Pitfalls in the triage and evaluation of patients with suspected acute ethanol intoxication in an emergency department
- 47 Downloads
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.
KeywordsAlcoholic intoxication Emergency service (Hospital) Triage Left without being seen
We would like to thank Emmanuel Durand and Rodolphe Meyer for their contributions in terms of data extraction.
Compliance with ethical standards
Conflict of interest
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.
For this type of study, formal consent is not required.
- 2.Rehm J, Baliunas D, Borges GL, Graham K, Irving H, Kehoe T, Parry CD, Patra J, Popova S, Poznyak V, Roerecke M, Room R, Samokhvalov AV, Taylor B (2010) The relation between different dimensions of alcohol consumption and burden of disease: an overview. Addiction 105(5):817–843. https://doi.org/10.1111/j.1360-0443.2010.02899.x CrossRefPubMedPubMedCentralGoogle Scholar
- 7.Rutschmann OT, Kossovsky M, Geissbuhler A, Perneger TV, Vermeulen B, Simon J, Sarasin FP (2006) Interactive triage simulator revealed important variability in both process and outcome of emergency triage. J Clin Epidemiol 59(6):615–621. https://doi.org/10.1016/j.jclinepi.2005.11.003 CrossRefPubMedGoogle Scholar
- 8.Veit-Rubin N, Brossard P, Gayet-Ageron A, Montandon CY, Simon J, Irion O, Rutschmann OT, Martinez de Tejada B (2017) Validation of an emergency triage scale for obstetrics and gynaecology: a prospective study. BJOG 124(12):1867–1873. https://doi.org/10.1111/1471-0528.14535 CrossRefPubMedGoogle Scholar
- 12.Crawford MJ, Patton R, Touquet R, Drummond C, Byford S, Barrett B, Reece B, Brown A, Henry JA (2004) Screening and referral for brief intervention of alcohol-misusing patients in an emergency department: a pragmatic randomised controlled trial. Lancet 364(9442):1334–1339. https://doi.org/10.1016/S0140-6736(04)17190-0 CrossRefPubMedGoogle Scholar
- 14.Cherpitel CJ, Borges GLG, Wilcox HC (2004) Acute alcohol use and suicidal behavior: a review of the literature. Alcohol Clin Exp Res 28(5):18s–28s. https://doi.org/10.1097/01.Alc.0000127411.61634.14 CrossRefPubMedGoogle Scholar
- 15.Mackway-Jones K, Marsden J, Windle J (2014) Emergency triage. Wiley, Manchester Triage GroupGoogle Scholar
- 16.Gilboy N, Tanabe P, Travers DA, Rosenau AM Emergency Severity Index (ESI): a triage tool for emergency department care, version 4. Implementation HandbookGoogle Scholar
- 20.van Boekel LC, Brouwers EP, van Weeghel J, Garretsen HF (2013) Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: systematic review. Drug Alcohol Depend 131(1–2):23–35. https://doi.org/10.1016/j.drugalcdep.2013.02.018 CrossRefPubMedGoogle Scholar