Alcoholism in the Emergency Department: An Epidemiologic Study

Abstract

Abstract. Objective: To describe the epidemiology of alcoholism in ED patients. Methods: Over a twomonth period, every adult patient brought by ambulance to the ED of a large municipal hospital was prospectively enrolled by questionnaire. Data collected included demographics, previous ED use, triage complaint-related diagnoses, hospital admission rates, and ethanol levels (if determined). The CAGE alcoholism questions were administered to all patients by trained assistants. The only exclusion criterion was the inability to communicate while in the ED. A chisquare analysis was used to compare categorical variables. Results: A total of 2,658 patients were enrolled in the study; 226 were unable to respond to the CAGE questions. Five hundred eighty-eight of the remaining 2,432 patients (24%) were defined as being alcoholic by an affirmative response to at least two of the CAGE questions. All four questions were answered affirmatively by 17% of the total patients. Alcoholic patients were more likely to be male (88% vs 60%), unemployed (87% vs 71%), undomiciled (46% vs 20%), polysubstance users (52% vs 25%), and tobacco users (77% vs 41%), and to have had an ED visit in the previous six months (51% vs 35%) (p < 0.001 for all tests). Ethanol levels ranged from zero to 573 mg/dL. Whereas no positive response to a single CAGE question was predictive of a final diagnosis of alcoholism, a blood ethanol level more than 300 mg/dL predicted an affirmative response to at least two CAGE questions in 97% of cases. Conclusions: Alcoholism should be presumed to be present in a substantial number of patients who present to urban EDs by ambulance.

Binge ethanol administration enhances the MDMA-induced long-term 5-HT neurotoxicity in rat brain

“…This experiment allowed us to choose flow rates producing ethanol plasma concentrations of approximately 450 mg/dl. This level of ethanol was selected to mimic the exposure received by certain sectors of society who indulge in a repeated high level consumption of ethanol in a short interval ("binge" drinking) leading to severe intoxication (Doyle et al 1994;Parke et al 1996;Whiteman et al 2000).…”

Racial variations in the incidence of severe alcohol withdrawal

“…This study was approved by the Institutional Review Board and received exempt status for written consent. Authors from the two prospective studies [6,9] supplied unlinked summary data for analysis.…”

“…The patients included in Group 2 were typically admitted to "step-down" units, whereas those admitted directly to the ICU were excluded from this group but may have been in Group 1. I Group 3 patients were obtained from a prospective study of ED patients who were identified during a 2-month period as "at risk" for alcohol withdrawal by their affirmative response to 2 or more CAGE questionnaire items [9], thus defining themselves as alcoholics [10,11]. I Group 4 served as a general control for hospital demographics and included all adult ED patients who presented during a 6-month period in 2003.…”

Substance-related problems in patients visiting an urban Canadian emergency department

“…Although we found documentation of substance problems in approximately 18% of males and 8% of females visiting our ED, our numbers are lower than in some other ED-based studies. Whiteman and colleagues 19 screened 2432 adult patients visiting an inner city US hospital and found evidence of alcohol problems in 24%. In other US studies involving direct patient interviews, researchers found evidence of alcohol problems in 54% of drinking college students presenting to ED, 7 in 43% of young adult drinkers 8 and in 21% of all adult ED patients.…”

“…4 Numerous studies document a prevalence of substance abuse or dependence in approximately 20% of ED patients. [5][6][7][8][9][10][11][12] Substance abuse has been associated with up to 50% of all injuries. [13][14][15][16][17] Although the bulk of these data is from the United States, the Canadian situation is likely similar.…”