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MAYWOOD, IL – With as many as half of all trauma patients presenting with alcohol in their bloodstream at the time of admission, you can expect to see at least 10% returning to your emergency department within a year.
The question is how to identify those at greatest risk of future drinking-related trauma for intervention. A study published recently in The Journal of the American Osteopathic Association offers a suggestion: a 10-point questionnaire is more effective than the standard blood alcohol content test.
The Alcohol Use Disorders Identification Test (AUDIT), which assesses alcohol consumption, drinking behaviors, and alcohol-related problems, was developed by the World Health Organization to address difficulties in identifying at-risk drinking behavior.
In a study, Loyola University Medical Center researchers found the 10-point questionnaire to be 20% more effective than simply measuring blood alcohol level in detecting patients with at-risk drinking behaviors likely to result in future ED visits.
"Given the interactions between alcohol and trauma, screening and intervention for at-risk drinking behavior are important components of injury prevention and public health,” said lead researcher Timothy Plackett, DO. “Previous studies have shown that brief interventions with these patients can lead to a 50% reduction in future trauma visits.”
For the retrospective cohort study, the study team reviewed 222 records, including all patients 18 and older admitted to Loyola University Medical Center's level I trauma center between May 2013 and June 2014. Patients' records were included if both a blood-alcohol level result and an AUDIT score were on file, with a blood-alcohol level greater than 0 g/dL and an AUDIT score equal to or above eight considered positive for at-risk drinking.
Among records of 750 predominantly male (80%) patients admitted for trauma, 30% contained data on both blood-alcohol level and AUDIT score. The most common injury for the patients, who had a median age of about 40, was blunt trauma, diagnosed in 80%.
Of the group, 44% had a positive blood-alcohol level, 35% had a positive AUDIT score, and 24% met National Institute on Alcohol Abuse and Alcoholism criteria for at-risk drinking. While the sensitivity and specificity of having a positive blood-alcohol level identify at-risk drinking were 61% and 62%, respectively, the sensitivity and specificity of having a positive AUDIT score identify at-risk drinking were 83% and 81%, respectively, according to study results.
“As a stand-alone indicator of at-risk drinking behavior in trauma patients, the AUDIT score was shown to be superior to blood alcohol level,” the authors report. “The utility of obtaining routine blood alcohol levels in trauma patients as a screening tool for at-risk drinking should be reexamined.”
Yet, the AUDIT assessment added little time or cost to care of the trauma injured patient.
"The potential cost savings from reducing trauma visits could amount to more than $1.8 billion a year, making screening and intervention for at-risk drinking one of the single most cost-effective preventative healthcare measures," said Mark Mitchell, DO, president of the American College of Osteopathic Emergency Medicine.