Background: It is estimated that up to a third of injuries requiring emergency department (ED) admission are alcohol-related. While injuries that are alcohol-related are unsurprising to ED staff, less is understood about the precursors to the injury event.

Methods: Using data from representative ED injury patients in 22 countries, we examined associations between context of injury (private or public), cause of injury (fall or trip, being stuck/cut/or burned and violence) and alcohol use. Alcohol-related policy data were also obtained from each study locale.

Results: Injuries were similarly reported in private (54%) and public settings (46%), while cause of injury was most often due to falls (39%) or being struck/cut or burned (38%). Violence-related injuries were reported by approximately 1 in 5 patients (23%). Increased odds of drinking prior to the injury event was associated with injury due to violence in private settings but not public venues. Similarly, patients from regions with fewer restrictive alcohol policies were more likely to report drinking prior to an injury event and have elevated violence-related injuries in private settings.

Conclusion: Understanding the cause and context of injury and alcohol use are important components to evaluation and development of alcohol policies.