Alcohol has toxic effect on critical care services

By Eleanor McDermid

Alcohol may account for more than one in 10 emergency department (ED) admissions, a study from the UK suggests.

In all, 14% of 774 patients admitted to a single ED over the course of 1 week said that their attendance was directly related to alcohol, and a third of these required hospital admission. Extrapolated to England and Wales, this amounts to nearly two million ED attendances annually and 640,000 hospital admissions.

"However, extrapolation of this figure beyond the Bristol Royal Infirmary should be treated with caution because this study was conducted in an inner city hospital, and other parts of the country may have significantly different rates of alcohol-related ED attendance," say Rebecca Hoskins and Jonathan Benger (Bristol Royal Infirmary).

A total of 87 patients had alcohol-related injuries and the others had an illness (eg, upper gastrointestinal bleeding or pancreatitis).

In addition to this, ED medical staff felt that a further 7% of attendances were indirectly related to alcohol. In other words, an assailant may have been drinking or the patient had a condition such as pancreatitis that may have arisen from alcohol consumption.

"It is not clear whether patients were less likely to accept the role of alcohol in their attendance, or whether they failed to appreciate the indirect consequences of alcohol consumption," say the researchers.

Most patients whose attendances were directly related to alcohol had an injury rather than an illness, and 54% of these said they drank more than the recommended maximum of 21 units of alcohol per week.

"This suggests that the majority of patients injured as a result of alcohol are hazardous drinkers, and that they incur high healthcare costs," Hoskins and Benger write in the Emergency Medicine Journal.

However, 36% of patients said they did not regularly drink alcohol.

"The observation that some patients presenting with an alcohol-related injury reported no regular alcohol consumption may be explained by their view that they had been assaulted by a person under the influence of alcohol, or it may be the case that they drink alcohol only very occasionally, or had decided to do so in response to a specific life stress or crisis," says the team.

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