Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN.
Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN.
Ann Emerg Med. 2018 Mar;71(3):279-288. doi: 10.1016/j.annemergmed.2017.07.021. Epub 2017 Aug 24.
Emergency department (ED) visits for acute alcohol intoxication are common, but this population is at risk for decompensation and occult critical illness. The purpose of this study is to describe the incidence and predictors of unsuspected critical illness among patients with acute alcohol intoxication.
This was a retrospective observational study of ED patients from 2011 to 2016 with acute alcohol intoxication. The study cohort included patients presenting for alcohol intoxication, whose initial assessment was uncomplicated alcohol intoxication without any other active acute medical or traumatic complaints. The primary outcome was defined as the unanticipated subsequent use of critical care resources during the encounter or admission to an ICU. We investigated potential predictors for this outcome with generalized estimating equations.
We identified 31,364 eligible patient encounters (median age 38 years; 71% men; median breath alcohol concentration 234 mg/dL); 325 encounters (1%) used critical care resources. The most common diagnoses per 1,000 ED encounters were acute hypoxic respiratory failure (3.1), alcohol withdrawal (1.7), sepsis or infection (1.1), and intracranial hemorrhage (1.0). Three patients sustained a cardiac arrest. Presence of the following had an increased adjusted odds ratio (aOR) of developing critical illness: hypoglycemia (aOR 9.2), hypotension (aOR 3.8), tachycardia (aOR 1.8), fever (aOR 7.6), hypoxia (aOR 3.8), hypothermia (aOR 4.2), and parenteral sedation (aOR 2.4). The initial blood alcohol concentration aOR was 1.0.
Critical care resources were used for 1% of ED patients with alcohol intoxication who were initially assessed by physicians to have low risk. Abnormal vital signs, hypoglycemia, and chemical sedation were associated with increased odds of critical illness.
急性酒精中毒患者常到急诊科就诊，但此类患者有病情恶化和潜在重症的风险。本研究旨在描述急性酒精中毒患者中未被察觉的重症的发生率和预测因素。
这是一项回顾性观察性研究，纳入了 2011 年至 2016 年急诊科因急性酒精中毒就诊的患者。研究队列包括因酒精中毒就诊、初始评估为单纯酒精中毒且无其他急性内科或创伤性疾病的患者。主要结局定义为就诊或入住 ICU 期间意外使用重症监护资源。我们使用广义估计方程调查了该结局的潜在预测因素。
我们共确定了 31364 例符合条件的患者就诊（中位年龄 38 岁，71%为男性，中位呼气酒精浓度 234mg/dL），325 例（1%）使用了重症监护资源。每 1000 例急诊科就诊患者中最常见的诊断分别为急性低氧性呼吸衰竭（3.1 例）、酒精戒断（1.7 例）、脓毒症或感染（1.1 例）和颅内出血（1.0 例）。有 3 例患者发生心脏骤停。发生以下情况的患者发生重症的校正优势比（aOR）增加：低血糖（aOR 9.2）、低血压（aOR 3.8）、心动过速（aOR 1.8）、发热（aOR 7.6）、低氧血症（aOR 3.8）、低体温（aOR 4.2）和胃肠外镇静（aOR 2.4）。初始血酒精浓度的 aOR 为 1.0。
最初由医生评估为低风险的急诊科酒精中毒患者中，有 1%使用了重症监护资源。异常生命体征、低血糖和化学镇静与重症发生的几率增加相关。
