Diagnosis-based emergency department alcohol harm surveillance: What can it tell us about acute alcohol harms at the population level?

Abstract

Introduction and AimsAcute harm from heavy drinking episodes is an increasing focus of public health policy, but capturing timely data on acute harms in the population is challenging. This study aimed to evaluate the precision of readily available administrative emergency department (ED) data in public health surveillance of acute alcohol harms.Design and MethodsWe selected a random sample of 1000 ED presentations assigned an ED diagnosis code for alcohol harms (the ‘alcohol syndrome’) in the New South Wales, Australia, automatic syndromic surveillance system. The sample was selected from 68 public hospitals during 2014. Nursing triage free‐text fields were independently reviewed to confirm alcohol consumption and classify each presentation into either an ‘acute’ or ‘chronic’ harm. Positive predictive value (PPV) for acute harm was calculated, and predictors of acute harm presentations were estimated using logistic regression.ResultsThe PPV of the alcohol syndrome for acute alcohol harm was 53.5%. Independent predictors of acute harm were ambulance arrival [adjusted odds ratio (aOR) = 3.4, 95% confidence interval (CI) 2.4–4.7], younger age (12–24 vs. 25–39 years: aOR = 3.4, 95% CI 2.2–5.3), not being admitted (aOR 2.2, 95% CI 1.5–3.2) and arriving between 10 pm and 5.59 am (aOR 2.1, 95% CI 1.5–2.8). PPV among 12 to 24‐year‐olds was 82%.Discussion and Conclusions The alcohol syndrome provides moderate precision as an indicator of acute alcohol harms presenting to the ED. Precision for monitoring acute harm in the population is improved by filtering the syndrome by the strongest independent predictors of acute alcohol harm presentations. [Whitlam G, Dinh M, Rodgers C, Muscatello DJ, McGuire R, Ryan T, Thackway S. Diagnosis‐based emergency department alcohol harm surveillance: What can it tell us about acute alcohol harms at the population level? Drug Alcohol Rev 2016;35:693–701]

Alcohol‐related harm in emergency departments: linking to subsequent hospitalizations to quantify under‐reporting of presentations

“…Emergency departments (EDs) are an important first point of contact with the health system for acute conditions such as alcohol-related harm. It therefore provides a vital data source to aid in the surveillance of public health issues, while contributing as an evidence base to guide government policy [1,2]. There is mounting evidence that a substantial proportion of injury and other presentations to EDs are related to alcohol, which consequently require significant resources [3][4][5].…”

Enacting alcohol realities: gendering practices in Australian studies on ‘alcohol‐related presentations’ to emergency departments

“…Our second example of the ways in which methodological considerations shape the treatment of gender is found in Whitlam et al . (). The aim of the study was to ‘evaluate the precision of readily available administrative emergency department (ED) data in public health surveillance of acute alcohol harms’ (Whitlam et al .…”

“…But ‘sex’ is then removed from the analysis of the predictors of acute alcohol‐related harm ‘as it met the 0.15% significance level for exclusion’ (Whitlam et al . : 696). In other words, because men are heavily implicated in both acute and chronic forms of alcohol‐related harm (being 1.5 times more likely to experience acute forms of alcohol‐related harm and 1.8 times more likely to experience chronic forms), gender cannot be used to distinguish one from the other (for a similar methodological move, see Liang et al .…”

“…The aim of the study was to ‘evaluate the precision of readily available administrative emergency department (ED) data in public health surveillance of acute alcohol harms’ (Whitlam et al . : 693) – that is, to develop ways of distinguishing ‘chronic’ forms of alcohol‐related harm (e.g. withdrawal) from ‘acute’ forms (e.g.…”

Effect of the Prevent Alcohol and Risk‐Related Trauma in Youth (P.A.R.T.Y.) Program among senior school students

“…The most effective solution is injury prevention . EDs have been suggested as a focus for harm surveillance and intervention, but with varying success . Schools are recognised by government as appropriate targets for drug and alcohol prevention interventions, as they provide opportunity for the implementation of pre‐emptive and cost effective programmes that reach substantial and diverse student groups .…”