Home > Alcohol and injuries in the accident and emergency department - a national perspective.

(2006) Alcohol and injuries in the accident and emergency department - a national perspective. Drugnet Ireland , Issue 17, Spring 2006 , pp. 4-5.

[img]
Preview
PDF (Drugnet Ireland, issue 17) - Published Version
289kB

Hope and colleagues1 examined the association between injury and alcohol among persons attending accident and emergency (A&E) departments using the protocol developed by the World Health Organization for its collaborative research on alcohol and injury. The study was conducted in six major acute hospitals across Ireland.  Between April 2003 and May 2004 and between the hours of 10 am and  6 am, 2,500 patients aged 18 years or over who presented to A&E within six hours of an injury were invited to participate in the study; 2,093 (84%) agreed to participate.  The participants completed a questionnaire covering the type and cause of injury; alcohol consumption in the six hours prior to injury; usual frequency and consumption of alcohol, including the number of high-consumption periods, in the previous 12 months; and indicators of alcohol dependency and alcohol-related problems. The patients who reported drinking alcohol prior to injury were breathalysed to estimate their blood alcohol concentration.  Data were analysed to increase understanding of risk factors and to identify possible screening procedures for problem alcohol use. 

Of the 2,085 patients who participated, 478 (23%) had an alcohol-related injury and 1,607 (77%) had a non-alcohol-related injury.  Higher proportions of participants who had an alcohol-related injury were male or unemployed when compared to the corresponding proportions who had a non-alcohol-related injury (Table 1).  Higher proportions of participants who had an alcohol-related injury were seen between Friday and Monday and between midnight and 6 am, while the converse was observed for those with non-alcohol-related injury.  Over half the participants with an alcohol-related injury arrived at the A&E department within one hour, compared to 23% of those with a non-alcohol-related injury.  Blunt force injury was more common among participants with an alcohol-related injury than among those with a non-alcohol-related injury, 14% compared to 9%.  Both intentional self-inflicted injury and intentional injury by someone else were more common among participants with an alcohol-related injury than among those with a non-alcohol-related injury. Participants with alcohol-related injury were more commonly injured in a public place (pub or street). 

Table 1   Characteristics of patients who participated in the study, by type of injury

 

 

Non-alcohol-related injury

Alcohol-related injury

Number of cases

 

1607

478

 

 

 

 

Gender

Male

62.2%

73.8%

 

Female

37.8%

26.2%

 

 

 

 

Age group (in years)

18–29

44.5%

47.6%

 

30–49

29.0%

30.8%

 

50–64

12.6%

14.5%

 

65 or over

13.9%

7.1%

 

 

 

 

Employed

Yes

55.6%

46.0%

 

No

44.1%

52.5%

 

 

 

 

Formal education (average, in years)

 

13.6

12.5

 

 

 

 

Monthly income (average, in Euro)

 

1,707

1,533

 

Of the 478 participants who had an alcohol-related injury, 32% had consumed 5 to 11 drinks and 61% had consumed 12 or more drinks in the six hours prior to the injury.  Higher proportions of participants aged 18 to 29 years old or male engaged in harmful drinking, when compared to their older or female counterparts.  Over two-thirds attributed their injury to alcohol.  Just over 70% of participants had a blood alcohol level greater than 79 mg per 100 ml (above the legal limit for driving) and 48% has a blood alcohol level greater than 100 mg per 100 ml.  At clinical assessment, 77% were classified as moderately or severely intoxicated. 

The typical drinking habits among patients with alcohol-related injuries, in comparison to those with non-alcohol-related injuries, indicated that higher proportions drank alcohol daily, drank at least weekly, drank higher quantities per occasion, and engaged in hazardous or harmful drinking at least weekly.  All of these practices were higher among both male and female patients with alcohol-related injuries than among those with non-alcohol-related injuries. 

Two screening tools were used to identify problem alcohol use and the results indicated that higher proportions of those with an alcohol-related injury had a positive score (indicating problem alcohol use) compared to the proportions with a non-alcohol-related injury (Figure 1).  In addition, 13% of patients with alcohol-related injuries ‘needed to drink more to get the same effect’ compared to 2% of those with non-alcohol-related injuries. 

 

A logistic regression model was constructed in order to identify the independent influence of each factor on whether you had an alcohol-related injury.  After controlling for the influence of other factors, those who were most likely to attend an accident and emergency with an alcohol-related injury were those who:

·         presented at A&E between midnight and 6 am

·         presented at A&E at the weekend

·         presented at an inner city hospital

·         reported hazardous drinking at least monthly

·         responded positively to more than one of the problem-alcohol indicators

·         were injured on the street or road

·         reported a lower socio-economic status.

According to the authors, the results of the discriminate function analysis indicated that patients who consume any alcohol and who screen positive for two or more of the four questions listed below should be provided with a brief intervention to motivate them to address their problematic alcohol use.  The possible categorisation of responses and scoring technique for responses are not provided in the report. 

  1. In the past 12 months, how often did you drink between 5 and 11 drinks on one occasion?
  2. In the past 12 months, have you had feelings of guilt or remorse after drinking?
  3. In the past 12 months, has a family member or friend told you about things you said or did while you were drinking that you could not remember?
  4. In the past 12 months, how often did you drink 12 or more drinks on one occasion?

 The authors recommend that screening for, and brief interventions to address, problematic alcohol use be introduced in A&E departments throughout Ireland. 

 

1. Hope A, Gill A, Costello G, Sheehan J, Brazil E and Reid V (2005) Alcohol and injuries in the accident and emergency department – a national perspective. Dublin: Department of Health and Children.

Item Type:Article
Issue Title:Issue 17, Spring 2006
Date:January 2006
Page Range:pp. 4-5
Publisher:Health Research Board
Volume:Issue 17, Spring 2006
EndNote:View
Accession Number:HRB (Available)
Subjects:A Substance use, abuse, and dependence > Prevalence > Problem substance use
VA Geographic area > Europe > Ireland
A Substance use, abuse, and dependence > Effects and consequences
J Health care, prevention and rehabilitation > Health care programme or facility > Hospital

Repository Staff Only: item control page