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Pitfalls in the triage and evaluation of patients with suspected acute ethanol intoxication in an emergency department

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Abstract

Acute ethanol intoxication (AEI) is frequent in emergency departments (EDs). These patients are at risk of mistriage, and to leave the ED without being seen. This study’s objective was to describe the process and performance of triage and trajectory for patients with suspected AEI. Retrospective, observational study on adults admitted with a suspected AEI within 1 year at the ED of an urban teaching hospital. Data on the triage process, patients’ characteristics, and their ED stay were extracted from electronic patient records. Predictors for leaving without being seen were identified using logistic regression analyzes. Of 60,488 ED patients within 1 year, 776 (1.3%) were triaged with suspected AEI. This population was young (mean age 38), primarily male (64%), and professionally inactive (56%). A large proportion were admitted on weekends (45%), at night (46%), and arrived by ambulance (85%). The recommendations of our triage scale were entirely respected in a minority of cases. In 22.7% of triage situations, a triage reason other than “alcohol abuse/intoxication” (such as suicidal ideation, head trauma or other substance abuse) should have been selected. Nearly, half of the patients (49%) left without being seen (LWBS). This risk was especially high amongst men (OR 1.56, 95% CI 1.12–2.19), younger patients (< 26 years of age; OR 1.97, 95% CI 1.16–3.35), night-time admissions (OR 1.97, 95% CI 1.16–3.35), and patients assigned a lower emergency level (OR 2.32, 95% CI 1.58–3.42). Despite a standardized triage protocol, patients admitted with suspected AEI are at risk of poor assessment, and of not receiving optimal care.

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Data availability

The dataset generated and analysed during the current study is available from the corresponding author on reasonable request.

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Acknowledgements

We would like to thank Emmanuel Durand and Rodolphe Meyer for their contributions in terms of data extraction.

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Authors and Affiliations

  1. Division of Emergency Medicine, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals and Geneva University, Faculty of Medicine, Geneva, Switzerland

    Sarah Dugas, Pierre-Alexandre Poletti, Tibor Huwyler, Josette Simon, François P. Sarasin & Olivier T. Rutschmann

  2. Division of Primary Care Medicine, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals and Geneva University, Faculty of Medicine, Geneva, Switzerland

    Thierry Favrod-Coune

  3. Division of Psychiatric Specialties, Department of Mental Health and Psychiatry and Faculty of Medicine, Geneva University Hospitals and Geneva University, Faculty of Medicine, Geneva, Switzerland

    Hélène Richard-Lepouriel

Authors
  1. Sarah Dugas
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  2. Thierry Favrod-Coune
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  3. Pierre-Alexandre Poletti
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  4. Tibor Huwyler
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  5. Hélène Richard-Lepouriel
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  6. Josette Simon
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  7. François P. Sarasin
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  8. Olivier T. Rutschmann
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Corresponding author

Correspondence to Olivier T. Rutschmann.

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There are no potential conflicts of interest.

Statement of human and animal rights

This protocol has been approved by Geneva Central Ethics Commission (CER 14–083R) and was registered at Clinicaltrials.gov (NCT02449772). All procedures performed in this study were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Dugas, S., Favrod-Coune, T., Poletti, PA. et al. Pitfalls in the triage and evaluation of patients with suspected acute ethanol intoxication in an emergency department. Intern Emerg Med 14, 467–473 (2019). https://doi.org/10.1007/s11739-018-2007-7

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  • DOI: https://doi.org/10.1007/s11739-018-2007-7

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