Background: This study assessed the inconsistencies between self-reported alcohol consumption and blood alcohol content (BAC) in trauma patients. We aimed to identify the incidence of positive BAC in trauma patients who reported a zero score on the Alcohol Use Disorders Identification Test (AUDIT). We also sought to identify characteristics of individuals who were likely to negate alcohol use, yet yielded a positive BAC, to improve our ability to provide alcohol screening and healthcare to these atrisk alcohol consumers. Methods: We conducted a retrospective study from 2010 to 2018 at a university-based, level-one trauma emergency department. We identified 2581 adult trauma patients who reported a zero score on the AUDIT from the trauma registry. We collected BAC, age, gender, race, education level, mechanism of injury, language and injury severity score (ISS) from patient charts, and used descriptive analyses and multivariate logistic regression to analyze the data. Results: One hundred and thirty-one (5.08%) trauma patients who reported AUDIT of zero had a positive BAC. We found that being male (OR 1.53), assaulted or injured from a penetrating mechanism (OR 2.29) and having an ISS greater than 25 (OR 3.76) were independent positive predictors of trauma patients who reported an AUDIT of zero and had a positive BAC. Age (OR 0.99) was an independent negative predictor of trauma patients who reported an AUDIT of zero and had a positive BAC in this cohort. Conclusions: Inaccurate self-reporting of alcohol drinking behavior does exist in trauma patients. A composite of objective alcohol screening modalities, in addition to AUDIT, is needed to screen for alcohol use in this population. Healthcare providers should remain highly suspicious of alcohol-related injuries in individuals with the identified characteristics

Background: Patients with an alcohol use disorder (AUD) have an increased risk of developing complications during their hospital stays; however, how AUD impacts the length of stay (LOS) and the utilization of hospital resources remains inconclusive. Aim: This study aimed to identify the associations between AUD, defined by self-reported alcohol consumption, blood alcohol content (BAC), and hospital LOS (HLOS) including intensive care unit (ICU) LOS in the trauma patient population. Study Design: We conducted a retrospective study analyzing data obtained from 2010 to 2018 at a university-based, level-one trauma emergency department. We identified 1689 adult trauma patients who completed the AUDs identification test (AUDIT) and were admitted to the hospital. We retrieved BAC, age, gender, LOS, and injury severity score (ISS) from the patient charts. The independent samples' median test was used to assess the association of HLOS and ICULOS with ISS, BAC levels, or AUDIT scores. Results: ISS was directly associated with higher HLOS ( P < 0.001) and ICULOS ( P < 0.001); however there was no statistically significant association between AUDIT scores and ICULOS ( P = 0.21) or HLOS ( P = 0.86). There was also no statistically significant association between BAC and HLOS ( P = 0.09) or ICULOS ( P = 0.07). Conclusions: Our study found no associations between AUDIT, BAC, and both hospital and ICU LOS in trauma patients even though the literature supported an increased risk of medical complications in the AUD patients.

Introduction: Trauma patients who present to the emergency department (ED) intoxicated or with an alcohol use disorder (AUD) undergo more procedures and have an increased risk of developing complications. However, how AUD and blood alcohol concentration (BAC) impact a trauma patient’s disposition from the ED remains inconclusive. In this study we aimed to identify the associations between positive BAC or an AUD with admission to the hospital, including the intensive care unit (ICU). Methods: This was a retrospective study analyzing data from 2010–2018 at a university-based, Level I trauma ED. Included in the study were 4,699 adult trauma patients who completed the Alcohol Use Disorders Identification Test (AUDIT) and had blood alcohol content test results. Results: Positive BAC was associated with hospital admission and ICU admission after adjusting for injury severity score (ISS) (odds ratio 1.5 and 1.3, respectively). The AUDIT was only correlated with hospital and ICU admission in patients with ISS of 1 to 15. By increasing risk of AUD (low, moderate, high, and likely alcohol dependent) the proportion of ICU admissions rose from 29.3% to 37.3%, 40.0% and 42.0% (P <0.01). The results did not change significantly by adjustment for the age of patients. Conclusion: BAC is associated with increasing ED disposition to the hospital or ICU. Furthermore, self-reported alcohol use was associated with an increased risk of hospital or ICU admission in patients with minor or moderate injuries. Further studies to determine viable options to decrease admission rates in these patients are warranted.

Context. Opioid prescriptions from the emergency department (ED) have gradually increased over the last 20 years. Mounting evidence of the potential for abuse of these drugs, even after a transient ED encounter, has fueled a push to curtail the prescriptions of opioids from the ED. Objectives. It is important to analyze the types of etiologies and provider demographics that drive opioid prescription in our emergency departments. Our study aimed to determine which patients in the ED are receiving opioid prescriptions, as well as their strength and quantity. Secondary outcomes included identifying difference in prescribing between provider classes. Methods. We conducted a retrospective study at a tertiary care university-based, level-one trauma ED from November 2017 to October 2018. We identified and analyzed data from 2,259 patients who were sent home with an opioid prescription. We retrieved patient and provider demographics, diagnosis, etiologies, and prescription information. Results. The mean age of a patient receiving an opioid prescription was 45, and 72.7% of patients were white. The most common diagnosis groups associated with an opioid prescription were abdominal pain (18.5%), nonfracture extremity pain (18.4%), and back/neck pain (12.5%). Hydrocodone-acetaminophen 5–325 mg was the most commonly prescribed (67.4%). The median total prescribed milligram morphine equivalent (MME) was highest for extremity fracture (75.0; IQR 54.0–100.0). The median total prescribed amount of pills was highest for patients with extremity fractures (15.0; IQR 12.0–20.0). Conclusions. Our study elucidates the prescribing patterns of an academic level 1 trauma center and should pave the way for future studies looking to maximize effectiveness at ways to curb ED opioid prescription.

Objectives Undergraduate ultrasound education is becoming increasingly important, but its expansion is limited by time, space and the availability of trained faculty. In order to validate an alternative and more accessible teaching model, our aim was to assess whether combining teleguidance and peer‐assisted learning to teach ultrasound is as effective as traditional in‐person methods. Methods Peer instructors taught 47 second‐year medical students ocular ultrasound via either teleguidance or traditional in‐person methods. Proficiency was assessed using a multiple‐choice knowledge test and objective structured clinical examination (OSCE). Confidence, overall experience, and experience with a peer instructor were measured using a 5‐point Likert scale. Two one‐sided t‐tests were used to measure equivalency between the two groups. The null hypothesis that the two groups were not different was rejected when P < 0.05. Results The teleguidance group performed as well as the traditional in‐person group in terms of knowledge change, confidence change, OSCE time and OSCE score (p = 0.011, p = 0.006, p = 0.005 and  = 0.004, respectively, indicating the two groups are statistically equivalent). The teleguidance group rated the experience highly overall (4.06/5), but less than the traditional group (4.47/5; P = 0.448, indicating statistical difference). Peer instruction was rated 4.35/5 overall. Conclusion Peer‐instructed teleguidance was equivalent to in‐person instruction with respect to knowledge change, confidence gain and OSCE performance in basic ocular ultrasound.