Prediction of alcohol-related casualties among emergency room admissions

Highly reported prevalence of drinking and driving in Brazil: data from the first representative household study

OBJECTIVE

Brazil lacks information about driving under the influence of alcohol (DUI) originated from representative samples obtained from the general population.

METHOD

333 subjects with a valid driver's license and drinking in the last 12 months were drawn from a multistaged sample of 2,346 adults from the first Brazilian Household Survey of Patterns of Alcohol Use. A multivariate analysis was conducted to understand the associations between risk factors and driving after drinking three or more drinks.

RESULTS

the overall DUI prevalence reported in the sample was 34.7% - 42.5% among males and 9.2% among females. Being male (OR = 6.0, 95% CI 2.9-12.6), having a previous DUI accident (OR = 7.9, 95% CI 2.5-24.9), binging in the last year (OR = 2.2, 95% CI 1.03-4.5) and having an unfavorable opinion towards policies (OR = 2.9, 95% CI 1.4-6.2) remained associated with heavy drinking and driving after model adjustments.

DISCUSSION

This was the first study evaluating driving under the influence of alcohol in a representative sample of the Brazilian population. The prevalence of DUI found is alarming, and possibly underestimated in the sample. Results demonstrate the need for more studies on this association and show directions towards preventive strategies for the specific high-risk group of male drivers with previous problems with alcohol and unfavorable opinions about prevention policies.

Bad luck or bad decisions: college students' perceptions of the reasons for and consequences of their alcohol overdose

Reasons for and immediate consequences of an alcohol overdose were explored for 217 undergraduate students requiring a medical emergency transport because of excessive alcohol consumption. The sample was categorized into 26 students attributing their overdose solely to bad luck and 191 students citing bad decision making as an explanation. A discriminant analysis portrayed the bad luck students as more likely to change the type of alcohol consumed, worrying more about problems with friends, less likely to change how much they drink and less likely to feel that they learned something about themselves. Friends were not named as being involved, but lapses in knowing how to pace consumption were frequently cited. Design of preventive educational programs for underage drinkers with the aim of avoiding an overdose is discussed.

Predictors of problem drinking among older adolescent emergency department patients

This study investigated consumption patterns, alcohol-related problems and predictors of problematic drinking among older adolescents. Two-hundred eighty older adolescents (148 males, mean +/- SD age = 18.5 [1.8] years) treated in two Emergency Departments (ED) completed the Alcohol Use Disorders Inventory Test (AUDIT) to identify problem drinkers. Logistic regression was used to determine predictors of problem drinker status. Higher rates of problem drinking were found among participants who were treated for physical assaults or for acute alcohol intoxication than were found among participants treated for medical illness. Being alcohol-positive in the ED, increasing frequency of drunkenness, and being treated for physical assault were predictive of problematic drinking after controlling for demographic variables. In conclusion, older adolescents who present for treatment of an assault-related injury or acute alcohol intoxication, who are alcohol-positive in the ED, and who report getting intoxicated once a month or more are likely to have a severe drinking problem.

Substance abuse and the emergency room: programmatic implications

A literature review (1984 to 1995) was conducted to identify cost effective policy implications regarding substance use in the emergency room (ER) and trauma unit. Prevalence rates, ranging from 9% to 47%, vary according to where, when and who is tested. Other drugs, most commonly marijuana, benzodiazepines and cocaine, follow a similar pattern to alcohol. The optimal method of measuring substance use depends on the goal of the assessment and a combination of clinical, self-report and biochemical markers is recommended. Simple screening questions such as the TWEAK or AUDIT should be routinely used with all attendants and further assessment provided only when high risk factors have been identified. These include: males, younger patients, metropolitan centres, after midnight and on weekends, injury from violence, accidents including MVAs, high acuity and psychiatric morbidity. Further, this screening should be complimented by an intervention, referral and treatment resource for those in need.

Predictors of emergency room use by homeless adults in New York City: the influence of predisposing, enabling and need factors

Employing data from a 1987 shelter survey of 1260 homeless adults in New York City, multivariate models of emergency room (ER) use are developed which include an array of risk factors for visiting a hospital ER including health and mental health problems, victimization and injuries. The study's primary goal is to identify factors that predict ER use in this population. Multivariate logistic and linear regression models were tested separately for men and women predicting three outcomes: any use of the ER during the past 6 months, use of the ER for injuries vs all other reasons (given any ER use), and the number of ER visits (given any ER use). Lower alcohol dependence, health symptoms and injuries were strong predictors for both men and women; other significant predictors differed markedly by gender. Both models were highly significant and produced strikingly high risk profiles. A high prevalence of victimization and injuries underlies ER use among the homeless. Based upon the findings, we recommend expanded health and victim services as well as preventive measures. Until primary care becomes available for this population, we advise against policies that discourage ER use by the homeless.

Alcohol and injuries: a review of international emergency room studies

This paper reviews emergency room (ER) studies from a number of countries which have focused on the association of alcohol and casualties. The review emphasizes studies which used probability sample of patients to represent the population of the emergency facility where the data were collected, and which separated injured patients from patients with medical conditions not due to injuries (the 'non-injured'). Reviewed here are studies concerned with: (1) estimated prevalence of positive blood alcohol at the time of the ER visit; (2) self-reported alcohol consumption prior to the event resulting in a need for ER treatment; (3) patients' descriptions of their usual drinking patterns and alcohol-related problems; (4) predictions of casualties and of alcohol-related casualties. Comparisons of findings from several countries are also presented. Comments on limitations of ER studies as well as other issues pertaining to the usefulness and interpretation of such data, and future directions for research in emergency room populations are discussed.

Drinking patterns and problems: a comparison of ER patients in an HMO and in the general population

The purpose of this study was to compare drinking patterns and alcohol-related problems and associations of these variables with casualties in an emergency room (ER) population and in the general population from which these patients come. A probability sample of patients seen in all three health maintenance organization (HMO) hospital ERs in one U.S. county (N = 986) and a household probability sample of those living in the same county who reported belonging to the HMO (N = 735) were interviewed. The ER sample was more likely to report consequences related to drinking, less likely to report feeling they should cut down on their drinking, and more likely to report greater use of the ER than the general population sample. Similar associations were found between injured and noninjured in the two samples. These data lend support for the generalizability of findings of associations of alcohol and casualties obtained from ER studies to the larger general population.

Psychosocial factors influencing non-urgent use of the emergency room: a review of the literature and recommendations for research and improved service delivery

Despite dramatic increases in use of hospital emergency rooms (ERs) since the 1950s, an estimated 85% of ER visits are made for non-life-threatening reasons. Using a modified version of the Andersen and Newman model of health care utilization, this paper reviews the research literature on ER use to examine what is known about factors that influence three stages of the help-seeking process: (1) problem recognition; (2) the decision to seek help; (3) the decision to use the ER. While predisposing factors other than race are not generally significant, enabling factors such as income, insurance coverage, having a usual source of care, and geographic proximity affect use of the ER, both alone and in interaction with race and other factors. The most common reason for non-urgent ER use was 'other care not available'. In addition to the absence of primary care, non-urgent use of the ER is linked to need factors arising from socioeconomic stress, psychiatric co-morbidities, and a lack of social support. Recommendations for future studies include examining prospectively all 3 stages of decision-making leading to ER use, and considering interactive effects among predictors. Implications for service delivery are discussed, including the need to re-structure health care delivery systems to provide greater access to primary care and provide more attention to psychosocial aspects of patient care in clinical settings.

Injury-related medical care utilization in a problem drinking population

BACKGROUND

Population-based data on the overall risk of injury among problem drinkers are extremely limited.

METHODS

We conducted an eight-year study of injury-related medical care utilization for a group of problem drinkers (n = 3 729) enrolled in the health insurance plan of a large manufacturing firm with plants in a number of midwestern states. A comparison non-problem drinking cohort matched on age, gender, and number of years of enrollment with the same company plan was also utilized.

RESULTS

Problem drinkers utilized injury-related medical care at a rate 1.6 times that of the comparison group and experienced injury-related medical care costs which were three times as high. Increased risks were found for both men and women and for all ages studied.

CONCLUSIONS

This study is one of the few to examine the overall incidence of fatal and non-fatal injuries among a large population of problem drinkers and provides evidence that higher medical care costs are associated with chronic alcohol use.

Correlation of emergency health care use, 911 volume, and jail activity with welfare check distribution

STUDY OBJECTIVES

The purpose of this study was to examine the relationship among emergency health care use, 911 call volume, and jail admissions with the timing of the distribution of General Assistance, Aid to Families With Dependent Children, and Minnesota Supplemental Aid welfare checks.

DESIGN

This was a retrospective study analyzing previously collected census and welfare check distribution data.

SETTING

The data used in this study were obtained from the Hennepin County Medical Center, the Hennepin County jail and alcoholic receiving center, and Department of Economic Assistance.

INTERVENTIONS

The daily census for the years 1986 through 1988 in the Hennepin County Medical Center emergency department, ED resuscitation room, pediatric ED, crisis intervention center, urgent care center, and alcoholic receiving center was obtained. The numbers of daily ambulance runs, nonelective hospital admissions, Hennepin County 911 calls, and Hennepin County jail admissions for the same years also were obtained. Means for each day of the month were computed across the 36 months of observation. These data were correlated with the number of days elapsed since the monthly issuance of the General Assistance, Aid to Families With Dependent Children, and Minnesota Supplemental Aid welfare checks.

MEASUREMENTS AND MAIN RESULTS

There were significant correlations between the number of days after distribution of the checks and the average values of the census of the alcoholic receiving center (r = -.96, P less than .00001), the ED (r = -.80, P less than .0001), ambulance runs (r = -.68, P less than .0001), 911 calls (r = -.45, P = .01), jail admissions (r = -.45, P = .01), nonelective hospital admissions (r = -.44, P = .01), and the crisis intervention center visits (r = -.39, P = .03).

CONCLUSIONS

The findings suggest that scheduling and staffing practices of various emergency service areas in Hennepin County reflect patient load variation associated with time of welfare check distribution. Systematic variation of time or amount of welfare could lead to improved distribution and reduction of emergency services demand.

Prediction of alcohol-related casualties: a comparison of two emergency room populations

Logistic regression was used to compare the predictive value of alcohol consumption variables on casualty occurrence in probability samples of two diverse emergency room (ER) populations who were breathalyzed and interviewed at the time of ER admission: San Francisco General Hospital (N = 1459) and four hospitals representative of a nearby California county (N = 1756). Previous analyses suggested differences in the association of alcohol consumption and injury in these two samples. Age, breathalyzer reading and feeling drunk at the time of the event were consistent predictors of injury status in both samples while breathalyzer reading, quantity and frequency of usual drinking and place of injury occurrence (workplace vs. home) were consistent predictors of alcohol-related injuries (self-reported drinking 6 h prior to event).