C J Cherpitel
Breath analysis and self-reports as measures of alcohol-related emergency room admissions.
J Stud Alcohol. 1989 Mar;50(2):155-61.
Abstract/Text
This study reports breath-analyzer readings and self-reports as measures of alcohol-related admission to the emergency room of San Francisco General Hospital. A 20% probability sample of patients admitted during a 60-day period was breath analyzed and interviewed. Interviews and breath samples were obtained on 75% of the sample of 2,516 patients. Twice the proportion of injury patients compared to noninjury patients had positive admission breath samples and reported drinking prior to the event. Alcohol involvement reached 41% for self-reports among injured men and over half of both men and women injured in fights or assaults reported drinking prior to the event. Self-reported alcohol use was found to be a valid measure of alcohol consumption when compared to breath-analyzer readings for the same individuals. Emergency room patients may be more likely than others to provide accurate reports of alcohol consumption if they feel that disclosure of amount and timing of drinking prior to an injury or illness could be important in their care. The data suggest that self-reports when used in conjunction with a quantifiable estimate of blood alcohol may be an appropriate method of ascertaining alcohol's involvement in emergency room cases.
Lauren R Klein, Jon B Cole, Brian E Driver, Christopher Battista, Ryan Jelinek, Marc L Martel
Unsuspected Critical Illness Among Emergency Department Patients Presenting for Acute Alcohol Intoxication.
Ann Emerg Med. 2018 Mar;71(3):279-288. doi: 10.1016/j.annemergmed.2017.07.021. Epub 2017 Aug 24.
Abstract/Text
STUDY OBJECTIVE: Emergency department (ED) visits for acute alcohol intoxication are common, but this population is at risk for decompensation and occult critical illness. The purpose of this study is to describe the incidence and predictors of unsuspected critical illness among patients with acute alcohol intoxication.
METHODS: This was a retrospective observational study of ED patients from 2011 to 2016 with acute alcohol intoxication. The study cohort included patients presenting for alcohol intoxication, whose initial assessment was uncomplicated alcohol intoxication without any other active acute medical or traumatic complaints. The primary outcome was defined as the unanticipated subsequent use of critical care resources during the encounter or admission to an ICU. We investigated potential predictors for this outcome with generalized estimating equations.
RESULTS: We identified 31,364 eligible patient encounters (median age 38 years; 71% men; median breath alcohol concentration 234 mg/dL); 325 encounters (1%) used critical care resources. The most common diagnoses per 1,000 ED encounters were acute hypoxic respiratory failure (3.1), alcohol withdrawal (1.7), sepsis or infection (1.1), and intracranial hemorrhage (1.0). Three patients sustained a cardiac arrest. Presence of the following had an increased adjusted odds ratio (aOR) of developing critical illness: hypoglycemia (aOR 9.2), hypotension (aOR 3.8), tachycardia (aOR 1.8), fever (aOR 7.6), hypoxia (aOR 3.8), hypothermia (aOR 4.2), and parenteral sedation (aOR 2.4). The initial blood alcohol concentration aOR was 1.0.
CONCLUSION: Critical care resources were used for 1% of ED patients with alcohol intoxication who were initially assessed by physicians to have low risk. Abnormal vital signs, hypoglycemia, and chemical sedation were associated with increased odds of critical illness.
Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.
A B Lowenfels, T T Miller
Alcohol and trauma.
Ann Emerg Med. 1984 Nov;13(11):1056-60.
Abstract/Text
Available evidence implicates alcohol consumption as a major risk factor for almost all types of injury. An exceptionally strong relationship is noted between alcohol and motor vehicle accidents--particularly single-vehicle crashes. Recognition of the association between alcohol and trauma is important not only for proper care and for treatment of the underlying alcoholism, but to stimulate enactment of preventive measures aimed at reducing the risk of alcohol-associated injuries.
S C Chen, F Y Lin, K J Chang
Body region prevalence of injury in alcohol- and non-alcohol-related traffic injuries.
J Trauma. 1999 Nov;47(5):881-4.
Abstract/Text
OBJECTIVE: To explore the relationship between alcohol use and body region of injury in patients injured in traffic collisions.
MATERIALS AND METHODS: A prospective study of 381 patients involved in traffic collisions over the past 4 months. These patients were categorized as either using alcohol or not using alcohol on the day of the accident. Eighty of 381 patients (21%) had detectable blood alcohol concentrations. Age, sex, location of injury, helmet use, clinical diagnosis, Injury Severity Score, Glasgow Coma Scale score, and blood alcohol concentrations were collected for each patient. Blood alcohol concentrations were measured by the radioactive energy attenuation method.
RESULTS: The incidence of head, face, chest, abdomen, and extremity injury in patients with alcohol use was 39%, 56%, 13%, 15%, and 55%, respectively, and 26%, 32%, 15%, 12%, and 63% in those without alcohol use, respectively. The differences in the incidence of head and facial injuries were significant between these two groups (p<0.05). Mean blood alcohol concentrations in head, face, chest, abdomen, and extremity injury were 171, 204, 215, 231, and 163 mg/dL, respectively.
CONCLUSION: More injuries to the head and facial areas compared with other body parts were found in patients with alcohol use. However, alcohol level did not seem to influence the region of the body injured.
L M Gentilello, D M Donovan, C W Dunn, F P Rivara
Alcohol interventions in trauma centers. Current practice and future directions.
JAMA. 1995 Oct 4;274(13):1043-8.
Abstract/Text
Nearly half of all trauma beds are occupied by patients who were injured while under the influence of alcohol. Alcoholism plays such a significant role in trauma that efforts to reduce injury recurrence are unlikely to be successful if it remains untreated. An injury requiring hospitalization creates a unique opportunity to intervene and to motivate patients to alter their drinking behavior, thereby making trauma centers ideal sites to implement an alcohol screening, intervention, and referral program. However, despite emphasis on injury control and prevention, little has been done to incorporate alcohol intervention programs into care of the injured patient. Effective means of intervention exist that are consistent with the time, financial, and staffing constraints of trauma centers, and they should be implemented.
S Galbraith, W R Murray, A R Patel, R Knill-Jones
The relationship between alcohol and head injury and its effect on the conscious level.
Br J Surg. 1976 Feb;63(2):128-30.
Abstract/Text
The incidence of head injury has risen in recent years and now accounts for almost one-third of acute male surgical admissions to the Western Infirmary, Glasgow. A prospective study has established that in Glasgow alcohol is a major associated factor, 62% of males and 27% of females having detectable levels in the blood (greater than 5 mg/100 ml); in these patients the mean level was 193 mg/100 ml in men and 165 mg/100 ml in women. The alcohol level was significantly higher in patients who had had 'a fall under the influence', or had been the victims of an assault, than in those involved in traffic or other accidents. This suggests that alcohol may be an important contributroy cause of head injuries in this city. Depression of the conscious level occurred at blood alcohol levels aroung 200 mg/100 ml, but a significant number of patients in coma had a serious head injury.
Yosuke Homma, Takashi Shiga, Yuiko Hoshina, Kenji Numata, Michiko Mizobe, Yoshiyuki Nakashima, Jin Takahashi, Tetsuya Inoue, Osamu Takahashi, Hiraku Funakoshi
IV crystalloid fluid for acute alcoholic intoxication prolongs ED length of stay.
Am J Emerg Med. 2018 Apr;36(4):673-676. doi: 10.1016/j.ajem.2017.12.054. Epub 2017 Dec 26.
Abstract/Text
OBJECTIVES: Acute alcohol intoxication is often treated in emergency departments by intravenous crystalloid fluid (IVF), but it is not clear that this shortens the time to achieving sobriety. The study aim was to investigate the association of IVF infusion and length of stay in the ED.
METHODS: This single-center retrospective cohort study was conducted in Japan and included patients aged ≥20years of age and treated for acute alcohol intoxication without or with IVF. The primary outcome was the length of the ED stay and the treatments were compared by time-to-event analysis.
RESULTS: A total of 106 patients, 42 treated without IVF and 64 with IVF. The baseline characteristics of the two groups were similar. Kaplan-Meier analysis and the generalized Wilcoxon test found no significant difference between the two treatments in the time to ED discharge. The median time was 189 (IQR 160-230) minutes without IVF and 254.5 (203-267 minutes with IVF; p=0.052). A Cox proportional hazards regression model adjusted for potential confounding variables found that patients treated with IVF were less likely to be discharged earlier than those treated without IVF (HR 0.54, 95% CI: 0.35-0.84, p=0.006).
CONCLUSIONS: IVF for treatment of acute alcoholic intoxication prolonged ED length of stay even after adjustment for potential confounders. Patients given IVF for acute alcohol intoxication should be selected with care.
Copyright © 2017 Elsevier Inc. All rights reserved.
