Intoxicated ED Patients: A 5-Year Follow-Up of Morbidity and Mortality

doi:10.1016/S0196-0644(97)70074-X

Annals of Emergency Medicine

Volume 30, Issue 5, November 1997, Pages 593-597

Presented at the American College of Physicians, March 1992, and the Society for Academic Emergency Medicine, May 1992..

https://doi.org/10.1016/S0196-0644(97)70074-X Get rights and content

Abstract

Study objective: To determine the rates of alcohol-related morbidity and mortality in a cohort of intoxicated ED patients 5 years after presentation and to compare them with those of nonintoxicated ED patients. Methods: The study group comprised 150 consecutive ED patients who presented with intoxication (blood alcohol level higher than 100 mg/dL) in June 1986 and 50 control patients matched for age, sex, ED arrival time, and date. The setting was an urban university hospital ED. Morbidity and mortality over a 5-year follow-up period were measured using hospital ED and admission records from all state Level I trauma centers and computerized statewide databases. Results: The 5-year mortality rate among alcohol-intoxicated patients was 2.4 times that of the comparison group (95% confidence interval, .3 to 18.9). The 5-year death rate among intoxicated patients aged 40 to 69 years was especially high (19%). Thirty-seven percent of the intoxicated patients made at least one alcohol-related ED revisit during the follow-up period, compared with 6% of the comparison group (P<.001). Intoxicated patients were more likely to revisit EDs because of suicidal behavior or domestic violence (P=.001). Admission to an alcohol detoxification unit during the follow-up period occurred in 24% of the intoxicated patients, compared with 10% of the sober controls (P=.03). At least one arrest for drunk driving occurred in 47% of the intoxicated group; the rate was lower, but still substantial, in the comparison group (20%, P<.001). Conclusion: A single alcohol-related ED visit is an important predictor of continued problem drinking, alcohol-impaired driving and, possibly, premature death. [Davidson P, Koziol-McLain J, Harrison L, Timken D, Lowenstein SR: Intoxicated ED patients: A five-year follow-up of morbidity and mortality. Ann Emerg Med November 1997;30:593-597.]

Section snippets

INTRODUCTION

In 1808, Benjamin Rush recognized that “Spirituous liquors destroy more lives than the sword. War has its intervals of destruction—but spirits operate at all times and seasons upon human life.”¹ Alcohol abuse has persisted as a serious health care problem. An estimated 18 million Americans are alcohol dependent, and alcohol causes or contributes to about 100,000 deaths annually in the United States. Alcohol is a cause of death from cirrhosis, gastrointestinal bleeding, cancer, and pneumonia.2, 3

METHODS

We conducted a retrospective cohort study of patients who presented to an urban trauma center ED. The primary study group consisted of 150 consecutive patients who presented with intoxication during a 7-week period in 1986. This cohort, which included both trauma and nontrauma patients, was described in an earlier publication.⁴ Study patients were included only if their blood alcohol concentration was measured and exceeded 100 mg/dL.

We also identified a comparison group of 50 ED patients who

RESULTS

The majority of patients in the primary study group were young, male, white, and severely intoxicated (Table 1). Many had traumatic injuries, usually from domestic violence, traffic crashes, or falls. The comparison patients were demographically similar but appeared sober during their ED visit. Similar proportions of intoxicated and control patients had trauma as a reason for presentation; however, the types of trauma differed in the two groups (Table 1).

. Sample characteristics.

Parameter	Empty Cell

DISCUSSION

Alcohol abuse is one of society's most serious health problems, a fact that is self-evident in urban EDs. This study provides strong evidence that a single alcohol-related ED visit is a predictor of future problem drinking, alcohol-impaired driving, and premature death.

Similar results have been reported. Rivara et al⁵ found that intoxicated trauma patients were 2.5 times more likely to be readmitted to a trauma center during 2 years of follow-up, compared with similar patients who were not

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Previous studies have reported inconsistent results regarding the potential relationships between addictive behaviors and the risk of epilepsy.
To assess whether genetically predicted addictive behaviors are causally associated with the risk of epilepsy outcomes.
The causation between five addictive behaviors (including cigarettes per day, alcoholic drinks per week, tea intake, coffee intake, and lifetime cannabis use) and epilepsy was evaluated by using a two-sample Mendelian Randomization (MR) analysis. The inverse-variance weighted (IVW) method was used as the primary outcome. The other MR analysis methods (MR Egger, weighted median, simulation extrapolation corrected MR-Egger, and Mendelian Randomization Pleiotropy Residual Sum and Outlier (MR-PRESSO)) were performed to complement IVW. In addition, the robustness of the MR analysis results was assessed by leave-one-out analysis.
The IVW analysis method indicated an approximately 20% increased risk of epilepsy per standard deviation increase in lifetime cannabis use (odds ratio [OR], 1.20; 95% confidence interval [CI]), 1.02–1.42, P = 0.028). However, there is no causal association between the other four addictive behaviors and the risk of epilepsy (cigarettes per day: OR, 1.04; 95% CI, 0.92–1.18, P = 0.53; alcoholic drinks per week: OR, 1.31; 95% CI, 0.93–1.84, P = 0.13; tea intake: OR, 1.15; 95% CI, 0.84–1.56, P = 0.39; coffee intake: OR, 0.86; 95% CI, 0.59–1.23, P = 0.41). The other MR analysis methods and further leave-one-out sensitivity analysis suggested the results were robust.
This MR study indicated a potential genetically predicted causal association between lifetime cannabis use and higher risk of epilepsy. As for the other four addictive behaviors, no evidence of a causal relationship with the risk of epilepsy was found in this study.
Alcohol-Related Seizures
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This disease will surely progress if alcoholism is not recognized and the patient is not given the opportunity to participate in a rehabilitation program. It is up to the emergency physician to intervene on behalf of the patient and the public.40,41 Not all ARS are AWS
The Impact of Alcohol, Tobacco, and Other Drug Use and Abuse in the Emergency Department
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O'Brien and coworkers [19] found a higher likelihood of self-reported alcohol and drug use among patients who identified the ED as their regular source of care. A single alcohol-related ED visit has been shown to be an important predictor of continued problem drinking, alcohol-impaired driving, and possible premature death [20]. Problem drinkers average almost twice as many injury-related events per year as nonproblem drinkers and four times as many hospitalizations for injury [21].
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Alcohol-related seizures are defined as adult-onset seizures that occur in the setting of chronic alcohol dependence. Alcohol withdrawal is the cause of seizures in a subgroup of these patients; however, concurrent risk factors including pre-existing epilepsy, structural brain lesions, and the use of illicit drugs contribute to the development of seizures in many patients. New onset or a new pattern of alcohol-related seizures, e.g., focal seizures or status epilepticus, should prompt a thorough diagnostic evaluation. This is not indicated if patients have previously completed a comprehensive evaluation and the pattern of current seizures is consistent with past events. Treatment is initially directed at aggressively terminating current seizure activity. This should be followed by prevention of recurrent alcohol-related seizures and progression to status epilepticus during the ensuing 6-h high-risk period. Our purpose is to present recommendations for the diagnostic evaluation, treatment and disposition of these patients based on the current literature.
Alcohol-related injuries at an emergency department in Eastern Taiwan
2006, Journal of the Formosan Medical Association
Injuries are major causes of mortality and morbidity in Taiwan. Alcohol involvement often plays a role in injuries. The purpose of this study was to determine the prevalence of alcohol-related injuries at an emergency department in Eastern Taiwan and their associated factors.
All injured patients who made emergency visits between October 2002 and September 2003 were enrolled. For each patient, the attending nurse completed an injury-coding sheet, which included the results of an assessment of whether the patient had an alcohol odor or alcohol consumption related behavior. Nurses recorded suspicion of alcohol consumption based on possible categories of “no alcohol odor”, “alcohol odor”, “intoxicated”, “suspected” or “unknown”. Blood alcohol testing was also performed based on the decision of the attending physician. Injuries were defined as alcohol-related based on the report of “alcohol odor” or “intoxicated” by the nurse or a positive blood alcohol test. Logistic regression was used to assess the significance of the association of possible related factors with alcohol-related injury.
A total of 8822 eligible visits were studied and 14% were classified as alcohol-related. The proportion of alcohol-related injuries was 14.9% for vehicle-related injuries, and 51.3% for assaults. Male, young to middle aged, aboriginal ethnicity and visits after midnight were factors associated with increased likelihood of alcohol-related injuries. Multiple logistic regression analysis revealed that the three factors most significantly associated with alcohol-related injuries were visits after midnight (odds ratio, OR, 7.5; 95% confidence interval, CI, 6.4-8.9], assaults (OR, 3.4; 95% CI, 2.3-4.8), and head injuries (OR, 2.7; 95% CI, 2.3-3.2).
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The majority of studies focused on the relationship between chronic alcohol abuse or alcoholism and motor vehicle crash. In a retrospective study, a single alcohol-related ED visit was an important predictor of chronic drinking problems, alcohol-impaired driving, and premature death,8 with 37% of intoxicated subjects having at least a further alcohol-related ED visit in a 5-year follow-up. Acute and chronic alcohol abuse also affects the chance for recurrent trauma and readmission to an urban trauma center.4
The identification of risk factors for recurrent motor vehicle crashes is the basis for prevention, but few studies have been published on predictors of recurrence. Our objective is to determine the main variables predicting recurrent crashes in subjects attending an emergency department (ED) for injuries after motor vehicle crash.
During a 5-year follow-up period, we studied 2,354 consecutive adult subjects treated in the ED after a motor vehicle crash in 1998. The variables of the original event were tested for predicting recurrence in a Cox proportional hazard model.
During follow-up, 390 of 2,325 (16.8%) survivors were treated for injury after a new crash. The overall event rate was 34 per 1,000 subject-years. Four variables (age ≤32 years, male sex, nighttime crash, and blood alcohol concentration >50 mg/dL) were identified as independent predictors of recurrent crash. After adjustment for sex, age, and nighttime, alcohol was the leading predictor (relative risk 3.73; 95% confidence interval 3.00 to 4.64). In the presence of the 4 variables, the recurrence rate was as high as 145 (117 to 175) events per 1,000 subject-years, and alcohol per se accounted for more than 75% of events. In the absence of the 4 variables, the rate was as low as 11 (7 to 17) events per 1,000 subject-years.
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^☆: From the Colorado Emergency Medicine Research Center, Division of Emergency Medicine, University of Colorado Health Sciences Center^*; the Denver Health Medical Center Residency in Emergency Medicine^‡; and the Alcohol and Drug Abuse Division of the Colorado Department of Health, Denver, Colorado.^§

^☆☆: Reprint no. 47/1/85037

^★: Reprints not available from the authors.

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Intoxicated ED Patients: A 5-Year Follow-Up of Morbidity and Mortality☆,☆☆,★

Abstract

Section snippets

INTRODUCTION

METHODS

RESULTS

DISCUSSION

To John Adams, September 16, 1808: An inquiry into the effects of ardent spirits upon the human body and mind

Causes of death of alcoholics

Q J Stud Alcohol

The risk of alcohol addiction

Addiction

Alcohol intoxication, injuries and dangerous behaviors—and the revolving emergency department door

J Trauma

The effects of alcohol abuse on readmission for trauma

JAMA

Psychoactive substance dependence among trauma center patients

JAMA

Alcohol and other drugs: Toward a more rational and consistent policy

N Engl J Med

Alcohol and drug-related visits to hospital emergency departments: 1992 National Hospital Ambulatory Medical Care Survey

Advance Data

Alcohol Alert No. 3: Alcohol and Trauma

The reliability and stability of the Mortimer-Filkins test

J Stud Alcohol

The risk of dying in alcohol-related automobile crashes among habitual drunk drivers

N Engl J Med

Diagnostic and Statistical Manual of Mental Disorders