Blood alcohol and injury in Bhutan: targeted surveillance in a national referral hospital emergency department

Abstract

Bhutan is a low-middle-income country with poor roads, rapidly increasing motor vehicle use and heavy alcohol consumption. We estimated the proportion of emergency department patients presenting with injury who had positive blood alcohol. We sought to breathalyse and interview all adult patients (≥18 years) presenting with injury at the Jigme Dorji Wangchuck National Referral Hospital in the capital city Thimphu, from April to October 2015. Breath tests and interviews were conducted with 339 (91%) of 374 eligible adult patients. A third (34%) were alcohol-positive and 22% had blood alcohol concentrations >0.08 g/dL. The highest alcohol-positive fractions were for assault (71%), falls (31%) and traffic crashes (30%). Over a third (36%) of patients had a delay of >2 h between injury and breath test. The results underestimate blood alcohol concentrations at the time of injury so the true prevalence of pre-injury alcohol impairment is greater than our estimates suggest. Countermeasures are urgently needed, particularly roadside random breath testing and alcohol controls.

Prevalence of alcohol and other drug use in patients presenting to hospital for fall-related injuries: a systematic review

“…There were 100 records that reported on the prevalence of AOD involvement in injury events. Of the 100 records that reported on all causes of injury (excluding transport events), 30 studies reported on the prevalence of AOD involvement in patients presenting to hospital after falls 24–52. One of these studies was excluded, since it reported exclusively on patients who denied consuming alcohol in the past year 38.…”

“…Studies were predominantly from the USA (13 studies) 24 26–28 31 36 39 41–44 48–52. There were two studies from Norway,25 29 30 46 and one each from Bhutan,35 Ghana,37 Spain,33 34 Taiwan,32 45 Tanzania45 and the UK 40. One additional record compiled data from 22 studies across 10 countries from North and South America including Canada, the USA, Mexico, Brazil, Argentina, the Dominican Republic, Guatemala, Guyana, Nicaragua and Panama 53.…”

“…Across the 18 independent cohorts identified, most studies (n=14, 78%) used blood or serum samples to test for alcohol 24 27–33 36 39 43–46 48–51. The remaining studies used breath or saliva samples35 37 47 or did not report the sample type used 53. The blood alcohol thresholds used to define alcohol involvement ranged from 0% to 0.08% across studies.…”

Prevalence and Correlates of Current Alcohol Use among Bhutanese Adults: A Nationally Representative Survey Data Analysis

“…In 2017, there were 944 alcohol outlets in Thimphu, accounting for up to 17.5% of alcohol outlets in all injury victims were alcohol-positive. [54] Alcoholic liver disease continues to be in the top five causes of morbidity and mortality in Bhutan. [34,35,55] This has led to significant medical and health costs in terms of care and rehabilitation for those with alcohol dependence.…”

Prevalence of drink‐driving in Thimphu, Bhutan: Targeted surveillance at sentinel sites

“…Motivated by concern about this combination of increasing motorisation and very heavy drinking on population health, we undertook a study of alcohol‐related injury in 2015 [7]. Over a 6‐month period, we breath‐tested patients presenting with injury to the emergency department in the capital city Thimphu, finding that 34% were alcohol‐positive [blood alcohol concentration (BAC) >0] and 22% had BACs >0.08 g/dL.…”