1
|
Conzelmann M, Hoidis A, Bruckner T, Popp E, Koschny R. Aspiration risk in relation to Glasgow Coma Scale score and clinical parameters in patients with severe acute alcohol intoxication: a single-centre, retrospective study. BMJ Open 2021; 11:e053619. [PMID: 34598990 PMCID: PMC8488741 DOI: 10.1136/bmjopen-2021-053619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES In alcohol intoxicated patients, the decision for or against airway protection can be challenging and is often based on the Glasgow Coma Scale (GCS). Primary aim of this study was to analyse the aspiration risk in relation to the GCS score and clinical parameters in patients with severe acute alcohol monointoxication. Secondary aim was the association between the blood alcohol level and the GCS score. SETTING Single-centre, retrospective study of alcoholised patients admitted to a German intensive care unit between 2006 and 2020. PARTICIPANTS A total of n=411 admissions were eligible for our analysis. CLINICAL MEASURES AND ANALYSIS The following data were extracted: age, gender, admission time, blood alcohol level, blood glucose level, initial GCS score, GCS score at admission, vital signs, clinical signs of aspiration and airway management measures. The empirical distribution of continuous and categorical data was calculated. Binary multivariable logistic regression analysis was used to identify possible risk factors for aspiration. RESULTS The mean age was 35 years. 72% (n=294) of the admissions were male. The blood alcohol level (mean 2.7 g/L±1.0, maximum 5.9 g/L) did not correlate with the GCS score but with the age of the patient. In univariate analysis, the aspiration risk correlated with blood alcohol level, age, GCS score, oxygen saturation, respiratory rate and blood glucose level and was significantly higher in male patients, on vomiting, and in patients requiring airway measures. Aspiration rate was 45% (n=10) in patients without vs 6% (n=3) in patients with preserved protective reflexes (p=0.0001). In the multivariate analysis, only age and GCS score were significantly associated with the risk of aspiration. CONCLUSION Although in this single-centre, retrospective study the aspiration rate in severe acute alcohol monointoxicated patients correlates with GCS and protective reflexes, the decision for endotracheal intubation might rather be based on the presence of different risk factors for aspiration.
Collapse
Affiliation(s)
- Michael Conzelmann
- Dept. of Human Toxicology & Health Risk Assessment, BASF Corporate Health Management, Ludwigshafen am Rhein, Germany
- Postgraduate Study "Toxicology and Environmental Toxicology", Rudolf Boehm Institute of Pharmacology and Toxicology, Leipzig, Germany
| | - Anne Hoidis
- Dept. of Gastroenterology, University Hospital Heidelberg, Heidelberg, Germany
| | - Thomas Bruckner
- Institute for Medical Biometry and Informatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Erik Popp
- Dept. of Anaesthesiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Ronald Koschny
- Dept. of Gastroenterology, University Hospital Heidelberg, Heidelberg, Germany
| |
Collapse
|
2
|
Odeta K, Auge L, Rokas S, Vankeviciene R, Dervinyte-Bongarzoni A, Sigita L. Clinical and Social Characteristics of Deliberately Intoxicated Minors Treated in Pediatric Intensive Care. Clin Med Insights Pediatr 2021; 15:11795565211029258. [PMID: 34349583 PMCID: PMC8287355 DOI: 10.1177/11795565211029258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/03/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The aim of the study was to determine and compare the clinical and social characteristics of minors using alcohol and drugs for inebriation, and the same for those using them for suicide. METHODS This study includes an analysis of case histories of adolescents hospitalized in the Pediatric Intensive Care Unit because of acute alcohol or/and drug intoxication in 2015 to 2017. Two groups (group I: inebriation, and group II: suicide) were compared on age, sex, severity of intoxication, used substances, presence of other self-harm evidence, and social status. RESULTS A total of 390 cases were registered: 78.21% in Group I and 21.79% in Group II. The Glasgow-Coma-Scale scores showed that patients from Group I were more severely intoxicated, with an average score of 11.47, whereas patients from Group II averaged 13.45 (P < .001). Self-harm was more prominent among minors from Group II, with an incidence of up to 65.09%. The most common substance used to become inebriated was alcohol (72.79%), and for committing suicide was medication (88.24%). Patients who were living in children's care homes composed 13.33% of all cases included into the study, despite the low frequency of these minors in Lithuania (0.8%). CONCLUSIONS The substance used for deliberate intoxication was mostly alcohol. Minors experiencing inebriation were hospitalized in worse clinical condition in comparison to those who had attempted suicide. Other signs of self-harm were significantly more common among suicidal minors. Living in children's care homes is a possible risk factor for deliberate intoxication among young people in Lithuania.
Collapse
Affiliation(s)
- Kinciniene Odeta
- Vilnius University Faculty of Medicine,
Vilnius, Lithuania
- Institute of Clinical Medicine,
Vilnius, Lithuania
- Clinic of Children’s Diseases, Vilnius,
Lithuania
| | | | - Sambaras Rokas
- Vilnius University Faculty of Medicine,
Vilnius, Lithuania
| | - Ramune Vankeviciene
- Vilnius University Faculty of Medicine,
Vilnius, Lithuania
- Institute of Clinical Medicine,
Vilnius, Lithuania
- Clinic of Children’s Diseases, Vilnius,
Lithuania
| | - Asta Dervinyte-Bongarzoni
- Vilnius University Faculty of Medicine,
Vilnius, Lithuania
- Institute of Clinical Medicine,
Vilnius, Lithuania
- Clinic of Psychiatry, Vilnius,
Lithuania
| | - Lesinskiene Sigita
- Vilnius University Faculty of Medicine,
Vilnius, Lithuania
- Institute of Clinical Medicine,
Vilnius, Lithuania
- Clinic of Psychiatry, Vilnius,
Lithuania
| |
Collapse
|
3
|
Acker A, Norris ML, Coo H, Santos A, Allain D, Dow K. Severe alcohol intoxication among Canadian Youth: A 2-year surveillance study. Paediatr Child Health 2019; 26:e82-e88. [PMID: 33747315 DOI: 10.1093/pch/pxz152] [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: 04/11/2019] [Accepted: 09/23/2019] [Indexed: 11/14/2022] Open
Abstract
Purpose To obtain data on Canadian youth, aged 11 to 15 years, presenting to paediatric emergency departments, with severe alcohol intoxication and to describe demographics, presentations to hospital, concurrent substance use, comorbidities, and short-term outcomes of admission to emergency departments. Methods Between March 2013 and February 2015, through the established methodology of the Canadian Paediatric Surveillance Program, Canadian paediatricians and paediatric subspecialists were surveyed monthly to identify cases of young adolescents presenting to paediatric emergency departments across Canada with severe alcohol intoxication. Those that identified cases were subsequently sent a detailed questionnaire. The detailed questionnaires were then screened to ensure the reported cases met the study's inclusion criteria. Results A total of 39 cases (18 females and 21 males) were included in the final analysis. Overall, results indicate over 90% of presenting youth had consumed spirits, 39% had concurrent substance use and 46% experienced serious medical morbidity. Almost two-thirds of youth were admitted to hospital for a period ranging from 10 hours to 5 days; 12 youth required intubation. Follow-up referrals were provided to two-thirds of youth, with variable supports given. No statistically significant differences between sexes were noted for blood alcohol level or concurrent substance use. Conclusion Although rates of alcohol use in adolescents have been steadily decreasing, results from this surveillance study suggest that severe intoxication arising from the use of alcohol alone, and with concurrent substance use, results in significant immediate health consequences in young adolescents. Results from this study also highlight characteristics of patients, initial treatments and initial referrals across Canadian paediatric healthcare facilities, the results of which highlight variability and may aid in the guidance of a future longitudinal study, prevention strategies, and public health messaging.
Collapse
Affiliation(s)
- Amy Acker
- Department of Pediatrics, Queen's University, Kingston, Ontario
| | - Mark L Norris
- Department of Pediatrics, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, Ontario
| | - Helen Coo
- Department of Pediatrics, Queen's University, Kingston, Ontario
| | - Alexandre Santos
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario
| | - Dominic Allain
- Department of Pediatrics, University of Alberta, Stollery Children's Hospital, Edmonton, Alberta
| | - Kimberly Dow
- Department of Pediatrics, Queen's University, Kingston, Ontario
| |
Collapse
|
4
|
Grüne B, Piontek D, Pogarell O, Grübl A, Groß C, Reis O, Zimmermann US, Kraus L. Acute alcohol intoxication among adolescents-the role of the context of drinking. Eur J Pediatr 2017; 176:31-39. [PMID: 27838776 DOI: 10.1007/s00431-016-2797-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 08/10/2016] [Accepted: 10/17/2016] [Indexed: 10/20/2022]
Abstract
UNLABELLED This study aims (1) to describe the context of drinking among adolescents with acute alcohol intoxication (AAI) by gender, (2) to explore temporal changes in the context of drinking and (3) to analyse the association between the context of drinking and blood alcohol concentration (BAC). A retrospective chart review of 12- to 17-year-old inpatients with AAI (n = 1441) of the years 2000 to 2006 has been conducted in five participating hospitals in Germany. Gender differences in the context of drinking were tested with t test and chi2 test. Differences over time were analysed using logistic regressions. Multivariate linear regression was used to predict BAC. Girls and boys differed in admission time, drinking situation, drinking occasion and admission context. No temporal changes in drinking situation and in admission to hospital from public locations or places were found. Higher BAC coincided with male gender and age. Moreover, BAC was higher among patients admitted to hospital from public places and lower among patients who drank for coping. CONCLUSION The results suggest gender differences in the context of drinking. The context of drinking needs to be considered in the development and implementation of target group-specific prevention and intervention measures. What is known: • The context of drinking, e.g. when, where, why and with whom is associated with episodic heavy drinking among adolescents. What is new: • Male and female inpatients with acute alcohol intoxication differ with regards to the context of drinking, i.e. in admission time, drinking situation, drinking occasion and admission context. • Being admitted to hospital from public places is associated with higher blood alcohol concentration.
Collapse
Affiliation(s)
- Bettina Grüne
- IFT Institut für Therapieforschung, Munich, Germany. .,Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University, Munich, Germany.
| | | | - Oliver Pogarell
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University, Munich, Germany
| | - Armin Grübl
- Children's Hospital and Polyclinic for Children's and Youth Medicine, TUM Klinikum Schwabing StKM GmbH, Munich, Germany
| | - Cornelius Groß
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Olaf Reis
- Clinic for Child and Adolescent Psychiatry, University Medicine of Rostock, Rostock, Germany
| | - Ulrich S Zimmermann
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Ludwig Kraus
- IFT Institut für Therapieforschung, Munich, Germany.,Centre for Social Research on Alcohol and Drugs (SoRAD), Stockholm University, Stockholm, Sweden
| |
Collapse
|
5
|
Jünger E, Gan G, Mick I, Seipt C, Markovic A, Sommer C, Plawecki MH, O'Connor S, Smolka MN, Zimmermann US. Adolescent Women Induce Lower Blood Alcohol Levels Than Men in a Laboratory Alcohol Self-Administration Experiment. Alcohol Clin Exp Res 2016; 40:1769-78. [PMID: 27340798 DOI: 10.1111/acer.13122] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 05/02/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND Adolescence is a critical period for the development of alcohol use disorders; drinking habits are rather unstable and genetic influences, such as male sex and a positive family history of alcoholism (FH), are often masked by environmental factors such as peer pressure. METHODS We investigated how sex and FH modulate alcohol use in a sample of 18- to 19-year-olds from the Dresden Longitudinal Study on Alcohol use in Young Adults. Adolescents reported their real-life drinking in a TimeLine Follow-Back interview. They subsequently completed a training and an experimental session of free-access intravenous alcohol self-administration (i.v. ASA) using the computer-assisted alcohol infusion system to control for environmental cues as well as for biological differences in alcohol pharmacokinetics. During i.v. ASA, we assessed subjective alcohol effects at 8 time points. RESULTS Women reported significantly less real-life drinking than men and achieved significantly lower mean arterial blood alcohol concentrations (aBACs) in the laboratory. At the same time, women reported greater sedation relative to men and rated negative effects as high as did men. A positive FH was associated with lower real-life drinking in men but not in women. In the laboratory, FH was not linked to i.v. ASA. Greater real-life drinking was significantly positively associated with higher mean aBACs in the laboratory, and all i.v. ASA indices were highly correlated across the 2 sessions. CONCLUSIONS We conclude that adolescent women chose lower aBACs because they experienced adverse alcohol effects, namely sedation and negative effects, at lower aBACs than men. A positive FH was not apparent as risk factor for drinking in our young sample. The i.v. ASA method demonstrated good external validity as well as test-retest reliability, the latter indicating that a separate training session is not required when employing the i.v. ASA paradigm.
Collapse
Affiliation(s)
- Elisabeth Jünger
- Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Gabriela Gan
- Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Dresden, Germany.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Inge Mick
- Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Christian Seipt
- Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Alexandra Markovic
- Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Christian Sommer
- Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Martin H Plawecki
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana
| | - Sean O'Connor
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana.,Roudebush Veterans Medical Center, Indianapolis, Indiana
| | - Michael N Smolka
- Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Ulrich S Zimmermann
- Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| |
Collapse
|