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Substance-related problems in patients visiting an urban Canadian emergency department

Published online by Cambridge University Press:  21 May 2015

Jeffrey R. Brubacher ,
Amy Mabie ,
Michelle Ngo ,
Riyad B. Abu-Laban ,
Jan Buchanan ,
Tom Shenton  and
Roy Purssell
Jeffrey R. Brubacher*
Affiliation:
Department of Emergency Medicine, Vancouver General Hospital, Vancouver, BC University of British Columbia, Vancouver, BC
Amy Mabie
Affiliation:
University of British Columbia, Vancouver, BC
Michelle Ngo
Affiliation:
University of Western Ontario, London Ont.
Riyad B. Abu-Laban
Affiliation:
University of British Columbia, Vancouver, BC Vancouver Coastal Health Research Institute Centre for Clinical Epidemiology and Evaluation, Vancouver, BC
Jan Buchanan
Affiliation:
Department of Emergency Medicine, Vancouver General Hospital, Vancouver, BC University of British Columbia, Vancouver, BC
Tom Shenton
Affiliation:
VGH Chemical Dependency Resource Team, Vancouver General Hospital, Vancouver, BC University of British Columbia, Vancouver, BC
Roy Purssell
Affiliation:
Department of Emergency Medicine, Vancouver General Hospital, Vancouver, BC University of British Columbia, Vancouver, BC
*
Vancouver General Hospital, Department of Emergency Medicine, 855 West 12th Ave., Vancouver BC V5Z 1M9; Jbrubacher@shaw.ca

Abstract

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Objective:

For many patients with addiction and other substance problems, the emergency department (ED) is the sole provider of medical care. This study sought to determine the prevalence and characteristics of substance-related medical problems in ED patients, as defined by documentation in the medical record. We also sought to compare the ED resource use (length of ED stay and number of revisits) of patients with and without substance problems.

Methods:

Trained evaluators using explicit criteria reviewed all ED charts during a 6-week period at a Canadian tertiary care teaching centre. Data was collected on demographics, documentation of problematic substance use and whether the ED visit was due to substance problems. Using a computerized database, we determined how many patients with and without substance problems had 1 or more subsequent ED visits during the 1-year period from Sept. 1, 2002, to Aug. 31, 2003.

Results:

Of 6064 visits made by 5194 patients, 6026 visits (99.4%) representing 5188 patients (99.9%) were captured for review. Of those visits, 674 (11.2%, 95% confidence interval [CI] 10.4%–12.0%), made by 600 patients, had documentation of problematic substance use and 521 visits (8.6%, 95% CI 7.9%–9.4%) by 469 patients were caused by substance problems. The mean age of patients with a visit due to a substance problem was 39.2 years, compared with 48.5 years for those with other visits (p < 0.001). The admission rate for substance-related visits was 25.3%, compared with 17.6% for other visits (p < 0.001). For discharged patients, the median length of the ED visit owing to substance-related problems lasted 232 minutes (IQR [interquartile range] 267 min), compared with 164 minutes (IQR 167 min) for other visits (p < 0.001). In 1 year of follow-up, 161 of 600 patients (26.8%) with a substance problem made 466 revisits (mean 0.78 revisits/patient), compared with 975 of 4588 patients (21.3%) without a substance problem who made a total of 2150 revisits (mean 0.47 revisits/patient, p < 0.001).

Conclusion:

Substance problems contribute significantly to ED visits, hospital admissions and duration of ED stay at a tertiary centre. It is likely that our methodology underestimates the scope of the problem and that a universal screening program would find a higher prevalence. The magnitude of this problem supports the need for an interdisciplinary identification and intervention program for ED patients with substance-related issues.

Keywords

substance abusealcohol abuseaddictionemergency departmentemergency department visits
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 10 , Issue 3 , May 2008 , pp. 198 - 204
Copyright
Copyright © Canadian Association of Emergency Physicians 2008

References

1.Tjepkema, M. Alcohol and illicit drug dependence. Supplement to Health Reports. Volume 15. Ottawa (ON): Statistics Canada; 2004.Google Scholar
2.Rehm, J, Baliunas, S, Brochu, B, et al. The costs of substance abuse in Canada. 2002. Canadian Centre on Substance Abuse. Available: http://www.ccsa.ca (accessed 2008 Feb 25).Google Scholar
3.Single, E, Rehm, J, Robson, L, et al. The relative risks and etiologic fractions of different causes of death and disease attributable to alcohol, tobacco and illicit drug use in Canada. CMAJ 2000;162:1669–75.Google Scholar
4.Chafetz, ME. A procedure for establishing therapeutic contact with the alcoholic. Q J Stud Alcohol 1961;22:325–8.CrossRefGoogle ScholarPubMed
5.D’Onofrio, G. Screening and brief intervention for alcohol and other drug problems: What will it take? Acad Emerg Med 2000;7:69–71.CrossRefGoogle ScholarPubMed
6.Whiteman, PJ, Hoffman, RS, Goldfrank, LR. Alcoholism in the emergency department: an epidemiologic study. Acad Emerg Med 2000;7:14–20.CrossRefGoogle ScholarPubMed
7.Helmkamp, JC, Hungerford, DW, Williams, JM, et al. Screening and brief intervention for alcohol problems among college students treated in a university hospital emergency department. J Am Coll Health 2003;52:7–16.CrossRefGoogle Scholar
8.Hungerford, DW, Williams, JM, Furbee, PM, et al. Feasibility of screening and intervention for alcohol problems among young adults in the ED. Am J Emerg Med 2003;21:14–22.Google Scholar
9.Hungerford, DW, Pollock, DA, Todd, KH. Acceptability of emergency department-based screening and brief intervention for alcohol problems. Acad Emerg Med 2000;7:1383–92.CrossRefGoogle ScholarPubMed
10.Thom, B, Herring, R, Judd, A. Identifying alcohol-related harm in young drinkers: the role of accident and emergency departments. Alcohol Alcohol 1999;34:910–5.Google Scholar
11.Kinner, SA, Alati, R, Watt, K, et al. Substance misuse, anxiety and depression and urgency of presentation to a public emergency department in Australia. Emerg Med Australas 2005;17:363–70.CrossRefGoogle ScholarPubMed
12.Rockett, IR, Putnam, SL, Jia, H, et al. Assessing substance abuse treatment need: a statewide hospital emergency department study. Ann Emerg Med 2003;41:802–13.Google Scholar
13.Fantus, RJ, Zautcke, JL, Hickey, PA, et al. Driving under the influence: a level I trauma center’s experience. J Trauma 1991; 31:1517–20.CrossRefGoogle ScholarPubMed
14.Parran, TV Jr, Weber, E, Tasse, J, et al. Mandatory toxicology testing and chemical dependence consultation follow-up in a level-one trauma center. J Trauma 1995;38:278–80.CrossRefGoogle Scholar
15.Field, CA, Claassen, CA, O’Keefe, G. Association of alcohol use and other high-risk behaviors among trauma patients. J Trauma 2001;50:13–9.CrossRefGoogle ScholarPubMed
16.McLean, SA, Blow, FC, Walton, MA, et al. Rates of at-risk drinking among patients presenting to the emergency department with occupational and non-occupational injury. Acad Emerg Med 2003;10:1354–61.Google Scholar
17.Nordqvist, C, Johansson, K, Bendtsen, P. Routine screening for risky alcohol consumption at an emergency department using the AUDIT-C questionnaire. Drug Alcohol Depend 2004;74:71–5.CrossRefGoogle ScholarPubMed
18.Cherpitel, CJ, Giesbrecht, N, Macdonald, S. Alcohol and injury: a comparison of emergency room populations in two Canadian provinces. Am J Drug Alcohol Abuse 1999;25:743–59.CrossRefGoogle ScholarPubMed
19.Whiteman, PJ, Hoffman, RS, Goldfrank, LR. Alcoholism in the emergency department: an epidemiologic study. Acad Emerg Med 2000;7:14–20.CrossRefGoogle ScholarPubMed
20.Turner, JC, Shu, J. Serious health consequences associated with alcohol use among college students: demographic and clinical characteristics of patients seen in an emergency department. J Stud Alcohol 2004;65:179–83.CrossRefGoogle ScholarPubMed
21.Hulse, GK, Robertson, SI, Tait, RJ. Adolescent emergency department presentations with alcohol or other drug-related problems in Perth, Western Australia. Addiction 2001;96:1059–67.CrossRefGoogle ScholarPubMed
22.Carriere, G. Use of hospital emergency rooms. Statistics Canada Heath Reports. Volume 16. Ottawa (ON): Statistics Canada;2004.Google Scholar
23.D’Onofrio, G, Degutis, LC. Preventive care in the emergency department: screening and brief intervention for alcohol problems in the emergency department: a systematic review. Acad Emerg Med 2002;9:627–38.CrossRefGoogle ScholarPubMed
24.Savola, O, Niemela, O, Hillbom, M. Blood alcohol is the best indicator of hazardous alcohol drinking in young adults and working-age patients with trauma. Alcohol Alcohol 2004;39:340–5.Google Scholar
25.Monti, PM, Colby, SM, Barnett, NP, et al. Brief intervention for harm reduction with alcohol-positive older adolescents in a hospital emergency department. J Consult Clin Psychol 1999;67:989–94.Google Scholar
26.Crawford, MJ, Patton, R, Touquet, R, et al. Screening and referral for brief intervention of alcohol-misusing patients in an emergency department: a pragmatic randomised controlled trial. Lancet 2004;364:1334–9.CrossRefGoogle Scholar
27.Spirito, A, Monti, PM, Barnett, NP, et al. A randomized clinical trial of a brief motivational intervention for alcohol-positive adolescents treated in an emergency department. J Pediatr 2004;145:396–402.CrossRefGoogle ScholarPubMed