Routine alcohol screening in the ED: unscreened patients have an increased risk for hazardous alcohol use

Abstract

BackgroundRoutine screening programmes for hazardous alcohol use in the ED miss large numbers of patients. We investigated whether patient-related or staff-related factors cause screening failures and whether unscreened patients are at increased risk of hazardous alcohol use.MethodsThis is a secondary analysis of a prospective study. From November 2012 to November 2013, all adult patients visiting a Dutch inner city ED were screened for hazardous alcohol consumption using the Alcohol Use Disorders Identification Test-Consumption. Reasons for failure of screening were categorised as: (A) patient is unable to cooperate (due to illness or pain, decreased consciousness or incomprehension due to intoxication, psychiatric, cognitive or neurological disorder or language barrier), (B) healthcare professional forgot to ask, (C) patient refuses cooperation and (D) screening was recently performed (<6 months ago). Presence of risk factors for hazardous alcohol use was compared between screened and unscreened patients.ResultsOf the 28 019 ED patients, 18 310 (65%) were screened and 9709 (35%) were not. In 7150 patients staff forgot to screen, whereas 2559 patients were not screened due to patient factors (2340 being unable and 219 unwilling). Patients with any of these risk factors were less likely to be screened: male sex, alcohol-related visit, any intoxication, head injury, any kind of wound and major trauma. In multivariate analysis, all these risk factors were independently associated with not being screened. Patients with at least one risk factor for hazardous alcohol use were less likely to be screened. Highest prevalence of risk factors was found in patients unable or unwilling to cooperate.ConclusionPatients who do not undergo routine screening for alcohol use at triage in the ED have an increased risk for hazardous alcohol use. These data highlight the importance of screening patients, especially those initially unwilling or unable to cooperate, at a later stage.

A Deep Learning Algorithm to Predict Hazardous Drinkers and the Severity of Alcohol-Related Problems Using K-NHANES

“…In clinical settings, it is practically difficult to screen all patients for alcohol use. One study has used AUDIT-C for all patients visiting the emergency room for 1 year and found that only 65% of patients are screened (61). It was found that 25% of patients did not undergo such screening because their medical staff forgot to ask questions about alcohol and 8.8% of patients struggled with questions or refused to cooperate.…”

Identifying the Assumptions and Bias That Affect Screening and Brief Interventions for Harmful Alcohol Use

“…Of 28,019 patients, 65% were screened, and 35% were not. Failures to screen included patient refusal to cooperate due to pain, illness, intoxication, decreased level of consciousness, neurological deficits, language barriers, and acute mental illness (van Loon et al, 2020). Patients who were not screened were either unwilling or unable to participate.…”

“…Researchers found that male patients, alcohol-related visits, trauma, and head injuries were independently associated with a lack of screening. Patients at the highest risk for HAU were most often unscreened (van Loon et al, 2020). The importance of conducting repeat screening, flagging patients who were not screened, receiving prompts through the electronic medical record (EMR).…”

“…The importance of conducting repeat screening, flagging patients who were not screened, receiving prompts through the electronic medical record (EMR). Furthermore, educating staff about risk factors for HAU is of vital importance for addressing these barriers (van Loon et al, 2020).…”

Common Laboratory Parameters Are Useful for Screening for Alcohol Use Disorder: Designing a Predictive Model Using Machine Learning

“…Alcohol has also increased traffic accidents, trauma [ 6 ], absenteeism [ 7 ] at the workplace and school [ 8 ], job loss, violent behavior, and legal [ 9 ], family, economic, mental [ 10 ], and social problems [ 5 ]. Despite the significant benefits of alcohol abuse treatments [ 11 ], general practitioners only manage to diagnose a third of these patients [ 12 ].…”