Risk factors associated with 1-week revisit among emergency department patients with alcohol withdrawal

Abstract

Background Approximately one-quarter of emergency department (ED) visits for alcohol withdrawal result in unscheduled 1-week ED return visits, but it is unclear what patient and clinical factors may impact this outcome Methods From January 1, 2015, to December 31, 2018, at three urban EDs in Vancouver, Canada, we studied patients who were discharged with a primary or secondary diagnosis of alcohol withdrawal. We performed a structured chart review to ascertain patient characteristics, ED treatments, and the outcome of an ED return within 1 week of discharge. We used univariable and multivariable Bayesian binomial regression to identify characteristics associated with being in the upper quartile of 1-week ED revisits. ResultsWe collected 935 ED visits among 593 unique patients. Median age was 45 years (interquartile range 34 to 55 years) and 71% were male. The risk of a 1-week ED revisit was 15.0% (IQR 12.3; 19.5%). After adjustment, factors independently associated with a high risk for return included any prior ED visit within 30 days, no fixed address, initial blood alcohol level > 45 mmol/L, and initial Clinical Institute Withdrawal Assessment-alcohol revised score > 23. These factors explained 41% of the overall variance in revisits. Conclusion Among discharged ED patients with alcohol withdrawal, we describe high-risk patient characteristics associated with 1-week ED revisits, and these findings may assist clinicians to facilitate appropriate discharge planning with access to integrated follow-up support. Keywords Alcohol use disorder • Alcohol withdrawal RésuméContexte Environ un quart des visites aux urgences pour sevrage alcoolique se traduit par un retour non programmé aux urgences pendant une semaine, mais les facteurs cliniques et relatifs aux patients qui peuvent avoir une incidence sur ce résultat ne sont pas clairs. Méthodes Du 1er janvier 2015 au 31 décembre 2018, dans trois urgences urbaines de Vancouver, au Canada, nous avons étudié les patients qui sont sortis avec un diagnostic primaire ou secondaire de sevrage alcoolique. Nous avons procédé * Frank X. Scheuermeyer

Prevalence of probable substance use disorders among children in Ugandan health facilities

“…Despite well documented evidence that children start using alcohol and other substances early [ 7 , 12 , 13 ], additional evidence indicates that individuals with alcohol and substance use disorders often access the health care system for reasons other than seeking care for substance use problems [ 26 , 27 ]. Many do not seek specialty treatment but they are over-represented in many general health care settings, signalling that the health care system is an important entry point for recognising and later addressing these underlying disorders [ 27 , 28 ]. Some literature on the prevalence of substance use among children in the community as well as facility settings is available [ 11 , 29 – 33 ].…”

The management of alcohol use disorder in the emergency department, is it time for version 2.0?

“…As emergency care providers, it can be frustrating and seem futile to treat—or not treat—patients with AUD, as the ED often lacks the necessary resources to provide patients with interventions, pharmacotherapy, and access to addiction services. As Scheuermeyer et al [ 2 ] describe the 15% one-week ED revisit rate for those experiencing alcohol withdrawal, it calls attention to the ‘revolving door’ nature of current ED practices for patients presenting with AUD. Emergency care providers may have completed the CAGE questionnaire and identified that a patient has AUD, but now what?…”

“…In addition, they highlight the underprescription of pharmacotherapy. Less than 50% of their patient population was prescribed benzodiazepines at discharge for a diagnosis of alcohol withdrawal [ 2 ]. Is that due to emergency care providers underrecognizing AUD and its consequences?…”

“…Progress will require a concerted multidisciplinary and organizational effort and will need to be founded on elements of both advocacy and evidence-based guidance. To begin, we need to better characterize the risk factors for ED visits and re-visits in the AUD population, an expansion of the study by Scheuermeyer et al [ 2 ]. Next, it would be invaluable to complete a Canada-wide needs assessment to determine the prevalence of AUD and its consequences.…”

“…Which patients are at-risk for return? Scheuermeyer et al [2] investigated ED visits from three Canadian urban EDs with a diagnosis of alcohol withdrawal and identified risk factors for one-week revisit, which included: any prior ED visit within the past 30 days, no fixed address, high initial blood alcohol level, and high initial Clinical Institute Withdrawal Assessment (CIWA) score [2]. In addition, they highlight the underprescription of pharmacotherapy.…”