.); (W.E.H.); (M.M.)
| | - Martin Müller
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.B.); (G.K.); (A.K.E.); (T.C.S.); (W.E.H.); (M.M.)
- Institute of Health Economics and Clinical Epidemiology, University Hospital of Cologne, 50935 Cologne, Germany
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Myran DT, Hsu AT, Smith G, Tanuseputro P. Rates of emergency department visits attributable to alcohol use in Ontario from 2003 to 2016: a retrospective population-level study. CMAJ 2020; 191:E804-E810. [PMID: 31332048 DOI: 10.1503/cmaj.181575] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2019] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Alcohol use causes a large burden on the health of Canadians, and alcohol-related harms appear to be increasing in many high-income countries. We sought to analyze changes in emergency department visits attributable to alcohol use, by sex, age and neighbourhood income over time. METHODS All individuals aged 10 to 105 years living in Ontario, Canada, between 2003 and 2016 were included in this study. The primary outcome was age-standardized rates of emergency department visits attributable to alcohol use, defined using diagnostic codes from the Canadian Institute for Health Information Health Indicator "hospitalizations entirely caused by alcohol." We compared rates of these visits using a retrospective population-level design. RESULTS Among 15 121 639 individuals, there were 765 346 emergency department visits attributable to alcohol use over the study period. Between 2003 and 2016, the age-standardized rates of these visits increased more in women (86.5%) than in men (53.2%), and the increase in rates of emergency department visits attributable to alcohol use was 4.4 times greater than the increases in the rates of overall emergency department visits. Individuals aged 25-29 years experienced the largest change in the rate of emergency department visits attributable to alcohol use (175%). We found evidence of age-cohort effects, whereby the rate of emergency department visits attributable to alcohol use at age 19 years increased on average by 4.07% (95% confidence interval [CI] 3.71%-4.44%) per year for each cohort born between 1986 and 1999. Individuals in the lowest neighbourhood income quintile had 2.37 (95% CI 2.27-2.49) times the rate of emergency department visits attributable to alcohol use than those in the highest income quintile. This disparity increased slightly over the study period. INTERPRETATION Although men and lower-income individuals have the highest burden of emergency department visits attributable to alcohol use, the largest increases in visits have been in women and younger adults. Further research should focus on potential causes of these trends to provide guidance on how to reduce alcohol-related harms.
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Affiliation(s)
- Daniel T Myran
- School of Epidemiology and Public Health (Myran), Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program (Hsu, Smith), The Ottawa Hospital, Ottawa Hospital Research Institute; ICES uOttawa (Smith); Bruyère Research Institute (Hsu, Tanuseputro); Department of Medicine (Tanuseputro), University of Ottawa, Ottawa, Ont.
| | - Amy T Hsu
- School of Epidemiology and Public Health (Myran), Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program (Hsu, Smith), The Ottawa Hospital, Ottawa Hospital Research Institute; ICES uOttawa (Smith); Bruyère Research Institute (Hsu, Tanuseputro); Department of Medicine (Tanuseputro), University of Ottawa, Ottawa, Ont
| | - Glenys Smith
- School of Epidemiology and Public Health (Myran), Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program (Hsu, Smith), The Ottawa Hospital, Ottawa Hospital Research Institute; ICES uOttawa (Smith); Bruyère Research Institute (Hsu, Tanuseputro); Department of Medicine (Tanuseputro), University of Ottawa, Ottawa, Ont
| | - Peter Tanuseputro
- School of Epidemiology and Public Health (Myran), Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program (Hsu, Smith), The Ottawa Hospital, Ottawa Hospital Research Institute; ICES uOttawa (Smith); Bruyère Research Institute (Hsu, Tanuseputro); Department of Medicine (Tanuseputro), University of Ottawa, Ottawa, Ont
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Milne LW, Williamson D, Kraus C, Wilcox SR. Intervention to decrease leaving without treatment among intoxicated emergency department patients. J Subst Abuse Treat 2020; 111:23-28. [DOI: 10.1016/j.jsat.2019.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 12/22/2019] [Accepted: 12/27/2019] [Indexed: 10/25/2022]
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Derivation and validation of a multivariable model, the alcohol withdrawal triage tool (AWTT), for predicting severe alcohol withdrawal syndrome. Drug Alcohol Depend 2020; 209:107943. [PMID: 32172129 DOI: 10.1016/j.drugalcdep.2020.107943] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 02/25/2020] [Accepted: 02/25/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Alcohol withdrawal and its consequences are a common concern for the large numbers of patients who present to emergency departments (EDs) with alcohol use disorders. While the majority of patients who go on to develop alcohol withdrawal experience only mild symptoms, a small proportion will experience seizures or delirium tremens. The aim of this study was to develop a tool to predict the need for hospital admission in patients at risk for alcohol withdrawal using only objective criteria that are typically available during the course of an ED visit. METHODS We conducted a retrospective study at an academic medical center. Our primary outcome was severe alcohol withdrawal syndrome (SAWS), which we defined as a composite of delirium tremens, seizure, or use of high benzodiazepine doses. All candidate predictors were abstracted from the electronic health record. A logistic regression model was constructed using the derivation dataset to create the alcohol withdrawal triage tool (AWTT). RESULTS Of the 2038 study patients, 408 20.0 %) developed SAWS. We identified eight independent predictors of SAWS. Each of the predictors in the regression model was assigned one point. Summing the points for each predictor generated the AWTT score. An AWTT score of 3 or greater was defined as high risk based on sensitivity of 90 % and specificity of 47 % for predicting SAWS. CONCLUSIONS We were able to identify a set of objective, timely, independent predictors of SAWS. The predictors were used to create a novel clinical prediction rule, the AWTT.
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Marco CA, Gangidine M, Greene PJ, Taitano D, Holbrook MB, Ballester M. Delayed diagnosis of splenic injuries: A case series. Am J Emerg Med 2020; 38:243-246. [DOI: 10.1016/j.ajem.2019.04.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/23/2019] [Accepted: 04/24/2019] [Indexed: 11/30/2022] Open
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Verheij C, Rood PPM, Deelstra CK, Levendag MLL, Koch BCP, Polinder S, Schuit SCE, Haagsma JA. Emergency Department visits due to intoxications in a Dutch university hospital: Occurrence, characteristics and health care costs. PLoS One 2019; 14:e0226029. [PMID: 31856178 PMCID: PMC6922372 DOI: 10.1371/journal.pone.0226029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 11/19/2019] [Indexed: 11/19/2022] Open
Abstract
Background Intoxications with alcohol and drugs are common in the Emergency Department. This study aimed to describe the occurrence and characteristics of intoxications (alcohol, Drugs of Abuse (DOA), pharmaceutical and chemical) presented to the Emergency Department and the health care costs of these intoxications. Methods This was a retrospective medical record study of all patients (≥ 16 years) who presented to the Emergency Department of an inner-city academic hospital in the Netherlands due to single or multiple intoxication(s) as the primary or secondary reason in the year 2016. An intoxication was reported as present if the attending physician described the intoxication in the patient’s medical record. Results A total of 783 patients were included, accounting for 3.2% of the adult Emergency Department population (age ≥ 16 year). In 30% more than one substance was used. Intoxications with alcohol, Drugs of Abuse and pharmaceuticals was reported in respectively 62%, 29% and 21% of the intoxicated patients. The mean costs per patient presenting with an intoxication to the Emergency Department was € 1,490. The mean costs per patient were highest for pharmaceutical intoxications (€ 2,980), followed by Drugs of Abuse (€ 1,140) and alcohol (€ 1,070). Conclusions Intoxications among patients aged 16 years and older are frequently seen at the Emergency Department and are frequently caused by multiple substances. Alcohol is the most common intoxication. Substantial healthcare costs are involved. Therefore, this study suggests that further research into hazardous alcohol consumption and DOA abuse is warranted.
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Affiliation(s)
- C. Verheij
- Department of Emergency Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- * E-mail:
| | - P. P. M. Rood
- Department of Emergency Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - C. K. Deelstra
- Department of Emergency Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - M. L. L. Levendag
- Department of Emergency Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - B. C. P. Koch
- Department of Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - S. Polinder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - S. C. E. Schuit
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - J. A. Haagsma
- Department of Emergency Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Implementing and Evaluating SBIRT for Alcohol Use at a Level 1 Trauma Center: A Behavioral Medicine Approach. J Clin Psychol Med Settings 2019; 27:376-384. [DOI: 10.1007/s10880-019-09681-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Fischer M, Plorde M, Meischke H, Husain S. Lessons learned from a sobering center pilot for acute alcohol intoxication in South King County, Washington. JOURNAL OF SUBSTANCE USE 2019. [DOI: 10.1080/14659891.2019.1664666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Marlee Fischer
- Department of Health Services, University of Washington, Seattle, Washington, USA
| | - Michele Plorde
- Emergency Medical Services Division, Public Health – Seattle & King County, Seattle, Washington, USA
| | - Hendrika Meischke
- Department of Health Services, University of Washington, Seattle, Washington, USA
| | - Sofia Husain
- Emergency Medical Services Division, Public Health – Seattle & King County, Seattle, Washington, USA
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Triage of Mild Head-Injured Intoxicated Patients Could Be Aided by Use of an Electroencephalogram-Based Biomarker. J Neurosci Nurs 2019; 51:62-66. [DOI: 10.1097/jnn.0000000000000420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Smith-Bernardin SM, Kennel M, Yeh C. EMS Can Safely Transport Intoxicated Patients to a Sobering Center as an Alternate Destination. Ann Emerg Med 2019; 74:112-118. [PMID: 30926186 DOI: 10.1016/j.annemergmed.2019.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 01/10/2019] [Accepted: 02/04/2019] [Indexed: 11/19/2022]
Abstract
STUDY OBJECTIVE We evaluate a sobering center as an alternate destination for acute intoxication. Our aims are to count patient visits that originated from emergency medical services (EMS) or the emergency department (ED) that then result in a secondary transfer from the sobering center to the ED, and to describe and categorize the clinical reasons for transfer to the ED. METHODS The San Francisco Sobering Center, a continuously nurse-staffed facility operating since 2003, provides short-term (6- to 8-hour) care for adults with acute alcohol intoxication. Paramedics use a county EMS protocol to triage low-risk intoxicated patients to the sobering center. A case review was performed on all visitors during 3 years who were secondarily transferred from the sobering center. Reason for transfer was categorized by clinical indication. RESULTS From July 2013 to June 2016, 11,596 visits (from 3,268 unduplicated adults) were documented. Of these, 4,045 (35%) were referred by EMS and 1,348 (12%) were referred from the ED. Other referring parties included the mobile van service, police, homeless service provider, self-referral, and others. Of the total visitors, 506 (4.4%; 95% confidence interval 4.0% to 4.8%) were secondarily transferred to an ED; 151 were referred by EMS and 62 by the ED. Clinical indications for ED transfer included pulse greater than 100 beats/min (26%), alcohol withdrawal (19%), pain (excluding chest pain) (19%), altered mental status (13%), and emesis (13%). Most clients had more than one clinical indication for transfer (median 2; range 1 to 5). CONCLUSION The San Francisco Sobering Center is an appropriate, safe EMS destination for patients with acute alcohol intoxication.
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Affiliation(s)
- Shannon M Smith-Bernardin
- School of Nursing, University of California-San Francisco, CA; San Francisco Department of Public Health, San Francisco, CA.
| | - Megan Kennel
- San Francisco Department of Public Health, San Francisco, CA
| | - Clement Yeh
- Department of Emergency Medicine, University of California-San Francisco, CA; Division of Emergency Medical Services, San Francisco Department of Emergency Management, San Francisco, CA
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Vipond J, Mennenga HA. Screening, Brief Intervention, and Referral to Treatment by Emergency Nurses: A Review of the Literature. J Emerg Nurs 2019; 45:178-184. [DOI: 10.1016/j.jen.2018.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 09/19/2018] [Accepted: 10/23/2018] [Indexed: 10/27/2022]
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Wai JM, Aloezos C, Mowrey WB, Baron SW, Cregin R, Forman HL. Using clinical decision support through the electronic medical record to increase prescribing of high-dose parenteral thiamine in hospitalized patients with alcohol use disorder. J Subst Abuse Treat 2019; 99:117-123. [PMID: 30797383 DOI: 10.1016/j.jsat.2019.01.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 01/20/2019] [Accepted: 01/23/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with alcohol use disorder (AUD) are at an increased risk of developing Wernicke's encephalopathy (WE), a devastating and difficult diagnosis caused by thiamine deficiency. Even as AUD is present in up to 25% of hospitalized patients on medical floors, appropriate thiamine supplementation in the hospital setting remains inadequate. These patients are particularly susceptible to thiamine deficiency and subsequent WE due to both their alcohol use and active medical illnesses. The electronic medical record (EMR) has become ubiquitous in health care systems and can be used as a tool to improve the care of hospitalized patients. METHODS As a quality improvement initiative, we implemented a medication order panel in the EMR with autopopulated orders for thiamine dosing to increase the appropriate use of high-dose parenteral thiamine (HPT) for hospitalized patients with AUD. We conducted a retrospective cohort study of all inpatients with AUD who received an Addiction Psychiatry Consult Service consult three months before and after the EMR change. We compared the proportion of patients receiving HPT prior to consultation (primary outcome) and the length of stay (secondary outcome) between the historical control group and the EMR intervention group. RESULTS Patients in the EMR intervention group were significantly more likely to receive HPT than the historical control group (20.2% vs. 2.7%, p < 0.0001). This difference remained statistically significant when adjusted for potential confounders (OR: 9.89, 95% CI: [2.77, 35.34], p = 0.0004). There was a trend towards statistical significance that the intervention group had a higher likelihood of being prescribed any thiamine (76.6% vs. 64.6%, p = 0.06) and had a shorter length of stay (median (IQR): 3.8 (2.4, 7.0) vs. 4.6 (2.9, 7.8) days, p = 0.06). CONCLUSION These results indicate that providing autopopulated thiamine order panels for patients with AUD can be an effective method for specialty services to increase appropriate care practices without additional education or training for providers. Further research should consider the clinical outcomes of increasing HPT for patients with AUD.
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Affiliation(s)
- Jonathan M Wai
- Department of Psychiatry, Columbia University, 1051 Riverside Drive, Unit 66, Office 3705, New York, NY 10032, USA; Division on Substance Use Disorders, New York State Psychiatric Institute, Unit 66, Office 3705, New York, NY 10032, USA; Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA.
| | - Christopher Aloezos
- Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA; Department of Psychiatry, NYU School of Medicine, One Park Avenue, New York, NY 10016, USA
| | - Wenzhu B Mowrey
- Division of Biostatistics, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, USA
| | - Sarah W Baron
- Department of Medicine, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA
| | - Regina Cregin
- Department of Pharmacy, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA
| | - Howard L Forman
- Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA
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Hawk KF, Glick RL, Jey AR, Gaylor S, Doucet J, Wilson MP, Rozel JS. Emergency Medicine Research Priorities for Early Intervention for Substance Use Disorders. West J Emerg Med 2019; 20:386-392. [PMID: 30881562 PMCID: PMC6404722 DOI: 10.5811/westjem.2019.1.39261] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 01/22/2019] [Accepted: 01/25/2019] [Indexed: 11/15/2022] Open
Abstract
Introduction Patients with substance use disorders (SUDs) frequently seek emergency care, and the emergency department (ED) may be their only point of contact with the healthcare system. While the ED visit has been increasingly recognized as providing opportunity for interventions around substance use, many questions remain. Methods In December 2016 the Coalition on Psychiatric Emergencies (CPE) convened the first Research Consensus Conference on Acute Mental Illness, which consisted of clinical researchers, clinicians from emergency medicine, emergency psychiatry, emergency psychology, representatives from governmental agencies and patient advocacy groups. Background literature review was conducted prior to the meeting, and questions were iteratively focused, revised, voted on and ranked by perceived importance using nominal group method. Results The main goal of the SUD workgroup was to identify research priorities and develop a research agenda to improve the early identification of and management of emergency department (ED) patients with SUDs with the goal of improving outcomes. This article is the product of a breakout session on “Special Populations: Substance Use Disorder.” The workgroup identified with high consensus six research priorities for their importance related to the care of ED patients with SUDs in these overall domains: screening; ED interventions; the role of peer navigators; initiation of SUD management in the ED; specific patient populations that may impact the effectiveness of interventions including sociogenerational and cultural factors; and the management of the acutely intoxicated patient. Conclusion Emergency providers are increasingly recognizing the important role of the ED in reducing adverse outcomes associated with untreated SUDs. Additional research is required to close identified knowledge gaps and improve care of ED patients with SUD.
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Affiliation(s)
- Kathryn F Hawk
- Yale University, Department of Emergency Medicine, New Haven, Connecticut
| | - Rachel L Glick
- University of Michigan, Department of Psychiatry, Ann Arbor, Michigan
| | - Arthur R Jey
- Sutter Medical Center, Department of Emergency Medicine, Sacramento, California
| | - Sydney Gaylor
- University of California-San Diego, Department of Emergency Medicine, San Diego, California
| | | | - Michael P Wilson
- University of Arkansas for Medical Sciences, Department of Emergency Medicine, Little Rock, Arkansas
| | - John S Rozel
- University of Pittsburgh, Department of Psychiatry, Pittsburgh, Pennsylvania
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Phillips T, Coulton S, Drummond C. Burden of Alcohol Disorders on Emergency Department Attendances and Hospital Admissions in England. Alcohol Alcohol 2019; 54:516-524. [PMID: 33724349 DOI: 10.1093/alcalc/agz055] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 05/02/2019] [Accepted: 06/20/2019] [Indexed: 11/13/2022] Open
Abstract
AIMS This study aims to estimate the prevalence and burden of alcohol disorders on Emergency Department (ED) and hospital inpatients in England through the exploratory analysis of NHS data. METHODS ED attendances and admission data were linked using hospital episode statistics. Diagnoses were preserved at a patient level to identify individuals who had an alcohol attributable diagnosis. Four groups were identified; a) individuals with no alcohol disorder (NAD), b) acute alcohol disorder (AAD), c) chronic alcohol disorder (CAD) and d) those with any alcohol disorder (AD) (b) and c) combined). Associations between ED diagnosis and alcohol disorders were examined using logistic regression adjusted for hospital provider, age and sex. Non-parametric tests were employed examining ED and hospital service use. Cost differences by group was explored using a propensity scored match sample. RESULTS Of the 1.2million subjects 6.7% were identified as having one or more AD accounting for 11.7% of ED attendances, 9.2% of hospital admissions and 7.2% total bed days. Bootstrapped derived means identified that hospital service use varied significantly between AAD and CAD. Whilst AAD accounted for greater attendances than NAD (2.78; 95% CI 2.680-2.879) those with CAD accounted for even greater attendances (4.33; 95% CI. 4.136-4.515), admissions (2.56; 95% CI. 2.502-2.625) and total bed days (15.14; 95% CI. 14.716-15.559). CONCLUSIONS AD place a disproportionate impact on hospital services with CAD exerting the greatest burden on hospital utilization. The complexity and burden of CAD suggests this group should be a priority for intervention.
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Affiliation(s)
- Thomas Phillips
- Institute for Clinical and Applied Health Research (ICAHR), University of Hull, Hull, UK.,Addictions Department, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Simon Coulton
- Centre for Health Services Studies, University of Kent, Canterbury, Kent, UK
| | - Colin Drummond
- Addictions Department, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Cole JB, Klein LR, Martel ML. Parenteral Antipsychotic Choice and Its Association With Emergency Department Length of Stay for Acute Agitation Secondary to Alcohol Intoxication. Acad Emerg Med 2019; 26:79-84. [PMID: 29851193 DOI: 10.1111/acem.13486] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 05/20/2018] [Accepted: 05/25/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Acute agitation secondary to alcohol intoxication frequently requires parenteral sedatives for patient and caregiver safety. Antipsychotics play a prominent role; however, no consensus exists regarding the ideal agent. One important consideration when evaluating the choice of antipsychotic is its association with emergency department (ED) length of stay (LOS). OBJECTIVES We sought to determine the median ED LOS for patients receiving a single parenteral dose of an antipsychotic for acute agitation secondary to alcohol intoxication in an urban Level I trauma center. METHODS This was a retrospective review of patients receiving a single parenteral dose of droperidol, haloperidol, or olanzapine who were acutely intoxicated on alcohol from 2011 to 2016. Patients needing psychiatric assessment in our ED are discharged to a geographically separate department; thus, ED LOS is minimally impacted by waits for psychiatric assessment. Data were abstracted from the electronic medical record and are presented descriptively. RESULTS A total of 40,601 patients were identified and screened; 24,319 patients were intoxicated but received no sedation. Of those remaining 4,495 received multiple drugs and/or benzodiazepines leaving 11,787 for analysis. Median age was 42 years, 76% were male, and 5% of patients were admitted. Mean breath ethanol concentration was 227 mg/dL. Antipsychotics administered were as follows: droperidol (n = 3,790), haloperidol (n = 1,449), and olanzapine (n = 6,548). Median ED LOS was shortest for droperidol (499 minutes, 95% confidence interval [CI] = 493-506 minutes), which was significantly shorter than both haloperidol (524 minutes, 95% CI = 515-537 minutes) and olanzapine (533 minutes, 95% CI = 528-539 minutes). No cases of sudden cardiac death occurred. CONCLUSION Droperidol, when given as monotherapy for sedation of acute agitation secondary to alcohol intoxication, was associated with significantly shorter ED LOS than either parenteral haloperidol or parenteral olanzapine. No difference in ED LOS was observed between haloperidol and olanzapine.
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Affiliation(s)
- Jon B. Cole
- Department of Emergency Medicine Hennepin County Medical Center Minneapolis MN
| | - Lauren R. Klein
- Department of Emergency Medicine Hennepin County Medical Center Minneapolis MN
| | - Marc L. Martel
- Department of Emergency Medicine Hennepin County Medical Center Minneapolis MN
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Terry-McElrath YM, Patrick ME. Simultaneous Alcohol and Marijuana Use Among Young Adult Drinkers: Age-Specific Changes in Prevalence from 1977 to 2016. Alcohol Clin Exp Res 2018; 42:2224-2233. [PMID: 30277588 DOI: 10.1111/acer.13879] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 08/21/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND The overall prevalence of U.S. young adult alcohol use has decreased, but little is known about historical change in related behaviors such as simultaneous alcohol and marijuana (SAM) use that may increase alcohol-related risks and societal costs. The purpose of this paper was to examine historical change in SAM use prevalence among U.S. young adult alcohol users from 1977 to 2016, and consider the extent to which observed historical change in SAM use among alcohol users reflects co-occurring change in marijuana use during these years. METHODS Data on past 12-month alcohol, marijuana, and SAM use at up to 6 modal ages (19/20, 21/22, 23/24, 25/26, 27/28, and 29/30) were collected from 11,789 individuals (45.0% men) participating in the Monitoring the Future panel study. Annual prevalence estimates within modal age group were obtained; historical SAM use trends among alcohol and marijuana users were estimated. RESULTS From 2014 to 2016, SAM use was reported by approximately 30% of alcohol users aged 19/20 and 21/22, and 20 to 25% of alcohol users aged 23/24 through 29/30. Since the mid-1990s, age-specific historical trends in SAM use prevalence among alcohol users followed 1 of 4 patterns: significant increase followed by oscillating increases/decreases (at modal age 19/20), consistent and significant increases (at modal ages 21/22, 23/24, and 25/26), stability followed by increase (at modal ages 27/28), or stability (at modal ages 29/30). In contrast, SAM use trends among marijuana users primarily reflected stability, with some evidence of a decrease across time at modal ages 19/20 and 23/24. Historical change in SAM prevalence among alcohol users was strongly and positively correlated with changes in overall marijuana use prevalence. CONCLUSIONS A growing proportion of early and mid-young adult alcohol users reported SAM use, with the highest risk among those in the early years of young adulthood. Young adult SAM use may continue to increase in proportion to the degree that young adult marijuana use continues to increase.
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Affiliation(s)
| | - Megan E Patrick
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan
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