Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Metro North Health, Brisbane, Australia.
Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Australia.
Drug Alcohol Rev. 2023 Jan;42(1):146-156. doi: 10.1111/dar.13534. Epub 2022 Aug 31.
The aim was to determine the prevalence of alcohol-related presentations to an emergency department (ED) in a major Australian hospital, through a novel surveillance approach using two biomarkers, blood ethanol and phosphatidylethanol (PEth).
Observational study using secondary testing of blood samples collected during routine clinical care of ED patients presenting to the Royal Brisbane and Women's Hospital in Queensland, Australia, between 22 January and 2 February 2021. Data were collected from 1160 patients during the 10-day study period. The main outcomes were the prevalence of acute alcohol intake, as determined by blood ethanol, and recent use over 2-4 weeks, as determined by PEth concentrations, for all ED presentations and different diagnostic groups.
The overall prevalence for blood ethanol was 9.3% (95% confidence interval [CI] 7.8%, 11.1%), 5.3% for general medical presentations, increasing four-fold to 22.2% for injury presentations. The overall prevalence of PEth positive samples was 32.5% (95% CI 29.9%, 35.3%) and 41.4% for injury presentations. There were 263 (25.3%) cases that tested negative for acute blood ethanol but positive for PEth concentrations indicative of significant to heavy medium-term alcohol consumption.
This novel surveillance approach demonstrates that using blood ethanol tests in isolation significantly underestimates the prevalence of medium-term alcohol consumption in ED presentations. Prevalence of alcohol use was higher for key diagnostic groups such as injury presentations. Performing periodic measurement of both acute and medium-term alcohol consumption accurately and objectively in ED presentations, would be valuable for informing targeted public health prevention and control strategies.
本研究旨在通过使用两种生物标志物（血液乙醇和磷脂酰乙醇（PEth））的新型监测方法，确定澳大利亚一家主要医院急诊科（ED）中与酒精相关的就诊病例的发生率。
这是一项观察性研究，使用在澳大利亚昆士兰州皇家布里斯班妇女医院急诊科就诊患者的常规临床护理中采集的血液样本进行二次检测。该研究于 2021 年 1 月 22 日至 2 月 2 日期间进行，共收集了 1160 名患者的数据。主要结局是通过血液乙醇确定的急性酒精摄入的发生率，以及通过 PEth 浓度确定的过去 2-4 周内的近期使用频率，所有 ED 就诊病例和不同诊断组的结果均有报告。
血液乙醇阳性的总体发生率为 9.3%（95%置信区间 [CI] 7.8%，11.1%），普通内科就诊的发生率为 5.3%，而损伤就诊的发生率则增加了四倍，达到 22.2%。PEth 阳性样本的总体阳性率为 32.5%（95%CI 29.9%，35.3%），损伤就诊的阳性率为 41.4%。有 263 例（25.3%）患者的急性血液乙醇检测为阴性，但 PEth 浓度检测为阳性，表明其存在中重度近期酒精摄入。
该新型监测方法表明，仅使用血液乙醇检测会显著低估 ED 就诊病例中中短期酒精摄入的发生率。酒精使用的发生率在损伤等关键诊断组中更高。在 ED 就诊病例中定期测量急性和中短期酒精摄入，可准确客观地评估，这对于制定有针对性的公共卫生预防和控制策略具有重要价值。
