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

Abstract

Introduction The aim was to determine the prevalence of alcohol‐related presentations to an emergency department (ED) in a major Australian hospital, through a novel surveillance approach using two biomarkers, blood ethanol and phosphatidylethanol (PEth). Methods Observational study using secondary testing of blood samples collected during routine clinical care of ED patients presenting to the Royal Brisbane and Women's Hospital in Queensland, Australia, between 22 January and 2 February 2021. Data were collected from 1160 patients during the 10‐day study period. The main outcomes were the prevalence of acute alcohol intake, as determined by blood ethanol, and recent use over 2–4 weeks, as determined by PEth concentrations, for all ED presentations and different diagnostic groups. Results The overall prevalence for blood ethanol was 9.3% (95% confidence interval [CI] 7.8%, 11.1%), 5.3% for general medical presentations, increasing four‐fold to 22.2% for injury presentations. The overall prevalence of PEth positive samples was 32.5% (95% CI 29.9%, 35.3%) and 41.4% for injury presentations. There were 263 (25.3%) cases that tested negative for acute blood ethanol but positive for PEth concentrations indicative of significant to heavy medium‐term alcohol consumption. Discussion and Conclusions This novel surveillance approach demonstrates that using blood ethanol tests in isolation significantly underestimates the prevalence of medium‐term alcohol consumption in ED presentations. Prevalence of alcohol use was higher for key diagnostic groups such as injury presentations. Performing periodic measurement of both acute and medium‐term alcohol consumption accurately and objectively in ED presentations, would be valuable for informing targeted public health prevention and control strategies.

Factors associated with higher alcohol concentrations in emergency department presentations: PACE study

“…The Prevalence of Alcohol Consumption in Emergency presentations (PACE) study involved secondary testing of blood alcohol concentrations from existing blood specimens of patients (N = 1160) presenting to the ED at the Royal Brisbane and Women's Hospital (RBWH) in Queensland, Australia, over a 10-day period. Further information about the study is published elsewhere [25,26].…”

“…Demographic data, that is, sex, age and Indigenous status (identifying as Aboriginal and/or Torres Strait Islander peoples) and clinical data were extracted from EDIS. Clinical data included the principal diagnosis code (ICD-10-AM) assigned by the ED clinician (with EDIS including both standard ICD-10-AM diagnosis codes and a selection of ICD-10-AM external cause codes as a principal diagnosis), patient mode of arrival, departure status, triage code, presenting problem (recorded in free text), presenting date and time, and the patient's compensation status (health care attendance potentially compensable under a transport, workers or liability insurance scheme) [25,26].…”

“…The overall prevalence for a positive PEth test increased from 32.5% overall to 41.4% for injury presentations. Over 25% of cases that tested negative for acute blood ethanol showed PEth concentrations indicative of significant to heavy medium-term alcohol consumption [18,25].…”

“…While the prevalence of blood ethanol and PEth positive samples have previously been reported from these data [25], this analysis aimed to determine the risk factors associated with higher PEth and ethanol concentrations in ED presentations. More specifically, to determine the clinical and demographic factors associated with increasing PEth and ethanol concentrations such as sex, age and clinical factors (e.g., primary diagnoses, triage category).…”

Impact of a Rounding Tool and Clinical Champion on Trauma Patient Screening, Brief Intervention, and Referral to Treatment for Alcohol Use Disorder

“…Alcohol use is often a contributing etiology for injuries sustained by patients presenting to emergency departments for diagnosis and treatment. Evidence of alcohol use is found in 20%–40% of patients requiring hospital admission for injury treatment (Cameron et al, 2023; Dixit et al, 2016; Mehta, 2016; Rombouts et al, 2019). Acute alcohol intoxication is found more often in patients with severe injuries, leading to increased medical costs, lengths of stay, and, paradoxically, lower mortality rates than sober, similarly injured patients (Covarrubias et al, 2021).…”