McDonald Alden J, Wang Nan, Camargo Carlos A
Department of Emergency Medicine, Massachusetts General Hospital, Boston, 02114, USA.
Arch Intern Med. 2004 Mar 8;164(5):531-7. doi: 10.1001/archinte.164.5.531.
Alcohol-related diseases and injuries pose a significant burden on hospital emergency departments (EDs). Recognized limitations of self-reported data suggest that previous single-year national studies may have underestimated the magnitude of this burden.
Data were obtained from the National Hospital Ambulatory Medical Care Survey for 1992 through 2000. Thirty-seven alcohol-related diagnoses and their corresponding alcohol-attributable fractions (AAFs) were used to estimate the number of ED visits attributable to alcohol. Diagnoses with an AAF of 1 were analyzed by age, sex, and race. Disposition to inpatient settings and alcohol screening also were examined.
During these 9 years, there were an estimated 68.6 million (95% confidence interval [CI], 65.6 million to 71.7 million) ED visits attributable to alcohol, a rate of 28.7 (95% CI, 27.1-30.3) per 1000 US population. The number of alcohol-related visits increased 18% during this period. Visit rates for diagnoses with AAFs of 1 were highest for those who were aged 30 through 49 years, male, and black. From 1992 to 2000, these disparities remained stable for age group but significantly changed for sex (+22%) and race (-76%). Most patients with diagnoses with AAFs of 1 were not admitted to an inpatient unit, and the percentage of patients who underwent blood alcohol concentration testing was substantially lower than corresponding AAFs.
Alcohol-related ED visits are approximately 3 times higher than previous estimates determined by physician documentation or patient disclosure of alcohol involvement. Rising trends, changing disparities, and suboptimal ED management of such visits are a call to action.
酒精相关疾病和损伤给医院急诊科带来了沉重负担。自我报告数据存在公认的局限性，这表明以往的单年度全国性研究可能低估了这一负担的严重程度。
数据来源于1992年至2000年的全国医院门诊医疗调查。使用37种与酒精相关的诊断及其相应的酒精归因分数（AAFs）来估计因酒精导致的急诊就诊次数。对AAF为1的诊断按年龄、性别和种族进行分析。还检查了住院处置情况和酒精筛查情况。
在这9年期间，估计有6860万（95%置信区间[CI]，6560万至7170万）次急诊就诊归因于酒精，即每1000名美国人口中有28.7次（95%CI，27.1 - 30.3）。在此期间，与酒精相关的就诊次数增加了18%。AAF为1的诊断的就诊率在30至49岁、男性和黑人中最高。从1992年到2000年，这些差异在年龄组方面保持稳定，但在性别方面（增加22%）和种族方面（减少76%）有显著变化。大多数AAF为1的诊断患者未被收治入院，且接受血液酒精浓度检测的患者比例远低于相应的AAF。
与酒精相关的急诊就诊次数比以往通过医生记录或患者披露酒精参与情况所确定的估计值高出约3倍。上升趋势、不断变化的差异以及对此类就诊的急诊管理欠佳都呼吁采取行动。
