Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Italy; Center for Applied Biomedical Research (C.R.B.A.), S.Orsola-Malpighi University Hospital, Bologna, Italy.
Department of Internal Medicine, SS Annunziata Hospital, Cento, Ferrara, Italy; "G. Fontana" Centre for the Study and Multidisciplinary Treatment of Alcohol Addiction, Department of Medical and Surgical Sciences, University of Bologna, Italy.
Addict Behav. 2018 Feb;77:1-6. doi: 10.1016/j.addbeh.2017.08.031. Epub 2017 Sep 1.
Alcohol use disorders (AUD) are a frequent cause of admission to emergency departments (EDs) for acute alcohol intoxication (AAI). Patients with AUD present a higher risk of readmission to EDs for AAI than the general population, however, the distinction between sporadic AAI and AAI in the context of AUD in the ED setting is difficult.
To analyze the epidemiological characteristics of patients admitted to EDs because of AAI and to identify factors associated with repeated admissions in order to develop a risk stratification system for patients with AUD based on objective data that can be easily applied in an ED setting.
An observational retrospective study was performed. All patients with diagnosis of AAI at admission in 2014 were enrolled.
Five hundred and sixty-five patients were enrolled, of which 92 (16%) were admitted more than once to the ED. At multivariate analysis, factors associated with readmission were past episodes of alcohol abuse, social discomfort, previous traumas and psychiatric disorders. Basing on this parameter, a risk-score for re-hospitalization was developed. This score has a high predictive power for the risk of readmission to the ED (AROC 0.837, 95%CI 0.808-0.866), moreover, the cumulative probability of readmission within one year, increased in parallel with score value, being highest in patients presenting 3 or more risk factors.
The present study demonstrates that several risk factors stratify the risk of re-hospitalization in patients admitted to EDs for AAI, allowing the identification of those presenting more severe conditions and who would likely benefit from multidisciplinary intervention.
酒精使用障碍（AUD）是急诊部（ED）因急性酒精中毒（AAI）入院的常见原因。与一般人群相比，AUD 患者因 AAI 再次入院到 ED 的风险更高，然而，ED 环境中 AUD 背景下偶发性 AAI 与 AAI 的区别很难界定。
分析因 AAI 而被收入 ED 的患者的流行病学特征，并确定与再次入院相关的因素，以便基于客观数据为 AUD 患者开发风险分层系统，该系统可在 ED 环境中轻松应用。
进行了一项观察性回顾性研究。所有在 2014 年入院时诊断为 AAI 的患者均被纳入研究。
共纳入 565 名患者，其中 92 名（16%）患者因 AAI 不止一次被收入 ED。多变量分析显示，与再次入院相关的因素包括过去的酒精滥用史、社交不适、既往创伤和精神障碍。基于这一参数，制定了再入院风险评分。该评分对 ED 再入院风险具有较高的预测能力（AROC 0.837，95%CI 0.808-0.866），此外，一年内再入院的累积概率与评分值呈平行增加，具有 3 个或更多危险因素的患者最高。
本研究表明，一些风险因素可对因 AAI 而被收入 ED 的患者的再入院风险进行分层，从而确定病情更严重、可能受益于多学科干预的患者。
