|Year : 2020 | Volume
| Issue : 4 | Page : 281-284
Alcohol-related acute presentations to the emergency department
P Manimaran1, P Neeraj George Paul2, Moses Kirubairaj Amos Jegaraj3
1 ASC Centre (North), Bengaluru, Karnataka, India
2 Department is Centre MI Room, Christian Medical College, Vellore, Tamil Nadu, India
3 Westcare Medical Centre, Melton, Victoria, Australia
|Date of Submission||03-Apr-2020|
|Date of Decision||01-May-2020|
|Date of Acceptance||05-May-2020|
|Date of Web Publication||19-Oct-2020|
Dr. P Manimaran
ASC Centre (North), Bengaluru, Karnataka
Source of Support: None, Conflict of Interest: None
Introduction: Alcohol consumption in excess leads to various consequences, either short term or long term. Acute alcohol impairment is a very important analysis topic for traffic safety, and a wide range of studies have indicated that alcohol is one of the root causes of driving impairment across the world. Methodology: The study was conducted at the emergency department (ED) of Christian Medical College, Vellore, from December 2014 to March 2015. After obtaining informed written consent, all patients above the age of 18 were included and data were analyzed. Results: During the study period, 153 patients presented with alcohol-related emergencies. Among them, 45.75% belonged to the age group of 21–30 years. The most common time of presentation to ED was in the evening from 15:30 to 22:30 (59%). Seventy-six percent of the patients presented with road traffic accidents (RTAs), of which 89.6% were two-wheeler-related RTAs. Among the two-wheeler RTAs, 98.2% did not wear a helmet. Nine percent of the total emergencies were related to acute poisoning incidents. Conclusions: Alcohol-related acute presentations to the ED are common but preventable emergencies, with RTAs and acute poisonings comprising the majority.
Keywords: Alcohol, emergency department, road traffic accident
|How to cite this article:|
Manimaran P, Paul P N, Jegaraj MK. Alcohol-related acute presentations to the emergency department. Curr Med Issues 2020;18:281-4
| Introduction|| |
For many centuries, alcohol has been used as a psychoactive substance, and it has dependence-producing properties. Excess use of alcohol is a burden in societies, both social and economic adverse implications. Variations and historical trends in alcohol consumption and its effects are often explained by factors such as economic development, religious and cultural beliefs, and ease of accessibility of alcohol. Alcohol use is prevalent among communities. Data on the impact of alcohol leading to emergency visits in India are sparse. Further, local and regional data are important as the spectrum of patients with alcohol presentation differs in different localities. Blood alcohol concentration (BAC) is the most common way for law enforcement to determine whether a person can safely operate a motor vehicle. BAC can be measured within 30–70 min after the person has consumed alcohol. The National Institute on Alcohol Abuse and Alcoholism defines binge drinking as a pattern of drinking that brings BAC levels to 0.08 g/dL. This typically occurs after four drinks for women and five drinks for men within 2 h. Heavy alcohol use is defined as binge drinking on 5 or more days in the past month.
Binge drinking and heavy alcohol use can increase an individual's risk of alcohol use disorder. In India, driving with a BAC more than 30 mg/dl is a punishable offense as per Se ction 185 of the Indian Motor Vehicles Act. Acute alcohol ingestion is associated with various acid-base abnormalities. According to the International Center for Alcohol Policies, the maximum legal alcohol concentration for driving in India is 0.3 mg/ml. We intend to take this outcome-based study to create awareness in the public regarding the hazardous effects of alcohol and the preventive measures with regard to alcohol-related emergencies.
| Methodology|| |
This study was done in the emergency department (ED) of Christian Medical College, Vellore. It is a 45-bedded independent clinical unit which handles about 250–270 adult emergencies daily. Everyday about 15 cases of medicolegally significant trauma are registered.
This was a prospective observational cohort study. After obtaining informed consent, a detailed history using the AUDIT-C questionnaire and physical examination and relevant investigations was collected. The AUDIT-C is a three-item alcohol screen that can help identify persons who are hazardous drinkers or have active alcohol use disorders (including alcohol abuse or dependence). All the data for the study were collected by the principal investigator. Data on the profile of alcohol-related emergencies, socioeconomic status, and common presentation data were collected from the patient, relative, or patient escort in ED. Their blood alcohol level and acid-base status were obtained from the investigations chart. Disposition for ED visit as admitted, discharge, discharge at request, or discharge against medical advice was noted.
The aim of this study was to assess the common emergencies related to acute alcohol ingestion.
The objectives of this study were as follows:
- To describe the spectrum of acute alcohol-related emergencies among adults
- To describe the injury pattern among those involved in trauma under the influence of alcohol.
All patients above 18 years of age presenting to adult ED with a history of acute alcohol ingestion within 12 h of presentation to ED were included in this study.
- Patients who refused consent
- All unconscious patients with an inadequate history who have no significant alcohol levels in blood as confirmed later by BAC were excluded from the study.
Data entry and analysis were done using the Statistical Package for the Social Sciences (SPSS Inc. Released 2007, version 16.0. Chicago, IL, USA). Categorical variables were summarized using counts and percentages. Quantitative variables were summarized using mean and standard deviation or median and interquartile range.
Ethics committee approval
Patient confidentiality was maintained using identifiers, and a password-protected access to the data for a limited number of individuals was maintained to ensure the protection of privacy. The study design and methods were approved by the Institutional Review Board (IRB), Christian Medical College, Vellore, IRB Min No. 9106 dated October 6, 2014.
| Results|| |
This prospective observational cohort study was conducted from December 2014 to March 2015. The baseline characteristics are shown in [Table 1]. During this period, 153 patients were admitted to ED with a history of alcohol consumption within 24 h. The strobe diagram of the study is mentioned in [Figure 1].
Alcohol-related emergencies were seen mostly among the age group of 21–30 years (45.75%). Twenty-six percent of the patients belonged to the age group of 31–40 years. Thirteen percent of the patients were over 50 years of age [Figure 2]. Among the 153 patients with alcohol-related emergencies, 90 patients (59%) presented from 15:30 h to 22:30 h. Thirty-nine patients (25%) presented between 22:30 h and 08:00 h in the morning, and 24 patients (16%) presented between 08:00 h and evening 15:30 h [Figure 3].
One hundred and sixteen patients (76%) sustained road traffic accidents (RTAs); 14 patients (9%) came with poisoning. Nine (6%) had acute alcohol intoxication, five (3%) had self-cut injury, and nine (6%) others were the different reasons for presentation to alcohol-related emergencies [Figure 4]. Out of 116 RTAs, 104 were two-wheeler related, and in the two-wheeler-related RTAs, only two (1.9%) wore a helmet while the other 98.1% did not use a helmet during the RTA. Injury severity scoring was calculated from 116 patients, and we found that 31% had moderate injury severity scoring while 28% had moderate-to-severe severity grading [Figure 5].
| Discussion|| |
Head injury is a potentially devastating consequence of acute alcohol-related emergencies. This is mainly due to driving two-wheelers without helmet after alcohol consumption. The primary objective of our study was to describe the profile of patients presenting to the ED with acute alcohol-related emergencies. All our patients with acute alcohol-related presentations were males. This is probably because majority of the cases were due to vehicular accidents. In our society, vehicles are mostly driven by males. Hence, male sex was found to be a higher risk factor for RTAs.
The severity and complexity of injuries from road traffic injuries are worsening by the day. Our data have identified RTA as the major cause of acute alcohol-related presentation In a study conducted in the USA by Booth et al., around 15% of the ED visits had criteria met for harmful use of alcohol. According to a study done in the northwestern part of the United Kingdom, the ED data regarding injuries due to harmful use of alcohol helped local authorities develop preventive measures which resulted in a decrease in alcohol-related emergencies. In 2000, a study done by Murthy et al. found that 60% of all traumas are related to alcohol misuse and 20% of all traumatic head injuries related to alcohol-related misuse. Over 231,000 people are killed in road traffic crashes in India each year according to reports. Poor infrastructure of roads, poor traffic regulation systems, over speeding, and driving under the influence of alcohol are some of the factors contributory to RTAs. Majority of the patients (98%) riding a two-wheeler were not wearing a helmet. This disregard for traffic rules is an alarming trend throughout our country. The importance of strictly implementing traffic rules is imperative in decreasing morbidity and mortality due to RTAs. In our study, majority of the patients are in the working age group. The need to implement measures to decrease the incidence of RTAs cannot be overstated. These would include strict traffic rules and education regarding the use of helmets and seat belts. Improved prehospital care and education regarding transporting patients help decrease the morbidity due to acute alcohol-related injuries. In our study, the second highest presentation to ED was acute poisoning due to alcohol itself or due to other drugs or substances under the influence of alcohol. Appropriate management of such patients needs skill, knowledge, fortitude, and accurate history taking.
Limitations of the study
Reliability of history provided by the patient was a major concern as they were under the influence of alcohol. As our hospital is a tertiary referral center, minor injuries and medical issues were less in our study. Proper demographic details could not be documented when the patient escorts were distant relatives or unknown persons.
| Conclusions|| |
Majority of the patients presenting with acute alcohol intoxication sustained RTAs, with two-wheeler being the most common motor vehicle used. The most common presentation of acute alcohol-related presentation was head injury which could have been minimized with the use of a helmet and seatbelt.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
Research quality and ethics statement
The authors of this manuscript declare that this scientific work complies with reporting quality, formatting, and reproducibility guidelines set forth by the EQUATOR Network. The authors also attest that this clinical investigation was determined to require IRB/Ethics Committee Review, and the corresponding protocol/approval number is IRB Min No. 9106 dated October 10, 2014. We also certify that we have not plagiarized the contents in this submission and have done a Plagiarism Check.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]