Hospital admissions for alcohol-related problems in concomitance with weekends, New Year’s Eve and Christmas Eve: Myth or reality?

Abstract

This retrospective observational study was carried out by searching the database of the laboratory information system for identifying all requests for alcohol testing placed from emergency departments and intensive care units of the University Hospital of Verona between June 29th, 2012 and December 31st, 2018. The study population consisted of 7488 patients. The number of alcohol tests was more than double in concomitance with New Year's Eve than in the rest of the year (7.6±6.1 vs 3.1±2.8 requests/day; P<0.001), whereas blood alcohol concentration was similar (1.55 vs 1.12 g/L; P=0.308). The risk of measuring alcohol concentrations >0.1 g/L and >1.0 g/L was 1.9-fold and 1.6-fold higher in concomitance with New Year's Eve. In multivariate analysis, younger age, female sex and alcohol testing during New Year's Eve remained significant predictors of alcohol concentrations >0.1 g/L and >1.0 g/L. The requests for alcohol testing were similar in concomitance with Christmas Eve and in other periods of the year, whilst number of requests (4.0±3.2 vs 2.8±2.5 requests/day; P<0.001) and concentration (1.37 vs 0.77 g/L; P<0.001) were higher during weekends than in other weekdays.

Full text

Abstract
This retrospective observational study was carried out by
searching the database of the laboratory information system for
identifying all requests for alcohol testing placed from emergency
departments and intensive care units of the University Hospital of
Verona between June 29th, 2012 and December 31st, 2018. The
study population consisted of 7488 patients. The number of alco-
hol tests was more than double in concomitance with New Year’s
Eve than in the rest of the year (7.6±6.1 vs 3.1±2.8 requests/day;
P<0.001), whereas blood alcohol concentration was similar (1.55
vs 1.12 g/L; P=0.308). The risk of measuring alcohol concentra-
tions >0.1 g/L and >1.0 g/L was 1.9-fold and 1.6-fold higher in
concomitance with New Year’s Eve. In multivariate analysis,
younger age, female sex and alcohol testing during New Year’s
Eve remained significant predictors of alcohol concentrations >0.1
g/L and >1.0 g/L. The requests for alcohol testing were similar in
concomitance with Christmas Eve and in other periods of the year,
whilst number of requests (4.0±3.2 vs 2.8±2.5 requests/day;
P<0.001) and concentration (1.37 vs 0.77 g/L; P<0.001) were high-
er during weekends than in other weekdays.
Introduction
Alcohol abuse is associated with a high burden of morbidity
and mortality in the general population, paralleled by an increasing
pattern of alcohol consumption in several Countries around the
world.1It is widely perceived, and somewhat demonstrated, that
some social events are associated with heavier alcohol consump-
tion and, consequently, with a higher number of alcohol-related
problems.2-5
Data collection on hospital admission for alcohol-related prob-
lems is challenging, mainly for difficulties in collecting history on
prior-day or prior-week drinking,6but also because the different
aspects of clinical assessment do not efficiently contribute to reli-
ably mirror the blood alcohol concentration.7Moreover, the lack of
routine measurement of alcohol concentration may further con-
tribute to amplify the epidemiological bias, since this type of lab-
oratory testing is sometimes prescribed when the clinical picture is
unclear, or when mandated by legal authorities.8
With the aforementioned limitations, the drinking patterns of
some social communities, such as college students, suggests that
heavy drinking may be particularly frequent in concomitance with
special events and holidays (New Year’s Eve or birthdays, among
others).4Although recent data seems to confirm that alcohol con-
sumption may be highly event-specific, thus suggesting to plan tar-
geted intervention strategies aimed at reducing or preventing alco-
hol-related harmful events on a population level,9other studies
failed to show similar temporal patterns, except for weekend
peaks.10 Therefore, this study was aimed to analyze the temporal
trends of alcohol tests and relative results performed in patients
admitted to a large University Hospital in Northern Italy.
Materials and Methods
This retrospective observational study was carried out with an
electronic search in the database of the local laboratory informa-
tion system (LIS) aimed at identifying all requests for alcohol test-
ing placed from emergency departments (EDs) or intensive care
units (ICUs) of the University Hospital of Verona, between June
29th, 2012 (i.e., the last searchable date in the database) and
December 31st, 2018. The University Hospital of Verona compris-
es two large academic centers (Borgo Roma and Borgo Trento
Hospitals), averaging ~1500 beds and serving an area with a pop-
ulation of approximately 400,000 inhabitants. Each hospital has
ED and ICU; the facility is also a reference Trauma Center.
Laboratory tests requests are always placed using a computerized
physician order entry (Metafora Informatica Srl, Milan, Italy) and
results are permanently stored in the LIS. Alcohol concentration is
conventionally measured in lithium-heparin plasma, with an alco-
hol dehydrogenase assay, on Siemens Dimension Vista (Siemens
Emergency Care Journal 2019; volume 15:8024
Correspondence: Giuseppe Lippi, Section of Clinical Biochemistry,
University Hospital of Verona, Piazzale L.A. Scuro, 37134 Verona,
Italy.
E-mail: giuseppe.lippi@univr.it
Key words: Alcohol; Intoxication; Epidemiology; Emergency medicine.
Contributions: the authors contributed equally.
Conflict of interest: the authors declare no potential conflict of interest.
Funding: none.
Ethical statement: due to the retrospective nature of the study, and to the
anonymous way in which the data was managed, informed consent was
not required.
Received for publication: 3 January 2019.
Revision received: 28 January 2019.
Accepted for publication: 29 January 2019.
This work is licensed under a Creative Commons Attribution 4.0
License (by-nc 4.0).
©Copyright: the Author(s), 2019
Licensee PAGEPress, Italy
Emergency Care Journal 2019; 15:8024
doi:10.4081/ecj.2019.8024
[Emergency Care Journal 2019; 15:8024] [page 57]
Hospital admissions for alcohol-related problems in concomitance with
weekends, New Year’s Eve and Christmas Eve: Myth or reality?
Giuseppe Lippi,1,2 Anna Ferrari,2 Chiara Bovo,3Gianfranco Cervellin4
1Section of Clinical Biochemistry, University Hospital of Verona; 2Service of Laboratory Medicine,
University Hospital of Verona; 3Medical Direction, University Hospital of Verona; 4Emergency Department,
University Hospital of Parma, Italy
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[page 58] [Emergency Care Journal 2019; 15:8024]
Healthcare Diagnostics, Camberley, UK). The methods were not
changed throughout the study period. The measuring range of this
method is comprised between 0.1-3.0 g/L; concentrations >3.0 g/L
are automatically diluted 1:4 with sample buffer and then retested
to obtain a precise value. The imprecision of this assay is com-
prised between 1.5-2.5%, as declared by the manufacturer. The
local laboratory is accredited according to the ISO 15189 standards
and the quality of test results was validated throughout the study
period by regular performance of internal quality controls and par-
ticipation to a certified external quality assessment scheme.
Alcohol testing requests and relative results were divided between
those performed in concomitance with specific periods of the year
(i.e., New Year’s Eve: December 31st and January 1st; Christmas
Eve: December 24th and 25th; weekends: Saturdays and Sundays)
and those carried out in the remaining periods. Continuous data
were shown as median value and interquartile range (IQR), whilst
categorical data were presented as number and percentage.
Significance of differences was assessed with Mann-Whitney and
Chi square tests for continuous and categorical data, respectively.
The statistical analysis was carried out with Analyse-it (Analyse-it
Software Ltd, Leeds, UK) and MedCalc version 12.3.0 (MedCalc
Software, Mariakerke, Belgium). The statistical significance was
set at P<0.05.
Results
The final study population consisted of 7488 patients who had
a request for alcohol testing placed from the local EDs (n=7457;
99.6%) or ICUs (n=31; 0.4%) throughout the study period (2379
days). Albeit the number of alcohol tests was more than double in
concomitance with New Year’s Eve than in the remaining period of
the year (7.6±6.1 vs 3.1±2.8 requests per day; P<0.001), the blood
alcohol concentration measured in these two days (median, 1.55
g/L; IQR, 0.25-2.16 g/L) was slightly but not significantly higher
than in the remaining period of the year (median, 1.12 g/L; IQR,
0.10-2.31 g/L; P=0.308). Patients who had a request for alcohol
testing placed in concomitance with New Year’s Eve were younger
(32 vs 45 years; P<0.001) and were slightly more frequently
women (32 vs 24%; P=0.045) than in the rest of the year (Table 1).
The number of patients with measurable alcohol concentration
(i.e., >0.1 g/L) was 63/84 (75%) in concomitance with New Year’s
Eve compared to 4560/7404 in the remaining period of the year
(62%; P=0.001), whilst that of patients with toxic alcohol concen-
tration (i.e., >1 g/L)11 was 53/84 (63%) in concomitance with New
Year’s Eve compared to 3814/7404 in the remaining period of the
year (52%; P=0.023). Overall, the risk of measuring alcohol con-
centrations >0.1 g/L and >1.0 g/L was 1.9-fold (odds ratio [OR],
1.87; 95% confidence interval [95% CI], 1.14-3.07) and 1.6- fold
(OR, 1.61; 95% CI, 1.03-2.51) higher in concomitance with New
Year’s Eve than in the rest of the year, respectively (Figure 1).
In multivariate linear regression analysis, alcohol concentra-
tion was found to be significantly associated with younger age
(beta coefficient, -0.01; P<0.001), female sex (beta coefficient,
0.174; P<0.001), but not with alcohol testing concomitant with
New Year’s Eve (beta coefficient, 0.05; P=0.970). Unlike these
findings, younger age (beta coefficient, 0.04; P<0.001), female sex
(beta coefficient 0.04; P=0.002) and alcohol testing concomitant
with New Year’s Eve (beta coefficient, 0.104; P=0.019) remained
significant predictors of alcohol concentration >0.1 g/L, whilst
younger age (beta coefficient, 0.04; P<0.001), female sex (beta
coefficient 0.04; P=0.003) and alcohol testing concomitant with
New Year’s Eve (beta coefficient, 0.085; P=0.049) remained also
significant predictors of alcohol concentration >1 g/L. Albeit the
requests for alcohol testing were slightly higher in concomitance
with Christmas Eve than in other periods of the year, this differ-
Article
Table 1. Characteristics of patients with alcohol test requests placed in concomitance with New Year’s Eve and in the remaining period
of the year.
Variables New Year’s Eve Rest of the year P
Number of requests 84 in 11 days (7.6/day) 7404 in 2368 days (3.1/day) <0.001
Age (years) 32 (IQR, 21-51) 45 (IQR, 31-59) <0.001
Sex (women) 27/84 (32%) 1749/7404 (24%) 0.045
Alcohol
Median concentration (g/L) 1.55 (IQR, 0.25-2.16) 1.12 (IQR, 0.10-2.31) 0.308
Patients with >0.1 g/L 63/84 (75%) 4560/7404 (62%) 0.001
Patients with >1.0 g/L 53/84 (63%) 3814/7404 (52%) 0.023
IQR, interquartile range.
Table 2. Characteristics of patients with alcohol test requests placed in concomitance with new weekends and in the remaining days of
the week.
Variables Weekends Weekdays P
Number of requests 2721 in 680 days (4.0/day) 4767 in 1699 days (2.8/day) <0.001
Age (years) 42 (IQR, 27-59) 46 (IQR, 33-60) <0.001
Sex (women) 632/2721 (23%) 1174/4767 (25%) 0.382
Alcohol
Median concentration (g/L) 1.37 (IQR, 0.10-2.35) 0.77 (IQR, 0.10-2.24) <0.001.
Patients with >0.1 g/L 1819/2721 (67%) 2836/4767 (59%) <0.001
Patients with >1.0 g/L 1541/2721 (57%) 2339/4767 (49%) <0.001
IQR, interquartile range.
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[Emergency Care Journal 2019; 15:8024] [page 59]
ence did not reach statistical significance (3.9±2.8 vs 3.2±2.9
requests per day; P=0.077), nor were significantly different the
alcohol concentration (2.18 vs 2.00 g/L; P=0.417) and the number
of patients with either measurable or toxic alcohol concentrations
(Figure 1).
Interestingly, a sub-analysis of data revealed that the number of
alcohol tests was also higher during weekends than in the other
weekdays (4.0±3.2 vs 2.8±2.5 requests per day; P<0.001), and that
the blood alcohol concentration measured in these two days (medi-
an, 1.37 g/L; IQR, 0.10-2.35 g/L) was nearly double than in the
remaining period of the week (median, 0.77 g/L; IQR, 0.10-2.24
g/L; P<0.001) (Table 2). Similarly, the number of patients with
measurable alcohol concentration (i.e., >0.1 g/L) measured during
the weekends was significantly higher compared to the remaining
weekdays (67% vs 59%; OR, 1.37 and 95% CI, 1.24-1.51;
P<0.001). The number of patients with toxic alcohol concentration
(i.e., >1 g/L) measured during the weekends was also significantly
higher compared to the other weekdays (57% vs 49%; OR, 1.45
and 95% CI, 1.23-1.49; P<0.001) (Figure 1).
Discussion and Conclusions
Although it has been hypothesized that some social events may
considerably increase alcohol consumption and alcohol-related
complications in many worldwide countries, the literature data are
somehow controversial. Poikolainen et al. studied fatal alcohol
intoxications in Finland,12 and found that fatal alcohol poisonings
were especially frequent in midsummer and Christmas compared
to all other periods of the year. In a subsequent investigation
Mäkelä et al. also studied the temporal variation in deaths attribut-
able to alcohol intoxication in the Finnish death register and the
Finnish Drinking Habits Survey.3In close agreement with our find-
ings, the risk of intoxication-related deaths during the New Year’s
day increased by 48% (OR, 1.48 95% CI, 1.20-1.80) in men and by
77% (OR, 1.77; 95% CI, 1.08-2.74) in women, respectively.
Intoxication-related deaths were also found to be between 1.6-fold
and 2.2-fold higher on Saturdays, Sundays and in concomitance
with Christmas Eve. In a following study based on telephone sur-
veys of Canadian residents drinking alcohol at least once per
month, Kushnir and Cunningham also found a consistent temporal
trend in alcohol consumption, with higher peaks on Fridays,
Saturdays, Christmas and New Year’s Eve.9Foster et al. explored
the trend of alcohol consumption and alcohol-related road acci-
dents in young Swiss men,13 observing that the overall volume of
drinking and alcohol-related road accidents were up to 4-fold high-
er during New Year’s Eve and in the period between Friday
evening and Saturday morning, whilst a minor peak was noticed
during Christmas Eve. More recently Comelli et al. reviewed the
data of all patients admitted to a large urban Italian ED for alcohol-
related problems,10 and found that the largest number of visits was
recorded during the weekends, whilst no clear seasonality could be
observed.
The results of our retrospective analysis of alcohol tests per-
formed in a large Italian University Hospital pave the way to for-
mulate some interesting considerations. Overall, the number of
requests for alcohol testing placed from the local EDs or ICUs in
concomitance with New Year’s Eve was more than double than in
the remaining period of the year, and this figure is then mirrored
by a similar risk of measuring alcohol concentrations >0.1 g/L and
>1.0 g/L (Figure 1). Similar results were found for alcohol tests
requested during weekends compared to other weekdays. On the
other hand, the median alcohol concentration measured in con-
comitance with New Year’s Eve was found to be slightly, but not
significantly, higher than in the rest of the year, whilst that meas-
ured on weekends was significantly higher than in the rest of week.
This would actually mean that the number of people admitted to
the hospital for suspected alcohol intoxication is higher in con-
comitance with New Year’s Eve, but the overall volume of alcohol
drank of people admitted to the hospital is likely the same. Unlike
these findings, both the number of patients and alcohol concentra-
tion measured during weekends were found to be considerably
higher than in the remaining period of the week, whilst neither the
number of test or the relative alcohol concentration was found to
be significantly different in concomitance with the Christmas Eve.
This investigation has some clear limitations, mostly attributa-
ble to the study design. Basically, our analysis was based on data
retrieved from the local LIS, so that no information was available
on drinking patters, reasons underneath alcohol requests and clini-
cal picture. Nevertheless, our results may still be of some impor-
tance for both establishing targeted interventions aimed at reduc-
ing or preventing the alcohol-related emergencies in certain peri-
ods of the year such as the New Year’s Eve and weekends. On the
other hand, they also provide valuable information for proactively
addressing potential organizational issues in EDs and ICUs (i.e.,
overcrowding), as well as in clinical laboratories (availability of
staff and reagents), which may emerge from larger hospital admis-
sion of critical patients during certain periods of the year.
Article
Figure 1. Percentage of patients admitted to the hospital with A)
measurable (>0.1 g/L) or B) toxic (>1.0 g/L) alcohol concentra-
tion.
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[page 60] [Emergency Care Journal 2019; 15:8024]
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