Alcohol-related Emergency Department Presentations Research Articles

Changes in alcohol-related emergency department presentations—a comparison of three waves in 2013, 2017 and 2022

aims: Emergency departments (EDs) around the world are increasingly overcrowded, which is associated with significant patient harm. Alcohol use is a known contributor to ED overcrowding. This study aimed to assess trends in the characteristics of alcohol-related ED presentations over time. methods: A cross-sectional observational study of Christchurch ED attendances during 3-week waves of data collection in November–December 2013, 2017 and 2022 was conducted. Potential participants were those patients attending the Christchurch Hospital ED who had ingested alcohol in the 4 hours prior to arrival, and/or the presentation was thought to be related to alcohol. Those who consented to take part were interviewed to examine amount and source of alcohol. results: There has been a change in the age profile towards a greater proportion of older patients attending the ED with alcohol-related issues. In 2022, a greater proportion of alcohol was purchased from on-licence venues compared to previous years, although off-licence alcohol purchase and consumption in private locations remained the most common. conclusion: Alcohol use and harm places a significant, yet preventable, burden on EDs and the wider healthcare system. Implementation of evidence-based alcohol policies is urgently needed to reduce the impact of alcohol in the ED and improve the health of communities.

Alcohol-related emergency department presentations and hospital admissions around the time of minimum unit pricing in Ireland

BackgroundMinimum unit pricing (MUP) was recently introduced in Ireland to reduce alcohol-related harms. The size of the impact of alcohol on hospital emergency departments (EDs) in Ireland is poorly understood due to inconsistent alcohol screening and documentation. AimsWe sought to systematically characterise the volume, timing, and nature of alcohol-related presentations and admissions to a busy urban ED in Dublin, Ireland. MethodPatients presenting to the ED were assessed by a dedicated clinician during selected time periods before (Nov–Dec 2021) and after (Feb–Apr 2022) the introduction of MUP. A total of 725 interviews were conducted over 168 h in the ED. FindingsAlcohol consumption was a factor in 19.4% of ED presentations and in 17.3% of hospital admissions across the entire study period. A reduction in overall alcohol-related ED presentations was noted in the period following MUP, although it is not possible to conclude a direct effect. ConclusionAlcohol-related harm places a significant strain on EDs and hospitals, and the impact of MUP on hospital burden in Ireland merits further evaluation. Effective measures at local and population levels are urgently required to address this burden.

1390Utilisation of hospital Services during COVID 19 Pandemic in New Zealand

Abstract Background Many factors have impacted the use of hospital services during the COVID-19 pandemic. This work described the volume and pattern changes of emergency department (ED) and inpatient admissions during earlier pandemic period in New Zealand in 2020. Methods ED and inpatient admissions during the pandemic period were compared with the figures and characteristics in the same time period in the previous years Results Over the period, ED and inpatient admissions decreased by 25 and 20 percent respectively. Remarkable declines of 41% in ED and 40% in inpatient were observed during the alert level 4 lockdown period. In the ED admissions, the degree of the decline was higher in less urgent presentations (triage levels 4 and 5), young patients (aged 0-24 years) and the patients without long term conditions. In the inpatient admissions, the degree of the decline was higher in the patients with lower level of inpatient clinical complexity, young patients and the admissions of respiratory diseases (especially influenza), viral infections, and injuries due to traffic and sport accident. In contrast, some hospitalisations increased during the period, including alcohol-related ED presentations, bacterial infections and injuries related to falls and assault occurred in home. Conclusions The changes in hospitalisation utilisation are likely associated with the changes in people’s behaviour in seeking health services, in behaviours of health risk or protective factors, and the changes in healthcare provided to the population during the period. Key messages The results provide insights for further assessment of health needs and health services.

Alcohol-related harm in emergency departments: linking to subsequent hospitalizations to quantify under-reporting of presentations.

Alcohol-related harm in emergency departments: linking to subsequent hospitalizations to quantify under-reporting of presentations. To quantify the proportion of emergency department (ED) presentations that could be identified as alcohol-related when linking to a patient's subsequent hospitalization, compared with using ED data alone, and to assess that comparison according to the change in alcohol harm rates over time and potential variations within subpopulations. A retrospective study using linked hospital administrative data to identify ED patients who had subsequent alcohol-related hospitalizations. Western Australia. A total of 533 816 Western Australian young people (246 866 females and 286 950 males), aged 12-24years. Whether or not presentations of young people to ED could be identified as alcohol-related, and for those that were not, how many had a subsequent alcohol-related hospitalization. Rates and proportions of alcohol-related harm for both methods of ascertainment were estimated by sex and Aboriginality across different age groups. Alcohol-related hospitalizations that followed an initial presentation at ED allowed the identification of an additional 19 994 alcohol-related presentations (95% increase). Linking to additional hospitalization information also resulted in significant variation in alcohol-related harm trends. In particular, trends in alcohol-related ED presentations for 21-24-year-old males were stable to slightly increasing using only ED data, but decreased after linking with hospitalization data (P<0.05). Similarly, trends among Aboriginal persons aged 21-24 shifted from increasing using only ED data to being stable in comparison to presentations using subsequent hospitalizations (P<0.05). Among young people in Western Australia, twice as many emergency department presentations could be identified as being alcohol-related using diagnosis information from subsequent hospitalizations compared with emergency department data alone. When supplemented with hospitalization data, trends in alcohol-related harm presentations become significantly different within some subpopulations compared with using emergency department presentation data alone.

P108: Alcohol-related emergency department visits by youth aged 12-24: trends over 4 years in one Canadian centre

Introduction: Recent evidence shows an increase in alcohol-related emergency department (ED) visits among youth. Highly publicized collegiate rituals such as Homecoming may create a climate for problematic alcohol use. This study describes the frequency of youth alcohol-related ED visits per year and during pre-specified ritualized drinking dates in one academic centre. Methods: This was a chart review of patients aged 12-24 with alcohol-related ED presentations between Sept 2013-Aug 2017. The National Ambulatory Care Reporting System (NACRS) database was searched for visits with ICD-10 codes related to alcohol. The Canadian Hospital Injury Reporting and Prevention Program (CHIRPP) database was also searched using the keyword alcohol. Duplicate visits were removed. Visits were excluded if patients had a history of psychosis, were held in the ED for involuntary psychiatric assessment, were homeless, were inmates from a correctional institute, if alcohol use was not mentioned and for complaints of sexual assault/domestic violence. Data abstraction by two reviewers used a standard form with variables predetermined. Differences were resolved with third party adjudication. Interrater reliability of the reviewers was assessed through duplicate review of 10% of randomly selected charts. A further 10% were assessed by a 3rd reviewer for extraction accuracy. Results: A total of 3,256 ED visits were identified with 777 meeting exclusion criteria. The remaining 2,479 visits were reviewed and subclassified into injury (51.8%), acute intoxication (45.1%) and mental health issue (3.2%). Interrater agreement was high for extracted variables with Kappa scores &gt; 0.8. Despite a decrease in the region's youth population during the study period (28,325 to 25,125), overall standardized ED visits by youth increased by 12% (66,538 to 78,129). Adjusted for population, youth alcohol-related visits increased by 86.4% from 1,557 in 2013-14 to 2,902 in 2016-17. Co-ingestion of other substances was reported in 292 (11.8%) of visits, with cannabis the most common (57%). The 17 pre-specified ritualized days saw 578 (23.3%) of ED visits. Conclusion: Alcohol-related ED visits in youth are increasing in our region. Ritualized drinking dates appear to be particularly risky for youth with high rates of observed ED utilization. Strategies to manage high volume ritual days are being piloted, including temporary diversion to an in-hospital sobriety centre.

Effect of the Australian "Alcopops Tax" on Alcohol-Related Emergency Department Presentations for Injury in Two States.

The purpose of this study was to examine the impact of a specific tax increase on ready-to-drink beverages (the "alcopops" tax) on male injuries presenting to emergency departments during times likely to be highly alcohol related in two Australian states. Poisson regression was used to compare annual risk of Western Australian and Victorian male emergency department injuries occurring during high alcohol-related times before and after the implementation of the alcopops tax. A range of age groups was examined. Surrogate methodology was applied to identify numbers of emergency department injuries that occurred during high and low alcohol-related times. Risk of injury during high alcohol-related times (incident rate ratio [IRR]) was lower among Western Australian 12- to 15-year-olds beginning from the year of the tax increase and continued throughout. Lower IRRs were also apparent for 15- to 19-year-olds, although some delay was implicated. There was no change for 12- to 15-year-old Victorians, but immediate declines were evident for 15- to 19-year-olds. To a lesser extent, delayed effects were also indicated for 20- to 29-year-olds in both states. There was no evidence of a change in injury risk during high alcohol-related times among the oldest age group (35-39 years). Previous research on beverage-specific taxes has suggested that they may increase alcohol-related harms among the target group. This study found no evidence of increased injury during high alcohol-related times associated with the alcopops tax in two states. Evidence of reduced harm was apparent, however, and strongest for Western Australian males aged 19 years and younger. These outcomes are consistent with documented national reductions in alcopops sales.

Patterns of 'at-home' alcohol-related injury presentations to emergency departments.

This study aimed to establish the scale of alcohol-related injuries originating in the home. Despite recent media and public attention on alcohol-related injuries occurring at licensed venues, many occur in other locations including the home. A retrospective observational study. Emergency department surveillance data sourced from the Queensland Injury Surveillance Unit were interrogated for alcohol-related emergency department presentations from 2003-2012 (n=12,296). Descriptive analysis was undertaken to assess alcohol involvement in injury, and analysis of variance was used to determine the differences among group means and their associated presentations. The relationship between demographic variables and injury location was assessed using p value of <0·05 as statistically significant. Of all injuries that were positively identified as being alcohol related, 41·07% occurred at the 'other' location, 36·14% 'at home', 13·00% on the street and 9·78% at licensed premises. Of these, males (n=2635; 59%) represented a higher proportion than females (n=1807; 41%). Of injuries identified as domestic violence by spouse or partner (n=510), 59·5% occurred 'at home'. This is the first study to investigate alcohol-related injuries occurring at home. The home accounts for a greater proportion of injuries than the frequently assessed licensed premises location. Further research is required to validate these findings in a wider setting. A public health campaign is required to minimise harm associated with alcohol-related injuries in the home, and nurses are positioned to inform health policy makers around this issue. Furthermore, emergency department nurses are in a unique position to provide brief interventions around safe alcohol consumption and injury prevention.

Characteristics and comorbidity of drug and alcohol‐related emergency department presentations detected by nursing triage text

This study used nursing triage text to detect drug- and alcohol-related emergency department (ED) presentations and describe their patient and service delivery characteristics. Data were reviewed for all ED presentations from 2004 to 2006 (n = 263 937) from two hospitals in Sydney, Australia. Each record included two nursing triage free-text fields, which were searched for more than 100 drug-related and more than 60 alcohol-related terms. Adjusted odds ratios were used to compare the characteristics of drug and alcohol-related ED presentations with all other ED presentation types. Just over 5% of ED presentations were identified as alcohol-related and 2% as drug-related. The most prevalent drug-related ED presentations specified were related to amphetamines (18%), heroin (14%), cannabis (14%) and ecstasy (12%), while nearly half (43%) were drug unspecified. Polydrug use was mentioned in 25% of drug-related and 9% of alcohol-related ED presentations, with the highest rate of polydrug use among ecstasy-related (68%) presentations. Drug- and alcohol-related ED presentations were significantly more likely than other ED presentations to have a mental health diagnosis, with the highest rates found among cannabis-related (OR = 7.6) or amphetamine-related (OR = 7.5) presentations. The ED provides an opportunity for early intervention for patients presenting with comorbid drug and alcohol and mental health problems. Further research is needed to assess the prevalence of drug and alcohol problems in ED patients with mental health problems and to develop effective interventions in that setting.

Comparing methods of detecting alcohol-related emergency department presentations

Objectives:To assess the strengths and limitations of different methods for detecting alcohol-related emergency department (ED) presentations and to compare the characteristics of patients who present to the ED with an...

Why are alcohol‐related emergency department presentations under‐detected? An exploratory study using nursing triage text

This study examined two methods of detecting alcohol-related emergency department (ED) presentations, provisional medical diagnosis and nursing triage text, and compared patient and service delivery characteristics to determine which patients are being missed from formal diagnosis in order to explore why alcohol-related ED presentations are under-detected. Data were reviewed for all ED presentations from 2004 to 2006 (n = 118,881) for a major teaching hospital in Sydney, Australia. Each record included two nursing triage free-text fields, which were searched for over 60 alcohol-related terms and coded for a range of issues. Adjusted odds ratios were used to compare diagnostically coded alcohol-related presentations to those detected using triage text. Approximately 4.5% of ED presentations were identified as alcohol-related, with 24% of these identified through diagnostic codes and the remainder identified by triage text. Diagnostic coding was more likely if the patient arrived by ambulance [odds ratio (OR) = 2.35] or showed signs of aggression (OR = 1.86). Failure to code alcohol-related issues was more than three times (OR = 3.23) more likely for patients with injuries. Alcohol-related presentations place a high demand on ED staff and less than one-quarter have an alcohol-related diagnosis recorded by their treating doctor. In order for routine ED data to be more effective for detecting alcohol-related ED presentations, it is recommended that additional resources such as an alcohol health worker be employed in Australian hospitals. These workers can educate and support ED staff to identify more clearly and record the clinical signs of alcohol and directly provide brief interventions.

Racial Differences in Treatment of Alcohol-related Emergency Department Presentations

Racial Differences in Treatment of Alcohol-related Emergency Department Presentations