University of California, Irvine School of Medicine, Department of Emergency Medicine, Orange, California.
Eisenhower Medical Center, Department of Emergency Medicine, Rancho Mirage, California.
West J Emerg Med. 2022 Feb 28;23(2):158-165. doi: 10.5811/westjem.2021.9.51376.
Trauma patients who present to the emergency department (ED) intoxicated or with an alcohol use disorder (AUD) undergo more procedures and have an increased risk of developing complications. However, how AUD and blood alcohol concentration (BAC) impact a trauma patient's disposition from the ED remains inconclusive. In this study we aimed to identify the associations between positive BAC or an AUD with admission to the hospital, including the intensive care unit (ICU).
This was a retrospective study analyzing data from 2010-2018 at a university-based, Level I trauma ED. Included in the study were 4,699 adult trauma patients who completed the Alcohol Use Disorders Identification Test (AUDIT) and had blood alcohol content test results.
Positive BAC was associated with hospital admission and ICU admission after adjusting for injury severity score (ISS) (odds ratio 1.5 and 1.3, respectively). The AUDIT was only correlated with hospital and ICU admission in patients with ISS of 1 to 15. By increasing risk of AUD (low, moderate, high, and likely alcohol dependent) the proportion of ICU admissions rose from 29.3% to 37.3%, 40.0% and 42.0% (P <0.01). The results did not change significantly by adjustment for the age of patients.
BAC is associated with increasing ED disposition to the hospital or ICU. Furthermore, self-reported alcohol use was associated with an increased risk of hospital or ICU admission in patients with minor or moderate injuries. Further studies to determine viable options to decrease admission rates in these patients are warranted.
在急诊部（ED）就诊时处于醉酒或有酒精使用障碍（AUD）的创伤患者会接受更多的程序，并增加发生并发症的风险。但是，AUD 和血液酒精浓度（BAC）如何影响创伤患者从 ED 出院的情况仍不清楚。在这项研究中，我们旨在确定阳性 BAC 或 AUD 与住院治疗（包括重症监护病房（ICU））之间的关联。
这是一项回顾性研究，分析了 2010 年至 2018 年在一所大学一级创伤 ED 中的数据。该研究包括 4699 名成年创伤患者，他们完成了酒精使用障碍识别测试（AUDIT）并进行了血液酒精含量测试。
调整损伤严重程度评分（ISS）后，阳性 BAC 与住院和 ICU 入院相关（比值比分别为 1.5 和 1.3）。AUDIT 仅与 ISS 为 1 至 15 的患者的住院和 ICU 入院相关。随着 AUD 风险的增加（低，中，高和可能依赖酒精），ICU 入院的比例从 29.3％上升到 37.3％，40.0％和 42.0％（P <0.01）。通过调整患者的年龄，结果没有明显变化。
BAC 与 ED 向医院或 ICU 的处置增加有关。此外，自我报告的饮酒与轻度或中度损伤患者住院或 ICU 入院的风险增加有关。需要进一步研究以确定减少这些患者入院率的可行方法。
