Alcohol-related Presentations Research Articles

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.

Patterns of ‘at home’ alcohol-related injury presentations to emergency departments – An integrative literature review

Summary Introduction Alcohol abuse has significant personal and social impacts. Recent public health campaigns and media attention have drawn attention to the impact of excessive drinking and subsequent injury in public places. This overlooks that a significant proportion of injuries occur in or near the Aim The aim of this integrative review was to determine existing information about rates of department (ED) presentations for injuries that occurred ‘at home'. A secondary objective was to compare ED presentations for injuries that occurred ‘at home' with presentations for injuries that occurred at licensed venues. Method A search was conducted in: PubMed, CINAHL, and google scholar databases using the following search terms: alcohol-related injury; alcohol-related injuries; emergency department; and, home. Results 398 papers were located, 389 were excluded leaving nine papers that were included in the review. The review found that a large number of ED injury presentations originated at home (ranging from 10% to 49%) with licensed premises as the other most likely location. Conclusion In a majority of the studies, the incidence of injuries sustained at home was greater than at licensed venues. Alcohol-related injury presentations to EDs are an important area of study. Nurses need to be aware of the importance of collecting accurate demographic data associated with the location of injury to provide evidence to inform health promotion and social policy.

Trends and characteristics of short-term and frequent representations to emergency departments: A population-based study from New South Wales, Australia.

The objective of this study is to describe the trends and characteristics of short-term and frequent representations to EDs in New South Wales, Australia. This was a retrospective analysis of a linked population-based registry of ED representations in New South Wales, conducted as part of the Demand for Emergency Services in Years 2010-2014 project. Trend analysis of unplanned representations to ED within 3 days of discharge from ED, readmission to an in-patient unit within 30 days of index in-patient admission from ED and demographic data and trends for frequent and very frequent ED presenters is discussed. A total of 10 798 797 ED presentations were identified from 4 188 283 individual patients. Within 1 year, 48.9% of ED presentations had a previous presentation, and 4.9% had represented within 3 days of a previous presentation. The readmission rate within 30 days was 2.8%, the proportion of frequent (representing 5212 [0.1%] individual patients) and very frequent representations (representing 1186 [0.03%] individual patients) were 1.7% and 1.0%, respectively. The overall rate of representations within 3 days has decreased from 5.1% in 2010 to 4.7% in 2014 (P < 0.001). The rate of readmissions within 30 days has increased from 2.4% in 2010 to 3.1% in 2014 (P < 0.001). In this population-based study, short-term representations were highest in the infant patient population, in-patient readmission rates were highest in the elderly and very frequent representations to ED were characterised by middle-aged patients with mental health or drug and alcohol related presentations.

Perceptions of Australasian emergency department staff of the impact of alcohol-related presentations.

To survey emergency department (ED) clinical staff about their perceptions of alcohol-related presentations. A mixed methods online survey of ED clinicians in Australia and New Zealand, conducted from 30 May to 7 July 2014. The frequency of aggression from alcohol-affected patients or their carers experienced by ED staff; the perceived impact of alcohol-related presentations on ED function, waiting times, other patients and staff. In total, 2002 ED clinical staff completed the survey, including 904 ED nurses (45.2%) and 1016 ED doctors (50.7%). Alcohol-related verbal aggression from patients had been experienced in the past 12 months by 97.9% of respondents, and physical aggression by 92.2%. ED nurses were the group most likely to have felt unsafe because of the behaviour of these patients (92% reported such feelings). Alcohol-related presentations were perceived to negatively or very negatively affect waiting times (noted by 85.5% of respondents), other patients in the waiting room (94.4%), and the care of other patients (88.3%). Alcohol-affected patients were perceived to have a negative or very negative impact on staff workload (94.2%), wellbeing (74.1%) and job satisfaction (80.9%). Verbal and physical aggression by alcohol-affected patients is commonly experienced by ED clinical staff. This has a negative impact on the care of other patients, as well as on staff wellbeing. Managers of health services must ensure a safe environment for staff and patients. More importantly, a comprehensive public health approach to changing the prevailing culture that tolerates alcohol-induced unacceptable behaviour is required.

The effect of short-term alcohol restriction on risk of alcohol-related injury: A state wide population-based study

BackgroundAlcohol consumption and related harms are largely determined by both demand and supply of alcohol. Across Western Australia, under state licensing laws, there are state-wide alcohol sales restrictions imposed on Good Friday and Christmas Day each year. This study aimed to evaluate the effect of the Good Friday and Christmas Day state-wide alcohol restrictions on the risk of alcohol-related injuries presenting at emergency departments. MethodsThis is a population-based cohort study using ED injury presentation data for the period 1st January 2002 to 1st January 2015. Risk of injury during the alcohol-related time of day affected by the alcohol restrictions (intervention periods, including Good Friday and Christmas Day) were compared to the same time of day over a number of control days. Multivariable Poisson regression model was used to perform the analysis. ResultsThe crude injury risk was considerably lower during the alcohol restriction periods compared to control periods in both metropolitan and non-metropolitan areas. The protective effect observed on the days of the alcohol restrictions remained significant, and largely unchanged, when potential confounding effects were controlled for. ConclusionThe significant reduction in alcohol-related injury presentations observed for public holiday periods with alcohol restrictions were likely caused by the alcohol restriction policy and its direct effect on alcohol supply.

Presentations with alcohol-related serious injury to a major Sydney trauma hospital after 2014 changes to liquor laws.

To determine any impact associated with changes to liquor licensing regulations on emergency department attendances for alcohol-related serious injuries in an inner-city entertainment precinct. A blinded retrospective analysis of data from the Emergency Department Information System (EDIS) of the major trauma and teaching hospital (St Vincent's Hospital, Darlinghurst) in the Sydney CBD Entertainment Precinct. Data for trauma cases classified as Australasian triage categories 1 (immediately life-threatening) and 2 (imminently life-threatening, important time-critical treatment, very severe pain) in the 12 months before (24 February 2013 - 23 February 2014; period 1) and the 12 months after (24 February 2014 - 23 February 2015; period 2) the 2014 changes to liquor licensing regulations applied to the precinct. Critically or seriously injured emergency presentations that were identified as related to alcohol use. In the 2-year study period, there were 13 110 triage category 1 and 2 presentations to the St Vincent's Hospital emergency department: 6467 during period 1 and 6643 during period 2. Of these, 1564 (4.3%) were patients who presented with alcohol-related serious injuries: 318 (4.9%) during period 1 and 246 (3.7%) during period 2 (P <0.05). The proportion of alcohol-related serious injury presentations (triage categories 1 and 2) was much higher (9.1% of presentations) during the high alcohol time (HAT; 6 pm Friday to 6 am Sunday) than during the rest of the week (3.1%). After the introduction of the regulatory changes, there was a significant decrease in the number of seriously injured patients during HAT, from 140 presentations (10.4% of presentations) before the change to 106 (7.8%) after their introduction, a relative reduction of 24.8% (P <0.05). There was a small increase in the number of patients presenting with alcohol-related injuries between 9 pm and midnight. There was a significant reduction in the number of alcohol-related serious injury and trauma presentations to the emergency department in the 12 months after the introduction of the new liquor regulations. This change was seen throughout the week, but was especially marked at weekends.

A time series analysis of alcohol-related presentations to emergency departments in Queensland following the increase in alcopops tax

BackgroundRaising duty on alcohol across the board can reduce morbidity, mortality and other adverse consequences of alcohol use. However, effectiveness is less certain for measures that target specific types of...

Bullying and harassment of trainees: an unspoken emergency?

Bullying and harassment of trainees: an unspoken emergency?

G102(P) The characteristics of drug and alcohol-related presentations to the emergency department amongst adolescents

Introduction Concerns have been raised about the increasing presentation of children and young people (CYP) to the Emergency Departments (EDs) having taken recreational drugs or alcohol. Aims The aims of this study are to estimate the proportion of drug and alcohol-related presentations to a large ED and to identify associated patient and presentation characteristics. Methods A retrospective analysis of patients aged 12–18 years attending a large ED from January 2012–December 2012 was carried out. Characteristics of all presentations related to alcohol and recreational drug use were recorded. Results 167 patients were included in the study. 35% of patients were under 16 years of age, over 50% were female and over half of the presentations were at night or weekends. 51% presented with an altered level of consciousness, other presentations included respiratory or circulatory compromise, agitation, vomiting and injuries. Alcohol was the commonest substance taken seen in over three quarters of presentations, 38% had taken illegal drugs and 18.5% admitted to taking both drug and alcohol. 78% presented to the ED via an ambulance. Investigations were performed in approximately half of the patients and included CT (0.5%), ECG (23%), blood tests (22%) and urine toxicology (4.3%). More than two-thirds did not receive any treatment but 16% of those attending the ED were admitted, mainly because of the effects of alcohol. 49% of admitted patients were under 16 years of age. Conclusion The number and presentations of alcohol and drug related attendances present a risk to CYP and is a burden to the ED and paediatric inpatient services. Effective intervention and preventative strategies are needed to reduce drug and alcohol related behaviour and co- morbidity.

Last drinks: A study of rural emergency department data collection to identify and target community alcohol-related violence.

The present study summarises the methodology and findings of a pilot project designed to measure the sources and locations of alcohol-related harm by implementing anonymised 'last drinks' questions in the ED of a rural community. 'Last drinks' questions were added to computerised triage systems at South West Healthcare ED in rural Warrnambool, Victoria, from 1 November 2013 to 3 July 2014. For all injury presentations aged 15 years or older, attendees were asked whether alcohol was consumed in the 12 h prior to injury, how many standard drinks were consumed, where they purchased most of the alcohol and where they consumed the last alcoholic drink. From 3692 injury attendances, 10.8% (n = 399) reported consuming alcohol in the 12 h prior to injury. 'Last drinks' data collection was 100% complete for participants who reported alcohol use prior to injury. Approximately two-thirds (60.2%) of all alcohol-related presentations had purchased their alcohol at packaged liquor outlets. During high-alcohol hours, alcohol-related injuries accounted for 36.1% (n = 101) of all ED injury presentations, and in total 41.7% of alcohol-related attendances during these hours reported consuming last drinks at identifiable hotels, bars, nightclubs or restaurants, or identifiable public areas/events. This pilot demonstrates the feasibility and reliability of implementing sustainable 'last drinks' data collection methods in the ED, and the ability to effectively map the source of alcohol-related ED attendances in a rural community.

Health-care professionals' attitudes across different hospital departments regarding alcohol-related presentations.

Attitudes to individuals presenting with alcohol-related issues are important in developing therapeutic relationships and applying alcohol-related interventions. This study explores staff attitudes to these individuals across a range of roles and departments. Data were gathered from 204 staff in the Southern Health and Social Care Trust in Northern Ireland. Regression models were used to predict attitudes as measured by the Short Alcohol and Alcohol Problems Perception Questionnaire (SAAPPQ). Two hundred and four people participated in the study. The sample comprised doctors, nurses, allied health professionals and other staff who had face-to-face contact with patients. Staff worked in accident and emergency (A&E), medical, surgical, addiction or psychiatry departments. Staff working in addiction and psychiatry departments had significantly higher levels of role adequacy compared with those in A&E. Staff in addictions also demonstrated higher levels of role legitimacy, motivation and role satisfaction than those in A&E. Doctors had higher role adequacy and role legitimacy than nursing staff. There are critical differences in staff attitudes to patients presenting with alcohol-related issues in a range of hospital settings; training and working in a specialist setting have a significant positive influence on staff attitudes. This suggests that further training and support would positively enhance the attitudes of staff in a variety of professional roles and across a range of hospital settings in the management of patients presenting with alcohol-related difficulties. [Iqbal N, McCambridge O, Edgar L, Young C, Shorter GW. Health-care professionals' attitudes across different hospital departments regarding alcohol-related presentations. Drug Alcohol Rev 2015;34:487-94].

The relationship between deprivation and alcohol-related presentation at Accident and Emergency (A&E) over a three-month period.

To identify any relationship between deprivation and the level of presentation to Accident and Emergency with alcohol-related conditions in a busy East Coast teaching hospital in Scotland. Over an 87-day-period initial screening to determine whether alcohol played a part in each presentation was conducted at triage. These patients were then streamed according to their Paddington Alcohol Test (Pat) score into Pat +ve and Pat -ve groups. The postcode of each patient was recorded before they were assigned deprivation levels using the DepCat scoring system. This information was then compiled in Microsoft Excel 2003 and a graph showing the differences in the number of presentations across the social spectrum was constructed. Nine hundred and forty four patients were screened as attending due to alcohol with 43.86% being Pat +ve and 56.14% being Pat -ve. Overall 66.42% of the Pat +ve group and 54.42% of Pat -ve were from deprived or very deprived areas. The use of electronic-based screening was effective at highlighting patients presenting to Accident and Emergency with alcohol-related problems, and these presentations highlighted a direct link between the level of deprivation and attendances.

Survey of alcohol-related presentations to Australasian emergency departments.

To determine the proportion of alcohol-related presentations to emergency departments (EDs) in Australia and New Zealand, at a single time point on a weekend night shift. A point prevalence survey of ED patients either waiting to be seen or currently being seen conducted at 02:00 local time on 14 December 2013 in 106 EDs in Australia and New Zealand. The number of ED presentations that were alcohol-related, defined using World Health Organization ICD-10 codes. At the 106 hospitals (92 Australia, 14 New Zealand) that provided data, 395 (14.3%; 95% CI, 13.0%-15.6%) of 2766 patients in EDs at the study time were presenting for alcohol-related reasons; 13.8% (95% CI, 12.5%-15.2%) in Australia and 17.9% (95% CI, 13.9%-22.8%) in New Zealand. The distribution was skewed left, with proportions ranging from 0 to 50% and a median of 12.5%. Nine Australian hospitals and one New Zealand hospital reported that more than a third of their ED patients had alcohol-related presentations; the Northern Territory (38.1%) and Western Australia (21.1%) reported the highest proportions of alcohol-related presentations. One in seven ED presentations in Australian and New Zealand at this 02:00 snapshot were alcohol-related, with some EDs seeing more than one in three alcohol-related presentations. This confirms that alcohol-related presentations to EDs are currently underreported and makes a strong case for public health initiatives.

Alcohol‐related emergency department injury presentations in Queensland adolescents and young adults over a 13‐year period

The rate of alcohol-related emergency department (ED) presentations in young people has increased dramatically in recent decades. Injuries are the most common type of youth alcohol-related ED presentation, yet little is known about these injuries in young people. This paper describes the characteristics of alcohol-related ED injury presentations in young people over a 13-year period and determines if they differ by gender and/or age group (adolescents: 12-17 years; young adults: 18-24 years). The Queensland Injury Surveillance Unit (QISU) database collects injury surveillance data at triage in participating EDs throughout Queensland, Australia. A total of 4667 cases of alcohol-related injuries in young people (aged 12-24 years) were identified in the QISU database between January 1999 and December 2011, using an injury surveillance code and nursing triage text-based search strategy. Overall, young people accounted for 38% of all QISU alcohol-related ED injury presentations in patients aged 12 years or over. The majority of young adults presented with injuries due to violence and falls, whereas adolescents presented due to self-harm or intoxication without other injury. Males presented with injuries due to violence, whereas females presented with alcohol-related self-harm and intoxication. There is a need for more effective ways of identifying the degree of alcohol involvement in injuries among young people presenting to EDs.

Experiences of Pediatric Emergency Physicians in Providing Alcohol-Related Care to Adolescents in the Emergency Department

The emergency department (ED) is a key clinical care setting for identifying and managing patients with alcohol-related presentations. We explored the experiences of emergency physicians in providing alcohol-related care to adolescents. Purposeful sampling was used to identify pediatric emergency physicians with at least 1 year of experience (n = 12) from pediatric EDs across Canada. Data were collected via telephone using a semistructured interview guide. Hermeneutic phenomenology was used to identify common and unique experiences among respondents, using Moustakas' immersion/crystallization procedures. Physicians expressed frustration with patient behaviors accompanying intoxication and described providing care as a struggle; developing an effective therapeutic alliance was challenging. Physicians believed intoxicated adolescent patients required more clinical time and resources than they could offer. Although physicians described the ED as unsuitable for ensuring continuity of care and addressing the broader social issues that accompany alcohol use, they did view the ED as a place to medically stabilize the patient and initiate a discussion on alcohol use and its harmful effects. Pediatric ED physicians struggled during the caring experience and were skeptical that broader, more chronic social issues that are often associated with adolescent alcohol misuse can be effectively managed in a clinical setting where they feel primarily responsible for providing medical stabilization. Physicians did believe the ED was an appropriate place to ensure medical stability of a patient and then initiate a conversation regarding alcohol use and its harmful effects.

Larger Regional and Rural Areas in Victoria, Australia, Experience More Alcohol‐Related Injury Presentations at Emergency Departments

Alcohol consumption is higher in regional and rural areas compared to metropolitan locations, but it is unclear which areas suffer different levels of harm. The current study investigated the rates of alcohol-related injury presentations at emergency departments (EDs) in Victoria, Australia, across metropolitan, regional, rural, and remote areas, and within coastal locations. Using ED injury presentations data for Victorian hospitals from June 1999 to June 2011, the trends in alcohol-related injury rates over time were investigated. Compared to metropolitan locations, alcohol-related injuries were higher in larger regional and rural areas and similar in small rural towns. The rates of alcohol-related injuries are also significantly increasing over time for regional and rural locations. Lastly, for males, rates of alcohol-related injuries increased in coastal areas during November to February compared to the remaining months. Regional and coastal areas experience increased alcohol-related injury rates. The causes of this have yet to be investigated and future research is required to determine why and what interventions may be most effective at reducing these harms.

Unplanned alcohol withdrawal: a survey of consecutive admissions to an acute medical unit in 2010 and 2011

Alcohol-related presentations to hospital have been increasing in the UK in recent years, including the occurrence of acute withdrawal. This study sought to better characterize the clinical features, patterns of treatment and outcomes in this patient group. Patients admitted to the Acute Medical Unit of York Hospital due to acute alcohol withdrawal are normally treated according to a protocol that involves both fixed-dose and symptom-triggered drug administration. Admissions between 2010 and 2011 inclusive were studied. There were 211 admission episodes solely due to acute alcohol withdrawal, involving 127 patients (97 men, 76.4%) with median age of 45 years (interquartile range: 39-52 years). There was a high prevalence of depression (34%), alcoholic liver disease (22%) and drug misuse (12%). Total dose of chlordiazepoxide varied between 0 and 610 mg and tapered rapidly after the first day of admission. Vitamin supplements were administered to >90% of patients, including parenteral and oral in 74%, parenteral alone in 9% and oral alone in 9%. A specialist alcohol nurse reviewed patients while in hospital in 40% of cases. Approximately one-third of patients had multiple admissions for alcohol withdrawal during the study period. A high prevalence of physical and mental health disorders was observed. The local policy permitted high initial chlordiazepoxide doses and prompt downward titration, with a broad range of doses between individuals. Approximately 10% required no specific therapy, and there may be opportunities for developing alternative pathways for delivery of care in an ambulatory setting for these patients.

A Descriptive Comparison of Alcohol-Related Presentations at a Large Urban Hospital Center from 1902 to 2009

Although alcohol use has long been a significant cause of hospital presentations, little is published regarding the long-term demographic changes that have occurred at a single hospital site. To address this deficit, we prospectively studied all acute alcohol-related presentations to Bellevue Hospital Center (New York, NY) and compared this contemporary data set with one from the same institution from 1902 to 1935. We prospectively identified all patients presenting to the emergency department because of acute alcohol use over an 8-week period in 2009. We described the basic attributes of patients presenting currently because of alcohol and compared these data to those previously described between 1902 and 1935. We also compared our census data with contemporaneous data from all patients presenting to this hospital site. During the study period, 560 patients presented because of acute alcohol use which extrapolated to an estimated 3,800 patients over the calendar year. This compares to 7,600 presentations recorded annually early in the twentieth century. Twelve percent of patients in 2009 were female as compared to 18 % of patients between 1934 and 1935. Patients with alcohol-related presentations in 2009 were more likely to be admitted than contemporaneous patients without an alcohol-related presentation (30 vs. 19 % admitted; p < 0.001). Since first measured 110 years ago at one large New York City hospital, alcohol-related presentations remain common representing 5 % of all emergency department visits. This demonstrates alcoholism's continuing toll on society's limited medical resources and on public health as a whole.

Management of intoxicated young people in the Emergency Department: results from a pan-London service evaluation

<h3>Aims</h3> Each year approximately 65,000 young people present to Emergency Departments (ED) as a result of alcohol intoxication. There is a large body of evidence in the written literature, detailing ways in which ED9s can use these presentations to help identify young people in need and intervene to reduce future alcohol related presentations. We performed a service evaluation to explore how EDs in London determine if a young person presenting intoxicated is at risk from their drinking, or drinking because of other co-morbidities, and what interventions are available to support the young person. We asked the paediatric lead for each of the 32 ED9s in the Greater London area to complete a short paper questionnaire. We hypothesised that the 16-17 year old group may be particularly at risk due to age thresholds between paediatric and adult services, and specifically asked questions to assess this risk. <h3>Results</h3> 22/32 ED9s completed the questionnaire (69%). <h3>Assessment of risk</h3> Alcohol screening tools were more common in adults (55%) than children under 16 (9%). Structured psychosocial histories were routinely taken in 7% units. <h3>Safeguarding practices</h3> 41% of ED9s always discuss patients under 16 in safeguarding meetings compared to 23% for patients aged 16-17 years. For under 169s, 71% of ED9s shared information with the patients GP, compared to 64% for 16-179s. For patients less than 16, 71% shared information with school nurses; 43% for those 16-17. <h3>Treatment/support</h3> Information about alcohol services was available in 73% ED9s. Referral pathways to drug and alcohol services were similar between adults and young people, 41-45%. <h3>Conclusion</h3> There appears to be inadequate screening and discussion of young people who present intoxicated to the ED and vulnerable young people could be missed. In particular we noted that the 16-17 age groups are potentially vulnerable as they fall in the gap between adult and child services. Where they exist, policies are variable and we call for college level guidelines to be developed and disseminated.

Effect of the increase in “alcopops” tax on alcohol‐related harms in young people: a controlled interrupted time series

To measure alcohol-related harms to the health of young people presenting to emergency departments (EDs) of Gold Coast public hospitals before and after the increase in the federal government "alcopops" tax in 2008. Interrupted time series analysis over 5years (28April 2005to 27April 2010) of 15-29-year-olds presenting to EDs with alcohol-related harms compared with presentations of selected control groups. Proportion of 15-29-year-olds presenting to EDs with alcohol-related harms compared with (i) 30-49-year-olds with alcohol-related harms, (ii)15-29-year-olds with asthma or appendicitis, and (iii) 15-29-year-olds with any non-alcohol and non-injury related ED presentation. Over a third of 15-29-year-olds presented to ED with alcohol-related conditions, as opposed to around a quarter for all other age groups. There was no significant decrease in alcohol-related ED presentations of 15-29-year-olds compared with any of the control groups after the increase in the tax. We found similar results for males and females, narrow and broad definitions of alcohol-related harms, under-19s, and visitors to and residents of the Gold Coast. The increase in the tax on alcopops was not associated with any reduction in alcohol-related harms in this population in a unique tourist and holiday region. A more comprehensive approach to reducing alcohol harms in young people is needed.