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El-Menyar A, Mekkodathil A, Consunji R, Abeid A, Latifi R, Rizoli S, Al-Thani H. Implementation of mandatory blood alcohol screening in trauma patients: A retrospective study from a tertiary trauma center in a Middle Eastern country. Alcohol 2024; 119:7-15. [PMID: 38043650 DOI: 10.1016/j.alcohol.2023.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 11/26/2023] [Accepted: 11/29/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Alcohol consumption is a significant risk factor for several types of injuries and trauma recidivism and remains an important public health concern worldwide. We aimed to describe the implementation of mandatory alcohol screening and the AUDIT tool among trauma patients admitted to a level 1 trauma center in a country with a partial ban on alcohol consumption. METHODS This was a retrospective analysis of trauma patients (>12 years old) who required hospital admission and underwent blood alcohol concentration (BAC) screening between 2014 and 2019. This was achieved via an enzymatic method using alcohol dehydrogenase for ethanol detection in the plasma and serum samples. Trauma patients with a BAC <2.2 mmol/L were referred to as "negative", and BAC >2.2 mmol/L was referred to as "BAC positive". A comparative analysis was performed between the two BAC groups. Alcohol Screening, Brief Intervention, Referral for Treatment [ASBIRT] program, and AUDIT were applied. RESULTS A total of 7326 BAC screening tests were performed on 7284 patients during the study period. With slight variation over the years, the compliance rate was 77% (70.4%-85.3%), and the test positivity rate was 10% (8.6%-12.5%). There were 42 repeated admissions, of which seven patients were BAC positive at every admission. Young age and non-Arab patients were more likely to test positive, and the main mechanism of injury (MOI) was road traffic-related trauma (p < 0.05). Assault and self-inflicted injuries were significantly higher in BAC-positive patients than in BAC-negative patients (18% vs. 4% and 2.7% vs. 1.3%, respectively; p = 0.001). The injury severity score (ISS) and mortality rate were comparable between the study groups. Patients with a positive BAC were significantly more likely to undergo pan-CT scan in the emergency department, intubation, and exploratory laparotomy than those with a negative BAC. In patients who sustained injuries due to assault, all-terrain vehicles, or motorcycle crashes, there was a significant association between the positivity of BAC tests and the patient's ISS. CONCLUSION Despite improvements in BAC screening in trauma admissions over the years, almost 20% of cases were missed. Although the mortality rates were comparable, alcohol consumption burdens resources in terms of excess imaging, intubation, open abdominal surgery, and possible disability. Further studies are needed to understand the key obstacles and challenges to achieving optimum compliance for screening in trauma settings.
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Affiliation(s)
- Ayman El-Menyar
- Trauma Surgery Section, Clinical Research, Hamad General Hospital (HGH), Doha, Qatar; Clinical Medicine, Weill Cornell Medical College, Doha, Qatar.
| | | | - Rafael Consunji
- Trauma Surgery Section, Injury Prevention Program, HGH, Doha, Qatar
| | - Aisha Abeid
- Trauma Surgery Section, Injury Prevention Program, HGH, Doha, Qatar
| | - Rifat Latifi
- Department of Surgery, Westchester Medical Center & New York Medical College, Valhalla, NY, United States
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Alabdulla M, Reagu S, Elhassan NM, Shinith D, Shiekh ST, Abbas MO, Chandrappa NSK. Emergency department presentations of alcohol and other substance misuse: first cross-sectional national study in Qatar. BMJ Open 2021; 11:e055181. [PMID: 34625419 PMCID: PMC8504350 DOI: 10.1136/bmjopen-2021-055181] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES This study attempts the first in a series of investigations into the misuse of alcohol and substances in Qatar. This study explores the emergency presentations of alcohol and substance abuse to all the state funded emergency departments (EDs) in the country which serve around 90% of the population over a 22-month period. Due to legal penalties for alcohol and substance use, and lack of subsidised community-based facilities, ED presentations are a good starting point to explore this burden. DESIGN AND PARTICIPANTS A retrospective population-based, cross-sectional study, analysing electronic patient records of all state funded EDs spanning a period of 22 months, from 1 January 2019 to 31 October 2020 was carried out. The study included all eligible individuals aged 18 or over. Primary reason/diagnosis for presentation containing any of the alcohol or substance use key words were included in the study using composite data capture forms by trained clinicians. RESULTS An overwhelming majority (95.5%) of the total 1495 cases presenting to the EDs with substance abuse were using alcohol. Only 2.1% of the cases were females. Those of Asian (non-Arab) constituted 70% of this group. Qatari citizens presented with highest proportion of substance abuse other than alcohol (23%). Overall, 2.26% of all presentations to the EDs were related to alcohol and substance abuse and this amounted to 3 ED visits per 10 000 of population per year. 56.6% of the cases presented over the weekend. Less than 1% were referred to psychiatry and no other meaningful rehabilitative interventions were offered to others. CONCLUSION As Qatar moves towards establishing community-based rehabilitative resources for alcohol and substances abuse, the findings from this study will help in shaping these developments. These can include ED-based routine screening for alcohol abuse and referral to rehabilitation services without fear of legal penalties.
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Affiliation(s)
- Majid Alabdulla
- Psychiatry, Hamad Medical Corporation, Doha, Qatar
- Qatar University, Doha, Qatar
| | - Shuja Reagu
- Psychiatry, Hamad Medical Corporation, Doha, Qatar
- Weill Cornell Medicine, Doha, Qatar
| | | | | | | | - Maha O Abbas
- Psychiatry, Hamad Medical Corporation, Doha, Qatar
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Abdelnaby M, Abdalla T, Al-Kahtani H, Al-Rayashi D, Bashir R, Wanas Y, Al-Neama A, Ibrahim H, Ibrahim H, Al-Adab A, Asim M, El-Menyar A. Demographics and clinical characteristics of alcohol-related admissions in a tertiary care hospital in Qatar: Does age matter? Qatar Med J 2021; 2021:36. [PMID: 34604015 PMCID: PMC8466544 DOI: 10.5339/qmj.2021.36] [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: 11/18/2020] [Accepted: 04/04/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Alcohol consumption is a major cause of acute and chronic health conditions associated with comorbidities and traumatic injuries, despite its partial prohibition in some countries. Moreover, alcohol-related hospital admissions increase the burden on the healthcare system. More than 80% of the population in Qatar comprises expatriates. This study aimed to analyze the demographics and clinical characteristics of subjects with alcohol-related emergency department (ED) visits/hospitalization with respect to different age groups in a single tertiary hospital in Qatar. METHODS It is a retrospective observational study of adult patients who visited the ED at Hamad General Hospital between January 2013 and March 2015 and were screened positive for alcohol use. Collected data included sociodemographic characteristics, blood alcohol concentration (BAC), pattern of admission, previous medical history, laboratory investigations, treatment, hospital course, and mortality. Data were compared with respect to the distribution of age groups such as < 25, 25-34, 35-44, 45-54, and >55 years. RESULTS In total, 1506 consecutively admitted patients screened positive for alcohol use were included in the study; the majority of them were males (95.6%), non-Qatari nationals (71.1%), and aged 35-44 years (30.9%). The age groups 35-44 years and 45-54 years showed the highest median BAC ([0.24 interquartile range (IQR: 0.14-0.33)] and [0.24 (IQR: 0.13-0.33)], respectively) as compared to the other age groups (P = 0.001). The pattern of hospital admission, sociodemographic status, presence of comorbidities, laboratory investigations, and mortality showed specific age-related distribution. Particularly, young adults were more likely to have a previous ED visit due to trauma, whereas older patients' previous hospital admissions were mostly related to various underlying comorbidities. CONCLUSION This study highlighted the patterns of age and clinico-epidemiological status of patients with alcohol-attributable hospital admissions. Our study showed that alcohol consumption was higher among the working-age group. Further studies are needed to investigate changes in the alcohol consumption patterns that may help plan for allocation of health resources and prevention of alcohol-related problems.
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Affiliation(s)
| | - Tasnim Abdalla
- College of Medicine, Qatar University, Doha, Qatar E-mail:
| | | | | | - Rim Bashir
- College of Medicine, Qatar University, Doha, Qatar E-mail:
| | - Yara Wanas
- College of Medicine, Qatar University, Doha, Qatar E-mail:
| | - Ahmed Al-Neama
- College of Medicine, Qatar University, Doha, Qatar E-mail:
| | - Hassan Ibrahim
- College of Medicine, Qatar University, Doha, Qatar E-mail:
| | | | - Aisha Al-Adab
- Department of Medicine, Hamad General Hospital, Doha, Qatar
| | - Mohammad Asim
- Trauma Surgery Section, Department of Surgery, Hamad General Hospital, Doha, Qatar
| | - Ayman El-Menyar
- Trauma Surgery Section, Department of Surgery, Hamad General Hospital, Doha, Qatar
- Clinical Medicine, Weill Cornell Medical School, Doha, Qatar
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Mollazehi M, El-Menyar A, Mekkodathil A, Consunji R, Al-Thani H. Violence -related injuries in a rapidly developing Middle Eastern country: a retrospective study from a level 1 trauma center. BMC Public Health 2020; 20:1640. [PMID: 33143676 PMCID: PMC7607632 DOI: 10.1186/s12889-020-09754-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 10/23/2020] [Indexed: 11/27/2022] Open
Abstract
Background Violence is a global public health concern leading to injuries, long-term physical, sexual or mental health problems and even mortality. The burden of violence-related injuries on hospital systems remains understudied in the Arabian Gulf region. The present study aimed to describe the epidemiology of hospitalized violence-related injuries in a rapidly developing Middle Eastern country. Methods A retrospective analysis from a level 1 trauma center, in the state of Qatar, was conducted. Data were retrieved from the Qatar national trauma registry for all patients who were admitted with violence-related injuries between June 2010 and June 2017. Analyzed data were used to compare hospitalized interpersonal and self-inflicted violence groups. Results The hospitalization rate of violence-related injuries was 4.6 per 100,000 population per year; it was significantly higher in males (5.5/100,000 males/year vs. 1.8/100,000 females/year) and younger persons, particularly in the 25–34 years old population (41%). South Asians constituted 55% of the affected study population. Interpersonal violence (76.7%) was the most common mechanism of injury. Significant differences between interpersonal and self-inflicted violence groups were evident, especially for the type of trauma (i.e. blunt or penetrating), injured body regions, alcohol use, injury severity, need for intubation and psychiatric referral (p < 0.05). Overall, in-hospital mortality was 6.4%; with a significantly higher rate in females (16% vs.5%, p = 0.001). Outcomes, including length of hospital stay and mortality, were comparable between the two study groups. Multivariate analysis showed that male gender and alcohol use were predictors for interpersonal violence whereas high Injury Severity Score (ISS) and low Glasgow Coma Scale (GCS) were predictors of hospital mortality. Conclusions The rate of hospitalization for violence-related injuries in Qatar is low; however, its burden on the trauma system is of concern. Although it comprised only 9.6% of the study population, females are more likely to get hospitalized following self-inflicted injuries when compared to interpersonal violence. The disproportionate burden of violence among South Asian and young populations warrants an evidence-based public health approach to appropriately address the risk factors and set prevention programs. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-020-09754-7.
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Affiliation(s)
- Monira Mollazehi
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Ayman El-Menyar
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar. .,Department of Clinical Medicine, Weill Cornell Medical College, Doha, Qatar. .,Trauma & Vascular Surgery Section, Hamad General Hospital, Hamad Medical Corporation & Weill Cornell Medical College, PO Box 3050, Doha, Qatar.
| | | | - Rafael Consunji
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Hassan Al-Thani
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
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El-Menyar A, Consunji R, Asim M, Mekkodathil A, Latifi R, Smith G, Parchani A, Al-Thani H. Traumatic brain injury in patients screened for blood alcohol concentration based on the mechanism of injury. Brain Inj 2019; 33:419-426. [DOI: 10.1080/02699052.2018.1553065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Ayman El-Menyar
- Clinical Research, Trauma &Vascular Surgery, Hamad General Hospital, Doha, Qatar
- Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
| | - Rafael Consunji
- Injury Prevention, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Mohammed Asim
- Clinical Research, Trauma &Vascular Surgery, Hamad General Hospital, Doha, Qatar
| | - Ahammed Mekkodathil
- Clinical Research, Trauma &Vascular Surgery, Hamad General Hospital, Doha, Qatar
| | - Rifat Latifi
- Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Gordon Smith
- Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ashok Parchani
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Hassan Al-Thani
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
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