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

  • Sarah Dugas
  • Thierry Favrod-Coune
  • Pierre-Alexandre Poletti
  • Tibor Huwyler
  • Hélène Richard-Lepouriel
  • Josette Simon
  • François P. Sarasin
  • Olivier T. RutschmannEmail author
EM - ORIGINAL
  • 47 Downloads

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.

Keywords

Alcoholic intoxication Emergency service (Hospital) Triage Left without being seen 

Notes

Acknowledgements

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.

Informed consent

For this type of study, formal consent is not required.

Supplementary material

11739_2018_2007_MOESM1_ESM.xlsx (189 kb)
Supplementary file1 (XLSX 189 kb)

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Copyright information

© Società Italiana di Medicina Interna (SIMI) 2018

Authors and Affiliations

  • Sarah Dugas
    • 1
  • Thierry Favrod-Coune
    • 2
  • Pierre-Alexandre Poletti
    • 1
  • Tibor Huwyler
    • 1
  • Hélène Richard-Lepouriel
    • 3
  • Josette Simon
    • 1
  • François P. Sarasin
    • 1
  • Olivier T. Rutschmann
    • 1
    Email author
  1. 1.Division of Emergency Medicine, Department of Community Medicine, Primary Care and Emergency MedicineGeneva University Hospitals and Geneva University, Faculty of MedicineGenevaSwitzerland
  2. 2.Division of Primary Care Medicine, Department of Community Medicine, Primary Care and Emergency MedicineGeneva University Hospitals and Geneva University, Faculty of MedicineGenevaSwitzerland
  3. 3.Division of Psychiatric Specialties, Department of Mental Health and Psychiatry and Faculty of MedicineGeneva University Hospitals and Geneva University, Faculty of MedicineGenevaSwitzerland

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