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Objective: Self-reports of alcohol consumption among patients visiting an emergency department (ED) have been used extensively in the investigation of the relationship between drinking and injury. Little is known, however, about the associations between validity of self-reports with patient and injury characteristics and whether these relationships vary across regions or countries. Both of these issues are explored in this article. Method: In the construct of a multilevel logistical model, validity of self-reports was estimated as the probability of a positive self-report given a positive blood alcohol concentration (BAC). The setting included 44 EDs across 28 studies in 16 countries. Participants included 10,741 injury patients from the combined Emergency Room Collaborative Alcohol Analysis Project (ERCAAP) and the World Health Organization Collaborative Study of Alcohol and Injuries. Data were analyzed on self reported drinking within 6 hours before injury compared with BAC results obtained from breath-analyzer readings in all but two studies, which used urine screens. Covariates included demographic, drinking, and injury characteristics and aggregate-level contextual variables. Results: At the individual level, a higher BAC measurement was associated with a higher probability of reporting drinking, as was heavy drinking and sustaining injuries in traffic accidents or violence-related events. At the study level, neither aggregate BAC nor other sociocultural variables affected the validity of self-reported drinking. Conclusions: This study provides further evidence of the validity of self-reported drinking measures in crossnational ED studies based on the objective criterion of BAC estimates., ALTHOUGH MANY STUDIES CARRIED OUT in the emergency department (ED) have relied on patient self-reports of alcohol consumption before the injury event to identify those injuries that may be considered [...]

Objective: Although injured patients in the emergency department (ED) report more frequent use of the ED compared with the general population, and alcohol-related admissions and chronic alcohol misuse have been found to be predictive of future ED admissions, these data are based on only a few U.S. studies. The purpose of this article was to explore the association of alcohol use and ED services use among injured patients cross-nationally. Method: Binary and multinomial logistic regression were used to analyze the association of alcohol consumption with prior ED visits among 9,743 injured patients surveyed in 37 EDs in 14 countries and reported in 23 studies from the combined Emergency Room Collaborative Alcohol Analysis Project (ERCAAP) and World Health Organization Collaborative Study of Alcohol and Injuries. Results: Drinking within 6 hours before injury was associated with prior ED visits during the last 12 months (odds ratio = 1.25, p < .05), with a positive dose-response relationship. Heavy drinkers and those drinkers who were alcohol-dependent were also significantly more likely to report multiple prior ED visits, reflecting an elevated burden of services use. At the ED level, stigmatization of alcohol use was the only significant contextual variable that consistently predicted cross-ED variation in the relationship between drinking and ED use, in which the association was weaker in areas where alcohol use is less accepted. Conclusions: This study lends additional support to the potential effectiveness of screening for acute and chronic alcohol use among ED injured patients to reduce ED services use and associated costs., EMERGENCY DEPARTMENT (ED) STUDIES in the United States have found that substantial proportions of both injured and noninjured patients report frequent use of the ED. One study found more than [...]

Objective: Hospital admission for an alcohol-related traumatic injury may offer a 'teachable moment' to address a patient's alcohol problem. Although trauma teams provide a number of other health-related services, there may be characteristics of alcohol-positive victims that act as barriers toward providing alcohol counseling. The purpose of this study was to compare the characteristics and hospital outcomes of trauma patients who tested positive for alcohol at the time of hospital admission with those who did not. This information is useful for planning interventions and referrals for treatment. Method: The study was a retrospective comparison of alcohol-positive and alcohol-negative patients who were admitted for at least 48 hours to a Level-I trauma center. Data from 1,049 trauma victims (736 male, 742 alcohol-negative) were abstracted from clinical records. Results: Several characteristics were found to be associated with alcohol-related injuries: being male, aged 40 years or less, having a toxicology screen positive for illicit drugs, lacking health insurance, being indigent and sustaining an injury related to violence. Alcohol-positive patients were also found to spend fewer days in a critical care unit, to be less likely to die and to be less likely to be transferred to another hospital than alcohol-negative patients, despite having similar injury severity. Conclusions: Patient characteristics suggest that there are obstacles to providing interventions and referrals by healthcare professionals for victims of alcohol-related injuries. Less expensive options that consider the demographic features of this patient population need to be developed as an alternative to expensive, professional interventions., IT HAS BEEN SUGGESTED that healthcare providers screen trauma victims for the presence of an alcohol use disorder, perform an intervention and refer them for further assessment and treatment (Gentilello [...]

Alcohol screening of severely injured patients should be universal. Hospitalization following alcohol -related injury provides an opportunity for intervention to reduce recidivism. This study examines the frequency of social services referral of an alcohol positive cohort of adolescent trauma patients. This was a retrospective analysis of data collected from 1994 through 1998 by the National Pediatric Trauma Registry. All patients between the ages of 12 and 17 who had a blood alcohol level (BAL) measured were analyzed. Patients receiving referral to the department of social services, family counseling, or addiction services, and those receiving any substance abuse education intervention were considered a positive referral. There were 6006 children age 12 to 17 included in the database during this five-year period, 751 of whom had a BAL measured. Of those screened, 15.5% were positive. Sixty-eight (59%) of the BAL positive patients were referred for intervention through social services. The only statistically significant predictor of referral was whether or not the patient was the operator of a vehicle involved in the motor vehicle collision. Nearly half of the adolescents in this study, who screened positive for alcohol, received no social services support. Keywords: Alcohol; Adolescent; Trauma; Social services; Intervention

Heavy drinkers may be less likely to visit a physician than moderate drinkers. This was the conclusion of a survey of 35,246 Canadians, which found that former drinkers made more visits to a physician than non-drinkers and current drinkers made the least visits of all. This was especially true the more drinks they had per day. This latter association was only seen in men., ABSTRACT. Objective: To examine the differences in visits to health care professionals between drinkers and nondrinkers, as well as between regular and frequent drinkers. Method: Multivariate analyses were conducted, using [...]

Primary care patients were surveyed to determine the frequency by which their physicians ask them about their alcohol consumption, warn them about the health risks of alcohol, and recommend changes in alcohol consumption. Results show that male patients are 1.5 times more likely than female patients to be warned by their physicians about alcohol. Patients with low educational attainment are more likely to be warned while older patients were more likely to be advised to change their alcohol consumption habits.

Physicians may individualize patient advice regarding alcohol consumption to promote the beneficial effects of alcohol while minimizing the adverse consequences. The positive and negative health effects of alcohol are well-reported and complicate physicians' recommendations to patients about its use. Research indicates that alcohol protects against heart disease and many people may derive cardiac benefits from moderate alcohol consumption. High consumption of alcohol, however, seems to be related to higher death rates. For this reason, public health advocates do not support alcohol use. Physician-patient alcohol counseling offers a solution to this dilemma. Physicians must determine a patient's history of alcohol consumption and probe for dependency in the patient or family members. Alcohol abstinence must be recommended for patients with certain diseases, pregnant women, and those on some medications. In appropriate patients, alcohol consumption of one ounce per day may be recommended with regular patient follow-up.