Patients Admitted to Emergency Services for Drunkenness: Moderate Alcohol Users or Harmful Drinkers?

Reynaud, Michel; Schwan, Raymund; Loiseaux-Meunier, Marie-Nadia; Albuisson, Éliane; Deteix, P

doi:10.1176/appi.ajp.158.1.96

Cited by 43 publications

(27 citation statements)

References 35 publications

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“…Further, no single laboratory test has been shown to be a substitute for questionnaire-based screening. 61,62 Routine screening. Experts have recommended routine alcohol screening focusing on new patient registrations, general health checks, and special types of consultation.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

Accuracy of one or two simple questions to identify alcohol-use disorder in primary care: a meta-analysis

et al. 2014

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BackgroundThere is much interest in ultra-short alcohol screening in primary care that may support brief alcohol interventions. Brief screening consisting of one or two questions might be used alone or in combination with longer tests as recommended by the Primary Care Service Framework. AimTo investigate whether a simple one and two question screening might prove an accurate and acceptable screening method in primary care. Design and settingA systematic literature search, critical appraisal and meta-analysis were conducted. MethodA comprehensive search identified 61 analyses of single questions to detect alcohol problems including 17 that took place in primary care, using a robust interview standard. Despite focusing alcohol-use disorder in primary care settings, heterogeneity remained high, therefore random effects and bivariate meta-analyses were used. ResultsAfter adjustments, diagnostic accuracy of a single-question approach was given by a sensitivity of 54.5% (95% CI = 43.0% to 65.5%) and a specificity of 87.3% (95% CI = 81.5% to 91.5%) using meta-analytic weighting. Two questions had a sensitivity of 87.2% (95% CI = 69.9% to 97.7%) and specificity of 79.8% (95% CI = 75.7% to 83.6%). Looking at each question individually, the most successful single question was a modification of the Single Alcohol Screening Question (SASQ) namely, 'How often do you have six or more drinks on one occasion?'. The optimal approach appears to be two questions followed by the CAGE questionnaire, which achieved an overall accuracy of 90.9% and required only 3.3 questions per attendee. ConclusionTwo brief questions can be used as an initial screen for alcohol problems but only when combined with a second-step screen. A brief alcohol intervention should be considered in those individuals who answer positively on both steps. Keywordsalcohol; diagnostic accuracy; diagnostic validity; primary care; sensitivity; specificity.

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Section: Comparison With Existing Literaturementioning

confidence: 99%

Accuracy of one or two simple questions to identify alcohol-use disorder in primary care: a meta-analysis

et al. 2014

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“…It is possible that our study underestimated chronic harms presenting to EDs due to insufficient detail in the triage notes or inadequate screening for chronic alcohol problems 33. To account for any potential underestimation, all undetermined presentations were combined with the chronic group.…”

Section: Discussionmentioning

confidence: 99%

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

Whitlam

Dinh

Rodgers

et al. 2016

Drug and Alcohol Review

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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]

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“…Given the strong association between alcohol and ED attendances, the prevalence of alcohol misuse is unsurprisingly high, but those at risk of AWS are not always apparent. Signs of alcohol abuse can be elusive and identification of alcohol misuse consequently overlooked (Crawford et al, 2004;Reynaud et al, 2001). In a study by Pirmohamed et al (2000), a pragmatic approach relying on clinical assessment was used to recognise AWS.…”

Section: Identifying Those At Risk Of Awsmentioning

confidence: 99%

“…Whilst there is obvious contention over the most appropriate tool, routine screening of patients for alcohol misuse provides a diagnostic approach to identifying those at risk of developing AWS (Reynaud et al, 2001). This presents invaluable insight that enables both nursing and medical staff to anticipate the need for early intervention.…”

Section: Identifying Those At Risk Of Awsmentioning

confidence: 99%

How is alcohol withdrawal syndrome best managed in the emergency department?

Jane

2010

International Emergency Nursing

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Patients Admitted to Emergency Services for Drunkenness: Moderate Alcohol Users or Harmful Drinkers?

Cited by 43 publications

References 35 publications

Accuracy of one or two simple questions to identify alcohol-use disorder in primary care: a meta-analysis

Accuracy of one or two simple questions to identify alcohol-use disorder in primary care: a meta-analysis

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

How is alcohol withdrawal syndrome best managed in the emergency department?

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