Alcohol-related Presentations Research Articles

Summer alcohol-related emergency department workload and occupancy in Australasia 2019-2022.

Alcohol is a major public health issue and the ACEM funds regular 'snapshot' surveys of the prevalence of alcohol-related presentations in EDs. The present study uses these data to investigate ED occupancy and alcohol- and methamphetamine-related presentations at the time of the COVID-19 pandemic. Survey-based point prevalence study of EDs in Australia and New Zealand conducted at 02:00 hours local time on the Saturday of the weekend before Christmas in 2019-2022. Primary outcomes were ED occupancy, the number of alcohol-related presentations and methamphetamine-related presentations in each ED at the time of survey. Seventy eight of a possible 152 hospitals answered all four surveys (51%, 95% confidence interval 43-59, individual yearly response rates ranged from 70.5% to 83.3%). The mean number of alcohol-related presentations in EDs at the snapshot time was 4.2 (95% confidence interval 3.2-5.2) in the 2019 survey and 3.8 (3.1-4.6) in 2022 with no significant variation over time. There was also no change in methamphetamine-related presentations which occurred at a lower level. There was a major increase in reported total ED occupancy - from 31.4 to 43.5 in Australia (P < 0.0001, paired t test) and from 22.8 to 38.7 in New Zealand (P = 0.0001). Subgroup analysis showed that both the number being treated and the number waiting to be seen increased, with little change in the number in observation units. The present study demonstrates that the COVID-19 pandemic did not affect summer alcohol-related ED presentations in Australasia but was associated with an unsustainable increase in ED crowding.

The Impact of Alcohol-Related Presentations to Emergency Departments on Days with a Public Holiday or Sporting Event: A Retrospective Cohort Study.

The consumption of alcohol within the Australian community continues to rise, impacting care delivery in already over-burdened emergency departments (EDs). This study aimed to examine the impact of alcohol-related presentations (ARPs) to EDs on days with a public holiday or sporting event. A retrospective cohort study was undertaken using routinely collected health data pertaining to patient presentations diagnosed with an alcohol-related disorder (ICD-10-AM code F10) to two EDs in Queensland, Australia from January 1, 2016 - December 31, 2020. Descriptive and inferential statistics were used to describe and compare ARPs on event days versus non-event days and uncomplicated versus other ARPs on event days only. Of all 5,792 ARPs, nine percent (n = 529) occurred on public holidays or sporting event days. When compared by day type, type of presentation, mode of arrival, and day of week differed between event and non-event days. On event days, uncomplicated ARPs differed to other ARPs, with uncomplicated ARPs being younger, having shorter median length-of-stay (LOS), and less likely to be admitted to hospital. In this multi-site study, public holidays and sporting events had a noteworthy impact on ARPs to EDs. Focused refinement on the clinical management of uncomplicated ARPs is warranted to inform future resource allocation, including on event days.

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.

Alcohol-Related Presentations to Emergency Departments on Days with Holidays, Social, and Sporting Events: An Integrative Literature Review.

Events, specifically those where excessive alcohol consumption is common, pose a risk to increase alcohol-related presentations to emergency departments (EDs). Limited evidence exists that synthesizes the impact from events on alcohol-related presentations to EDs. This integrative review aimed to synthesize the literature regarding the impact events have on alcohol-related presentations to EDs. An integrative literature review methodology was guided by the Preferred Reporting Items of Systematic Reviews and Meta-Analysis (PRISMA) Guidelines for data collection, and Whittemore and Knafl's framework for data analysis. Information sources used to identify studies were MEDLINE, CINAHL, and EMBASE, last searched May 26, 2021. In total, 23 articles describing 46 events met criteria for inclusion. There was a noted increase in alcohol-related presentations to EDs from 27 events, decrease from eight events, and no change from 25 events. Public holidays, music festivals, and sporting events resulted in the majority of increased alcohol-related presentations to EDs. Few articles focused on ED length-of-stay (LOS), treatment, and disposition. An increase in the consumption of alcohol from holiday, social, and sporting events pose the risk for an influx of presentations to EDs and as a result may negatively impact departmental flow. Further research examining health service outcomes is required that considers the impact of events from a local, national, and global perspective.

Assessing the utility of night-time presentations as a proxy for alcohol-related harm among young emergency department trauma patients.

To assess the usefulness of night-time presentations to measure alcohol-related harm (ARH) in young trauma patients, aged 12-24 years, attending Western Australian EDs. A retrospective longitudinal study examined alcohol-related ED presentations in Western Australia (WA; 2002-2016) among 12- to 24-year-olds. Data from the Emergency Department Data Collection, WA State Trauma Registry Database and Hospital Morbidity Data Collection were used to identify ARH through specific codes and text searches. These were compared to ARH estimates based on presentation time. Statistical analysis involved sensitivity and specificity calculations and Cox proportional hazards modelling. We identified 2644 (17.8%) night-time presentations as a proxy measure of ARH among the 14 887 presentations of patients aged 12-24 years. This closely matched the 3064 (20.6%) identified as ARH through coding methods. The highest risk for an ARH presentation occurred during the night hours between 00.00 and 04.59 hours. During these hours, the risk was 4.4-5.1 times higher compared to presentations at midday (between 12.00 and 12.59 hours). However, when looking at individual patients, we observed that night-time presentations were not a strong predictor of ARH (sensitivity: 0.39; positive predictive value: 0.46). Implementing targeted interventions during night hours could be beneficial in addressing ARH presentations. However, relying solely on the time of presentation as a proxy for ARH is unlikely to effectively identify ARH in young individuals. Instead, the present study emphasises the importance of implementing mandatory data collection strategies in EDs to ensure accurate measurement of ARH cases.

Impact of the COVID-19 pandemic on emergency department alcohol intoxication presentations and positive screens for problem drinking.

Our aim was to assess the changes in patients presenting with acute alcohol intoxications or positive screens for problem drinking during the COVID-19 pandemic compared to before the pandemic in a seven-hospital health system. A retrospective chart review of emergency department (ED) visits from seven hospitals in the Washington, DC/Baltimore, and MD area from January 2019 to June 2021 is provided. The health system utilizes a validated system for Screening, Brief Intervention, and Referral to Treatment (SBIRT) for ED patients. We evaluated trends in patients who had a positive SBIRT screen for problem drinking (AUDIT-C score ≥ 3 in women, 4 in men), alcohol misuse (≥5), and those presenting with acute alcohol intoxication before March 2020 and during the early COVID pandemic period. There were 510648 patients who were screened, ranging from ages of 16 to 95years during the study period. There was an overall increase in patients who screened positive for problem drinking, alcohol misuse, and acute intoxications. While there was an overall decrease in the total number of ED visits during the start of the pandemic, which later increased near prepandemic levels, alcohol-related presentations as a percentage of total visits increased during the early pandemic period. There was an overall decrease in ED visits during the COVID-19 pandemic study period; problem drinking and acute intoxication presentation held steady, leading to an overall increase in proportion compared to pre-COVID-19 levels. Future research should focus on lessons learned during this time and should navigate the postpandemic care of patients with AUD. There was an increase in the proportion of ED visits for alcohol intoxications and positive screens for problem drinking during the COVID-19 pandemic in our seven-hospital system.

Using the Cardiff model to reduce late-night alcohol-related presentations in regional Australia.

The Cardiff model is a data sharing approach that aims to reduce the volume of intoxicated patients in emergency departments (EDs). This approach has not been tested in a rural setting. This study assessed whether this approach would reduce the number of alcohol-associated presentations during high-alcohol hours (HAH) in a regional ED. From July 2017, people over the age of 18 attending the ED were asked by the triage nurse (1) whether they had consumed alcohol in the past 12 h, (2) their typical alcohol consumption level, (3) the location where most alcohol was purchased and (4) the location of the last drink. From April 2018, quarterly letters were sent to the top five venues reported within the ED. Deidentified, aggregated data were shared with local police, licensing authorities and local government, identifying the top five venues reported in the ED and providing a summary of alcohol-related attendances to the ED. Interrupted time series analyses were used to estimate the influence of the intervention on monthly injury and alcohol-related ED presentations. ITS models found that there was a significant gradual decrease in the monthly rate of injury attendances during HAH (Coefficient=-0.004, p = 0.044). No other significant results were found. Our study found that sharing last drinks data collected in the ED with a local violence prevention committee was associated with a small, but significant reduction in the rate of injury presentations compared with all ED presentations. This intervention continues to have promise for reducing alcohol-related harm.

Alcohol-related presentations to emergency departments on Crate Day in Waikato, New Zealand

Alcohol-related presentations to emergency departments on Crate Day in Waikato, New Zealand

Three years of minimum unit pricing in the Northern Territory, what does the evidence say?

Three years of minimum unit pricing in the Northern Territory, what does the evidence say?

The Impact of Alcohol Sales in A College Football Stadium on Healthcare Utilization.

In 2021, a large Midwestern university began selling alcohol to spectators within the football stadium for the first time. The stadium routinely hosts >65,000 spectators, and drinking alcohol is highly prevalent at pre-game tailgating events. Our goal in this study was to determine the impact of in-stadium alcohol sales on the incidence of alcohol-related emergency department (ED) visits and local emergency medical services (EMS) calls. We hypothesized that the availability of alcohol throughout the stadium would lead to an increase in alcohol-related patient presentations. This was a retrospective study including patients who used local EMS and presented to the ED on football Saturdays in the 2019 and 2021 seasons. There were 11 Saturday games with seven home games each year. The 2020 season was excluded due to the impact of COVID-19- related restrictions on attendance. Trained extractors using predefined criteria reviewed records for each patient to determine whether the visit was alcohol related. Using logistic regression analysis we examined the odds of an EMS call and ED visit being alcohol-related before and after the start of stadium alcohol sales. We compared characteristics of visits before and after the onset of stadium alcohol sales using Student's t-test for continuous variables and chi-square test for categorical variables. In 2021, after the onset of in-stadium alcohol sales, there were a total of 505 emergency calls to local EMS on football Saturdays (home and away), and 29% of them were for alcohol-related incidents down from 36% of 456 calls in 2019. After adjustment for covariates, the odds of a call being alcohol-related were lower in 2021 than 2019, but this difference was not significant (adjusted odds ratio [aOR] 0.83, 95% CI 0.48-1.42). Looking specifically at the seven home games each season, the difference was more pronounced (31% of calls in 2021 compared to 40% in 2019) but not statistically significant after adjustment for covariates (aOR 0.54, 95% CI 0.15-2.03). In the ED, 1,414 patients were evaluated on game days in 2021 and 8% of them for alcohol-related reasons. This is similar to 2019, when 9% of the 1,538 patients presented due to alcohol-related complaints. After adjustment for covariates, the odds of an ED visit being alcohol-related were similar in 2021 and 2019 (aOR 0.98, 95% CI 0.70-1.38). There was a decrease in alcohol-related EMS calls on home game days in 2021, although the result was not statistically significant. In-stadium alcohol sales had no significant impact on the frequency or proportion of alcohol-related ED visits. The reason for this outcome is unclear, but it is possible that fans drank less at tailgate parties knowing they could consume more once the game started. Long lines and a two-beverage limit at stadium concessions may have kept patrons from consuming excessively. The results of this study may inform similar institutions regarding the safe implementation of alcohol sales during mass-gathering events.

Age at first alcohol-related hospital separation or emergency department presentation and rate of re-admission: A retrospective data linkage cohort of young Australians.

Alcohol is a leading risk factor for death and disease in young people. We compare age-specific characteristics of young people who experience their first ('index') alcohol-related hospitalisation or emergency department (ED) presentation, and whether age at index predicts 12-month rates of readmission. We used a retrospective linked-data cohort of 10,300 people aged 12-20 years with an index alcohol-related hospital and/or ED record in New South Wales, Australia from 2005 to 2013. Age group (early adolescent [12-14 years], late adolescent [15-17 years], young adult [18-20 years]) and diagnosis fields were used in logistic regression analyses and to calculate incidence rates with adjustment for year of index event, sex, socioeconomic disadvantage and residence remoteness. People who experienced their index event in early adolescence (adjusted relative risk ratio [ARRR] 0.45 [95% confidence interval 0.39, 0.52]) or late adolescence (ARRR 0.82 [0.74, 0.90]) were less likely to be male compared to young adults. Early adolescents (ARRR 0.60 [0.51, 0.70]) and late adolescents (ARRR 0.84 [0.76, 0.93]) were less likely to have a hospitalisation index event. Early adolescents (adjusted incidence rate ratio 1.40 [1.15, 1.71]) and late adolescents (adjusted incidence rate ratio 1.16 [1.01, 1.34]) were more likely than young adults to have a subsequent 12-month non-poisoning injury ED presentation. We identified preventable hospital events in young people who have previously experienced an alcohol-related ED presentation or hospitalisation, with age-specific characteristics and outcomes that can be used to inform future health policy and service planning.

Gendering practices in quantitative research on alcohol and violence: Comparing research from Australia, Canada and Sweden.

In this article, we analyse the treatment of gender in Canadian and Swedish quantitative research on alcohol and violence and compare it with the treatment of gender in similar Australian research. In previously published work, we argued that Australian research on 'alcohol-related presentations' to emergency departments, and on alcohol and violence among young people participating in the night-time economy, tends to overlook the stark gendering of violence in its analyses and policy recommendations. It does this via a series of 'gendering practices' (Bacchi, 2017): omitting gender from consideration; overlooking clearly gendered data when making gender-neutral policy recommendations; rendering gender invisible via methodological considerations; displacing men and masculinities via a focus on environmental, geographical and temporal factors; and addressing gender in limited ways. We identify a similar set of gendering practices at work in Canadian and Swedish quantitative research on alcohol and violence, as well as a key difference. This key difference emerges in relation to the practice of addressing gender. Here, we see a bifurcation in the Canadian studies: between one group of articles in which gender is central to the analyses and ensuing policy recommendations, and a second group containing only one example in which gender is partially addressed. We draw attention to the differing realities of gender, alcohol and violence iterated by these contrasting knowledge practices, and offer two possible explanations for this difference. We close by asking how future research analyses and policy recommendations might differ if gender-sensitive quantitative tools were developed, gender considerations were systematically integrated, and gendered effects were taken into account when alcohol policy choices are made.

One year of psychiatric presentations to a hospital emergency department during COVID-19.

To examine the impact of the first full year of the COVID-19 pandemic and its associated restrictions on the volume and nature of psychiatric presentations to an emergency department (ED) in a large academic hospital. Anonymised clinical data on psychiatric presentations to the ED were collected for the 52-week period from the start of the COVID-19 pandemic and compared with corresponding 1 year periods in 2019 and 2018. There was a significant increase in psychiatric presentations overall to the ED during the first year of the COVID-19 pandemic compared to previous years, in contrast to a reduction in total presentations for all other specialties. There was a marked increase in psychiatric presentations of those below 18 years, and in the 30-39 years and 40-49 years age groups, but a decrease in the 18-29 years group. There was a significant increase in anxiety disorder presentations but a decrease in alcohol related presentations. There was no significant change observed in the rates of presentations for self-harm or suicidal ideation. Psychiatric presentations to the ED have increased during the first year of the COVID-19 pandemic in contrast to a decrease in presentations for other medical specialties, with this increase being driven by out-of-hours presentations. The fourfold increase in presentations of young people below the age of 18 years to the ED with mental health difficulties is an important finding and suggests a disproportionate burden of psychological strain placed on this group during the pandemic.

The Alternative Pre-hospital Pathway team: reducing conveyances to the emergency department through patient centered Community Emergency Medicine

BackgroundInternationally increasing demand for emergency care is driving innovation within emergency services. The Alternative Pre-Hospital Pathway (APP) Team is one such Community Emergency Medicine (CEM) initiative developed in Cork, Ireland to target low acuity emergency calls.In this paper the inception of the APP Team is described, and an observational descriptive analysis of the APP Team’s service data presented for the first 12 months of operation. The aim of this study is to describe and analyse the APP team service.MethodsThe APP Team, consisting of a Specialist Registrar (SpR) in Emergency Medicine (EM) and an Emergency Medical Technician (EMT) based in Cork, covers a mixed urban and rural population of approximately 300,000 people located within a 40-min drive time of Cork University Hospital. The team are dispatched to low acuity 112/999 calls, aiming to provide definitive care or referring patients to the appropriate community or specialist service.A retrospective analysis was performed of the team’s first 12 months of operation using the prospectively maintained service database.ResultsTwo thousand and one patients were attended to with a 67.8% non-conveyance rate. The median age was 62 years, with 33.0% of patients aged over 75 years. For patients over 75 years, the non-conveyance rate was 62.0%. The average number of patients treated per shift was 7. Medical complaints (319), falls (194), drug and alcohol related presentations (193), urological (131), and respiratory complaints (119) were the most common presentations.ConclusionIncreased demand for emergency care and an aging population is necessitating a re-design of traditional models of emergency care delivery. We describe the Alternative Pre-Hospital Pathway service, delivered by an EMT and an Emergency Medicine SpR responding to low acuity calls. This service achieved a 68% non-conveyance rate; our data demonstrates that a community emergency medicine outreach team in collaboration with the National Ambulance Service offering Alternative Pre-Hospital Pathways is an effective model for reducing conveyances to hospital.

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.

Substance misuse teaching: a patient safety issue

AimsClinical substance misuse presentations are commonly managed by Psychiatry Core Trainees (CTs) out of hours. However, specialist teaching is not included in the Maudsley Training Program (MTP) induction. We aimed to investigate whether this was of clinical concern and, if so identify interventions to address it.BackgroundThe association of substance misuse disorder and mental illness is widely recognised. The Adult Psychiatric Morbidity Survey 2014 reported that half of people dependent on drugs other than cannabis were receiving mental health treatment. Substance use substantially impacts clinical risk; 57% of patient suicides in 2017 had a history of substance misuse. It also effects emergency psychiatric services: 55-80% of patients detained under S136 are intoxicated. Therefore, it is imperative for patient safety that CTs can assess and manage these patients appropriately.The Royal College of Psychiatrists recognises the need for specialist substance misuse knowledge and skills, and lists this as a key ‘Intended Learning Outcome’ for CTs. Unfortunately, the availability of specialist drug and alcohol service placements for CTs has significantly declined. Only one placement is available per MTP rotation. Teaching is therefore relied upon to gain these competencies.MethodUsing a cross-sectional survey we explored CTs confidence in recognising and managing substance misuse presentations, knowledge of where to seek guidance and asked for teaching suggestions. We surveyed two CT1 cohorts in 2017 and 2019.ResultFifty-one CTs took the survey. Of these 92% did not feel prepared to manage acute substance intoxication or withdrawal and 96% would like relevant teaching at the start of CT1. Furthermore, 67% did not know where they could seek guidance.CTs felt confident at recognising and managing alcohol related presentations. However, they were less confident in recognising opioid withdrawal, how to safely prescribe opioid substitution therapy (OST), and the usual doses of OST (65%, 94%, 94% rated ‘neither confident nor not confident’ or below, respectively). CTs were not confident at recognising GBL and cannabinoid withdrawal, principles of harm minimisation, assessing readiness to change, delivering Brief Interventions and teaching patients to use Naloxone.ConclusionThe results were exceptionally similar between cohorts, demonstrating reliability of our findings and that CTs lack of substance misuse knowledge is a significant clinical concern.To address this deficit of knowledge, we are writing an introductory lecture with supporting guidance in the induction pack, developing an online video resource, and moving key substance misuse lectures to earlier in the MTP taught programme.

Drug- and alcohol-related emergency department patient presentations during the 2018 Commonwealth Games: A multi-site retrospective analysis.

To examine the impact of the 2018 Commonwealth Games on ED patient presentations related to drug(s) and/or alcohol. Retrospective observational study comparing ED patient presentations made pre, during and post the 2018 Commonwealth Games with either an International Classification of Diseases-10 diagnosis or presenting complaint related to drug and or alcohol misuse. Drug- and alcohol-related presentations accounted for 5% (n = 890) of all ED presentations across the 36-day study period with no significant difference between pre (n = 312), during (n = 301) and post (n = 277) periods (P=0.2). Overall, drug- and alcohol-related patient presentations made to the EDs tended to be young (median age 35 years, interquartile range 24-48), Australian (n = 820, 92%) and male (n = 493, 55%). The majority arrived by ambulance (n = 650, 73%), were allocated an Australasian Triage Scale category of 3 (n = 505, 57%), and arrived between 15.00 and 22.59 hours (n = 365, 41%). No demographic characteristics, ED characteristics or outcomes differed significantly over time. During the 2018 Commonwealth Games, minimal impact on the ED was noted pertaining to drug and alcohol misuse. Further research is required to understand whether this held true for other types of ED presentations and during other types and locations of mass gathering events.

Alcohol-Related Psychiatric Presentations at a University-Affiliated Emergency Department: A Descriptive Prevalence Study

ABSTRACT Background: Several previous studies have explored patterns of emergency department (ED) utilization for alcohol-related physical conditions. However, the characteristics of those presenting with alcohol-induced psychiatric presentations are less clear. Aims: To describe the sociodemographic features of patients seeking ED care for alcohol-related psychiatric presentations, and to identify which factors are associated with psychiatric admission. Methods: The present paper describes a retrospective cohort study with multivariate logistic regression with adjusted odds ratios (AOR). Findings: Between 2015 and 2018, there were 4237 alcohol-related presentations (39% female, median age 35.0 years). The most common diagnoses were alcohol intoxication (57%) and alcohol withdrawal (20%). Time trend analysis showed a nonsignificant increase in the number of visits by fiscal year. About 3% of all visits required psychiatric admission. Predictors of psychiatric admission were arrival by ambulance (AOR = 1.77, 95% CI, 1.38–2.29); Canadian Triage Acuity Score ratings of 1 (AOR = 24.9, 95% CI, 8.21–85.8) or 2 (AOR = 3.67, 95% CI, 1.63–9.88); greater length of stay (AOR = 2.6; 95% CI, 2.0–3.3); and age (AOR = 1.62 per decade, 95% CI, 1.53–1.72). Conclusion: Several sociodemographic variables could support future decision-making tools to guide psychiatric management for persons presenting to the ED with alcohol-related problems. Contexte: Plusieurs études antérieures ont exploré les modèles d’utilisation des services d’urgence (SU) pour les conditions physiques liées à l’alcool. Cependant, les caractéristiques de ceux qui présentent des symptômes psychiatriques induites par l’alcool sont moins claires. Objectifs: Décrire les caractéristiques sociodémographiques des patients qui recherchent des soins à l’urgence pour des symptômes psychiatriques liées à l’alcool et identifier les facteurs associés à l’admission en psychiatrie. Méthodes: Le présent article décrit une étude de cohorte rétrospective avec régression logistique multivariée avec rapports de cote ajustés (RC). Résultats: Entre 2015 et 2018, il y a eu 4 237 présentations liées à l’alcool (39% de femmes, âge médian de 35.0 ans). Les diagnostics les plus courants étaient l’intoxication alcoolique (57%) et le sevrage d’alcool (20%). L’analyse des tendances temporelles a montré une augmentation non significative du nombre de visites par exercice. 3% de toutes les visites ont nécessité une admission psychiatrique. Les indicateurs de l’admission psychiatrique étaient l’arrivée par ambulance (RC= 1.77, IC à 95%: 1.38-2.29); Notes du score canadien d’acuité au triage (CTAS) de un (RC = 24.9, IC à 95%: 8.21-85.8) ou deux (RC = 3.67, IC à 95%: 1.63-9.88); durée de séjour plus longue (RC = 2.6; IC à 95% = 2.0-3.3); et l’âge (RC = 1.62 par décennie, IC à 95% = 1.53-1.72). Conclusion: Plusieurs variables sociodémographiques pourraient soutenir les futurs outils de prise de décision pour guider la prise en charge psychiatrique des personnes qui se présentent à l’urgence avec des problèmes liés à l’alcool.

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.