Cross-Sectional Study of Risky Substance Use by Injured Emergency Department Patients

Strezsak, Valerie; Baird, Janette; Lee, Christina S.; Mello, Michael J.

doi:10.5811/westjem.2017.1.32180

Cited by 4 publications

(3 citation statements)

References 14 publications

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“…Alcohol dependence ranges from being most prevalent in A&E to least prevalent in general wards. We might have anticipated the prevalence to be higher in mental health in-patient units and A&E due to the high level of substance use comorbidity in patients with psychiatric illness and those with injuries [20,21]. This appears to be supported by the data which, despite high I 2 values, demonstrate coherent patterns of prevalence estimates across each setting.…”

Section: Discussionmentioning

confidence: 73%

The prevalence of wholly attributable alcohol conditions in the United Kingdom hospital system: a systematic review, meta‐analysis and meta‐regression

et al. 2019

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Background and Aims The prevalence of alcohol‐related conditions is often reported as higher in hospital in‐patients compared with the general population. However, formal prevalence estimates are commonly derived from small studies which report highly varied results. This systematic review and meta‐analysis, within the UK hospital system, aimed to estimate the pooled prevalence of the 26 ICD‐10 conditions that are wholly attributable to alcohol in in‐patient settings. Methods We searched Medline, Embase, PsychINFO and CENTRAL from database inception until 1 May 2018. We included studies of any design that reported the prevalence of one of 26 wholly attributable alcohol conditions defined by the ICD‐10. Studies were required to be conducted in one or more of the constituent nations of the United Kingdom and in an in‐patient setting (general wards, intensive care units, accident and emergency departments or mental health in‐patient units). Estimates were pooled using random‐effects meta‐analysis, and meta‐regression tested study and patient factors contributing to variation. Quality was assessed using the Grading of Recommendations Assessment Development and Evaluation (GRADE) framework. Results A total of 124 studies were included, reporting on a total of 1 657 614 patients. The majority of studies reported on harmful use of alcohol and alcohol dependence, for which the pooled prevalence was 19.76% [95% confidence interval (CI) = 15.61–24.26%] and 10.25% (95% CI = 7.06–13.96%), respectively. Mean patient age and type of in‐patient setting were identified as the main sources of variation in prevalence estimates, but not date of data collection. Both estimates were deemed very low quality according to GRADE. Conclusions An estimated one in five patients in the UK hospital system use alcohol harmfully, and one in 10 are alcohol‐dependent.

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Section: Discussionmentioning

confidence: 73%

The prevalence of wholly attributable alcohol conditions in the United Kingdom hospital system: a systematic review, meta‐analysis and meta‐regression

et al. 2019

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“…Similar to our study, a significant proportion of patients (33%) declined to participate in the study. Strzsak et al reported the use of a tablet-based Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) to determine the prevalence of “risky substance use” in the ED [ 41 ]. Similar to our study findings, 51% screened positive for risky substance use, and the mean time to completion was 5 minutes.…”

Section: Discussionmentioning

confidence: 99%

Emergency Department Screening for Unhealthy Alcohol and Drug Use with a Brief Tablet-Based Questionnaire

Elder

Chenoweth

et al. 2020

Emergency Medicine International

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Background. Screening for unhealthy alcohol and drug use in the emergency department (ED) can be challenging due to crowding, lack of privacy, and overburdened staff. The objectives of this study were to determine the feasibility and utility of a brief tablet-based screening method in the ED and if patients would consider a face-to-face meeting with a certified alcohol and drug counselor (CADC) for more in-depth screening, brief intervention, and referral to treatment (SBIRT) helpful via this interface. Methods. A tablet-based questionnaire was offered to 500 patients. Inclusion criteria were age ≥18, Emergency Severity Index 2–5, and English comprehension. Subjects were excluded if they had evidence of acute intoxication and/or received sedating medication. Results. A total of 283 (57%) subjects were enrolled over a 4-week period, which represented an increase of 183% over the monthly average of patients referred for SBIRT by the CADC prior to the study. There were 131 (46%) who screened positive for unhealthy alcohol and drug use, with 51 (39%) and 37 (28%) who screened positive for solely unhealthy alcohol use and drug use/drug use disorders, respectively. There were 43 (33%) who screened positive for combined unhealthy alcohol and drug use. Despite willingness to participate in the tablet-based questionnaire, only 20 (15%) with a positive screen indicated via the tablet that a face-to-face meeting with the CADC for further SBIRT would be helpful. Conclusion. Brief tablet-based screening for unhealthy alcohol and drug use in the ED was an effective method to increase the number of adult patients identified than solely by their treating clinicians. However, only a minority of subjects screening positive using this interface believed a face-to-face meeting with the CADC for further SBIRT would be helpful.

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“…While this study included all trauma patients, data on drug and alcohol use in drivers can help inform targeted interventions. Further, injured patients have high rates of ‘risky’ drug and alcohol use [9] , [10] , [11] , which contributes to trauma recidivism [12] . Multiple professional organisations in high income countries have recommended screening and brief intervention (SBI) for substance use disorders in trauma patients [10] , [13] .…”

Section: Introductionmentioning

confidence: 99%

Drug and alcohol use in Tanzanian road traffic collision drivers

Dozois

Nkondora

Noste

et al. 2021

African Journal of Emergency Medicine

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Introduction Road traffic collisions (RTCs) are an important public health problem in low and middle-income countries (LMIC), where 90% of RTC deaths occur. The World Health Organization has suggested strategies to address excess mortality from RTCs including efforts to combat driving after using alcohol or drugs. Data on the impact of drug and alcohol use on RTCs is limited in many low-resource settings including Tanzania. We sought to examine the prevalence of drug and alcohol use in Tanzanian RTC drivers. Methods This prospective, observational study was conducted in the emergency centre (EC) of Muhimbili National Hospital (MNH) in Dar es Salaam, Tanzania. We enrolled adult drivers presenting within 24 h of an RTC. We collected a saliva test of blood alcohol content (BAC) and a urine drug screen (UDS) and administered a validated substance use disorder screening tool, the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Patients were excluded from individual analyses if they could not produce saliva or urine or answer questions. Primary outcomes were rates of positive BAC, UDS and self-reported risky alcohol and drug use patterns. Results We screened 5264 trauma patients and enrolled 418, in whom 190 had a BAC, 364 had a UDS, and 410 had a complete ASSIST. 15 of 190 patients (7.9%) had a positive BAC, and 67/361 (18.7%) had a positive UDS for at least one drug. ASSIST scores showed 75/410 (18.3%) patients were at moderate or high risk for alcohol use disorder. Few were at risk for disordered use of other non-tobacco substances. Discussion In our population of RTC drivers, positive BAC and UDS tests were rare but many patients were at risk for an alcohol use disorder. Ideal screening for substance use in Tanzanian trauma populations may involve a combination of objective testing and a verbal screening tool.

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Cross-Sectional Study of Risky Substance Use by Injured Emergency Department Patients

Cited by 4 publications

References 14 publications

The prevalence of wholly attributable alcohol conditions in the United Kingdom hospital system: a systematic review, meta‐analysis and meta‐regression

The prevalence of wholly attributable alcohol conditions in the United Kingdom hospital system: a systematic review, meta‐analysis and meta‐regression

Emergency Department Screening for Unhealthy Alcohol and Drug Use with a Brief Tablet-Based Questionnaire

Drug and alcohol use in Tanzanian road traffic collision drivers

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