Although studies of patients seen in emergency department (ED) settings have documented a strong association of alcohol with injury, such patients are not necessarily representative of the larger population, and less is known of alcohol's association with risk of injury in patient samples outside the ED.
Drinking before injury was analyzed in the 2005 National Alcohol Survey among the 1,149 respondents (18.5%, weighted) who reported an injury during the past year; analysis was by injury treatment type (ED-treated, 29.2%; other-treated, 47.8%; and nontreated, 22.9%).
Based on case-crossover analysis, the relative risk of injury from drinking was 1.85 (p < .01) for those with an ED-treated injury, 1.42 (ns) for those with an other-treated injury, and 1.43 (ns) for those with a nontreated injury. Alcohol-attributable fractions based on these relative risk estimates were 2.96% for an ED-treated injury, 1.59% for an other-treated injury, and 1.89% for a nontreated injury. Comparative attributable fractions based on the person's causal attribution of injury to his or her drinking were 3.06%, 1.61%, and 1.47%, respectively. Although these attributable fractions based on case-crossover analysis and subjective evaluation of causal attribution were not greatly different, all estimates were considerably smaller than those found in studies of ED patients.
The data suggest that alcohol plays a larger role in those injuries for which treatment is sought in EDs, and this may be related to the severity of the injury. Additional studies of alcohol and injury in general populations that take into account the intensity of exposure to alcohol before the event, as well as recall bias by eliciting data on the proximity of the event to the time of the respondent interview, are necessary for determining unbiased estimates of the attributable fraction of alcohol in injury morbidity.
"It is estimated that the total economic cost of alcohol and drug abuse in the region is more than $240 billion annually, with about $97 billion due to drug abuse . Patients who visit hospital emergency departments (EDs) may be at particularly high risk for a variety of behavioral risk factors such as illicit substance use . "
[Show abstract][Hide abstract] ABSTRACT: BackgroundAlthough screening, brief intervention, and referral to treatment (SBIRT) has shown promise for alcohol use, relatively little is known about its effectiveness for adult illicit drug use. This randomized controlled trial assessed the effectiveness of the SBIRT approach for outcomes related to drug use among patients visiting trauma and emergency departments (EDs) at two large, urban hospitals.MethodsA total of 700 ED patients who admitted using illegal drugs in the past 30 days were recruited, consented, provided baseline measures of substance use and related problems measured with the Addiction Severity Index-Lite (ASI-Lite), and then randomized to the Life Shift SBIRT intervention or to an attention-placebo control group focusing on driving and traffic safety (Shift Gears). Both groups received a level of motivational intervention matched to their condition and risk level by trained paraprofessional health educators. Separate measurement technicians conducted face-to-face follow-ups at 6 months post-intervention and collected hair samples to confirm reports of abstinence from drug use. The primary outcome measure of the study was past 30-day drug abstinence at 6 months post-intervention, as self-reported on the ASI-Lite.ResultsOf 700 participants, 292 (42%) completed follow-up. There were no significant differences in self-reported abstinence (12.5% vs. 12.0% , p = 0.88) for Life Shift and Shift Gears groups, respectively. When results of hair analyses were applied, the abstinence rate was 7 percent for Life Shift and 2 percent for Shift Gears (p = .074). In an analysis in which results were imputed (n = 694), there was no significant difference in the ASI-Lite drug use composite scores (Life Shift +0.005 vs. Shift Gears +0.017, p = 0.12).ConclusionsIn this randomized controlled trial, there was no evidence of effectiveness of SBIRT on the primary drug use outcome.Trial registrationClinicalTrials.gov NCT01683227.
Addiction science & clinical practice 05/2014; 9(1):8. DOI:10.1186/1940-0640-9-8
"Heavy alcohol consumption is the major preventable cause of injury resulting in an emergency department (ED) visit; however, many alcohol-related injuries occur in people who drink in a hazardous manner without meeting criteria for alcohol dependence.1,2 Because such hazardous drinkers are excellent candidates for a brief intervention (BI) aimed at decreasing future alcohol-related problems, screening and BI has been recommended for ED patients.2,3 "
[Show abstract][Hide abstract] ABSTRACT: Brief alcohol intervention may improve outcomes for injury patients with hazardous drinking but is less effective with increased severity of alcohol involvement. This study evaluated a brief method for detecting problem drinking in minor trauma patients and differentiating hazardous drinkers from those with more severe alcohol problems.
Subjects included 60 minor trauma patients in an academic urban emergency department (ED) who had consumed any amount of alcohol in the prior month. Screening and risk stratification involved the use of a heavy-drinking-day screening item and the Rapid Alcohol Problems Screen (RAPS). We compared the heavy-drinking-day item to past-month alcohol use, as obtained by validated self-reporting methods, and measured the percentage of carbohydrate-deficient transferrin (%CDT) to assess the accuracy of self-reporting. The Alcohol Dependence Scale (ADS) was administered to gauge the severity of alcohol involvement and compared to the RAPS.
Eighty percent of the subjects endorsed at least one heavy drinking day in the past year, and all patients who exceeded recommended weekly drinking limits endorsed at least one heavy drinking day. Among those with at least one heavy drinking day, 58% had a positive RAPS result. Persons with no heavy drinking days (n=12) had a median ADS of 0.5 (range 0 to 3). RAPS-negative persons with heavy drinking days (n=20) had a median ADS of 2 (range 0 to 8). RAPS-positive persons with heavy drinking days (n=28) had a median ADS of 8 (range 1 to 43).
A heavy-drinking-day item is useful for detecting hazardous drinking patterns, and the RAPS is useful for differentiating more problematic drinkers who may benefit from referral from those more likely to respond to a brief intervention. This represents a time-sensitive approach for risk-stratifying non-abstinent injury patients prior to ED discharge.
The western journal of emergency medicine 05/2010; 11(2):133-7.
[Show abstract][Hide abstract] ABSTRACT: Case crossover studies are considered as a variant of case control studies, and they have been included in the scientific literature since approximately eighteen years ago. They have also been used in epidemiological research on acute or intermittent exposures that may lead to a number of events including heart attack or cardiac arrest, injuries, asthma, etc. Application of this particular study design requires defining concepts such as: triggers, induction time, case period and control period. Its use is limited in studies on chronic exposures. On the other hand, this type of design may reduce selection and misclassification bias, confounding, and overmatching. Another advantage is that it requires a small sample size because the same case can be used as its own control in one or several periods. Nevertheless, sample size calculation must be assessed as a matched case-control study. This is a type of study in which theoretical principles are accomplished in a sui generis manner.
Gaceta medica de Mexico 146(1):37-43. · 0.27 Impact Factor
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