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Routine alcohol screening in the ED: unscreened patients have an increased risk for hazardous alcohol use
  1. Merel van Loon1,
  2. Roos C Van der Mast2,3,
  3. M Christien van der Linden1,
  4. Floris A van Gaalen4
  1. 1 Emergency Department, Haaglanden Medical Centre, The Hague, The Netherlands
  2. 2 Department of Psychiatry, Leiden Universitair Medisch Centrum, Leiden, Zuid-Holland, The Netherlands
  3. 3 Department of Psychiatry, CAPRI, Antwerp, Belgium
  4. 4 Department of Rheumatology, Leiden Universitair Medisch Centrum, Leiden, Zuid-Holland, The Netherlands
  1. Correspondence to Merel van Loon, Emergency Department, Haaglanden Medical Centre, 2262 BA Leidschendam, The Netherlands; m.van.loon{at}


Background Routine screening programmes for hazardous alcohol use in the ED miss large numbers of patients. We investigated whether patient-related or staff-related factors cause screening failures and whether unscreened patients are at increased risk of hazardous alcohol use.

Methods This is a secondary analysis of a prospective study. From November 2012 to November 2013, all adult patients visiting a Dutch inner city ED were screened for hazardous alcohol consumption using the Alcohol Use Disorders Identification Test-Consumption. Reasons for failure of screening were categorised as: (A) patient is unable to cooperate (due to illness or pain, decreased consciousness or incomprehension due to intoxication, psychiatric, cognitive or neurological disorder or language barrier), (B) healthcare professional forgot to ask, (C) patient refuses cooperation and (D) screening was recently performed (<6 months ago). Presence of risk factors for hazardous alcohol use was compared between screened and unscreened patients.

Results Of the 28 019 ED patients, 18 310 (65%) were screened and 9709 (35%) were not. In 7150 patients staff forgot to screen, whereas 2559 patients were not screened due to patient factors (2340 being unable and 219 unwilling). Patients with any of these risk factors were less likely to be screened: male sex, alcohol-related visit, any intoxication, head injury, any kind of wound and major trauma. In multivariate analysis, all these risk factors were independently associated with not being screened. Patients with at least one risk factor for hazardous alcohol use were less likely to be screened. Highest prevalence of risk factors was found in patients unable or unwilling to cooperate.

Conclusion Patients who do not undergo routine screening for alcohol use at triage in the ED have an increased risk for hazardous alcohol use. These data highlight the importance of screening patients, especially those initially unwilling or unable to cooperate, at a later stage.

  • alcohol abuse
  • emergency department
  • emergency department management
  • quality improvement

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  • Contributors MvL and FAvG conceived the study and obtained research funding. MCvdL supervised the data collection. MvL and MCvdL managed the data, including quality control. MvL and FAvG analysed the data, and MCvdL and RCvdM provided statistical advice on the study design; MvL drafted the manuscript. All authors have contributed to the manuscript and all authors read and approved the final version of the manuscript. MvL takes responsibility for the paper as a whole.

  • Funding This study was financially supported by the Netherlands Emergency Medicine Research Fund (Spoedeisende Geneeskunde Onderzoeksfonds) for scientific evaluation of the data. In 2010, the Emergency Department of Haaglanden Medical Centre received a grant from The Partnership for Early Identification of Alcohol Use for implementation of the project in clinical practice. Furthermore, between 2011 and 2013, a grant from ZonMw was received for scientific evaluation of the implementation process.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The SIREN study was granted institutional review board exemption by the ethical review committee of the HMC (METC, Zuidwest Holland, nr. 11–079).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article. Participant data were extracted from the hospital database by Datawarehouse. They deidentified data by changing patient numbers for study numbers and then delivered them to the researcher, who analysed the data. Prior to the study, a research protocol and statistical analysis plan was composed, which was checked and approved by the hospital's science committee.