Prevalence of Alcohol Consumption in Emergency department presentations (PACE) in Queensland, Australia, using alcohol biomarkers ethanol and phosphatidylethanol: an observational study protocol

Abstract

IntroductionAlcohol use in patients presenting to the emergency department (ED) is a significant problem in many countries. There is a need for valid and reliable surveillance of the prevalence of alcohol use in patients presenting to the ED, to provide a more complete picture of the risk factors and inform targeted public health interventions. This PACE study will use two biomarkers, blood ethanol and phosphatidylethanol (PEth), to determine the patterns, presence and level of alcohol use in patients presenting to an Australian ED.Methods and analysisThis is an observational prevalence study involving the secondary use of routinely collected blood samples from patients presenting to the Royal Brisbane and Women’s Hospital (RBWH) Emergency and Trauma Centre (ETC). Samples will be tested for acute and medium-term alcohol intake using the two biomarkers blood ethanol and PEth respectively, over one collection period of 10–12 days. Descriptive statistics such as frequencies, percentages, means, SD, medians and IQRs, will be used to describe the prevalence, pattern and distribution of acute and medium-term alcohol intake in the study sample. The correlation between acute and medium-term alcohol intake levels will also be examined.Ethics and disseminationThis study has been approved by the RBWH Human Research Ethics Committee (reference, LNR/2019/QRBW/56859). Findings will be disseminated to key stakeholders such as RBWH ETC, Australasian College for Emergency Medicine, Royal Australasian College of Surgeons, Statewide Clinical Networks, and used to inform clinicians and hospital services. Findings will be submitted for publication in peer-reviewed journals and presentation at appropriate conferences.

Prevalence of alcohol consumption in emergency presentations: Novel approach using two biomarkers, ethanol and phosphatidylethanol

“…This observational study, assessing the Prevalence of Alcohol Consumption in Emergency presentations (PACE), was conducted at the Royal Brisbane and Women's Hospital (RBWH) in Queensland, Australia, using secondary testing of routinely collected blood samples from the Emergency and Trauma Centre [ 20 ], which will hereafter be referred to as ED. The RBWH is Queensland's largest hospital with over 82,000 ED presentations annually [ 21 ].…”

“…The RBWH is Queensland's largest hospital with over 82,000 ED presentations annually [ 21 ]. Approximately 40% of patients who present to RBWH ED have blood samples collected as part of routine clinical care [ 20 ].…”

“…During the study period, blood samples routinely sent to Pathology Queensland were intercepted and an aliquot separated and frozen without patient or treating clinician's knowledge [ 20 ]. To avoid any impact on patient care, the samples were batch tested after 3–4 months.…”

“…Blood ethanol concentrations were measured with an enzymatic assay on a Beckman Coulter analyser [ 22 ]. To quantify PEth, a validated ultra‐performance liquid chromatography tandem mass spectrometry (UPLC‐MS/MS) method was used in the range of 0–2000 μg/L [ 15 , 20 ]. PEth is extracted from whole blood by protein precipitation with 2‐propanol.…”

“…The homologue 16:0/18:1 was found to be the dominant species and showed excellent correlation with total PEth ( r 2 = 0.98, p < 0.001) and was therefore selected as the biomarker for measuring PEth in this study. Further details on PEth testing are provided in the study protocol [ 20 ].…”