Figure 3 - available via license: Creative Commons Attribution 4.0 International
Content may be subject to copyright.
Association of ICU admission with blood alcohol concentration, per Injury Severity Score category. ISS, Injury Severity Score.
Source publication
Introduction:
Trauma patients who present to the emergency department (ED) intoxicated or with an alcohol use disorder (AUD) undergo more procedures and have an increased risk of developing complications. However, how AUD and blood alcohol concentration (BAC) impact a trauma patient's disposition from the ED remains inconclusive. In this study we...
Context in source publication
Citations
... Therefore, clarifying the relevant factors of relapse is of great clinical significance in reducing the risk of alcohol dependence relapse (4). Previous studies have mostly explored the issue of alcohol dependence relapse from the perspective of psychological and social factors, with few studies on biological predictive indicators and family factors related to alcohol dependence relapse (5)(6)(7). ...
Objective
This study explored the impact of a family intervention on the relapse rate of Chinese patients with alcohol dependence.
Methods
A total of 151 male patients with alcohol dependence who were discharged from the Substance Dependence Department of the Wenzhou Seventh People’s Hospital from January to December 2020 were selected. They were divided into the control ( n = 73) and experimental ( n = 78) groups. Patients in both groups received routine alcohol cessation treatment. Moreover, patients in the experimental group were followed up by a professional psychiatrist to carry out individual family intervention. The Family Function Rating Scale (FAD), a Self-made general information questionnaire, and the Chinese version of the Family Intimacy and Adaptability Scale (FACESI-CV) were performed. Re-drinking rate and readmission rate were assessed.
Results
Family intervention could reduce relapse rate (31, 39.74%) and rehospitalization (27, 34.62%) compared with the control group. After family training, FAD factor scores were improved in the experiment group in comparison with the control group. Family training improved communication (18.2 ± 3.7), role (20.8 ± 2.5), emotional response (10.8 ± 1.8), emotional involvement (13.7 ± 1.2), behavioral control (19.8 ± 1.2), and overall functionality (23.5 ± 2.1) in the experiment group in comparison with the control group. After family training, intimacy (70.5 ± 8.7) and adaptability (64.1 ± 6.9) in the experiment group was higher than in the control group. After family intervention, Michigan Alcohol Dependence Scale (MAST) (9.21 ± 0.68) and Short-Form 36 (SF-36) (80.32 ± 4.47) in the experiment group were higher than the control group.
Conclusion
Family intervention for families of patients with alcohol dependence can improve their family function, increase their family intimacy and adaptability, and reduce the rate of relapse.
... Vanessa Cubas, 1 David N Naumann 2 Alcohol use is common among patients admitted to hospital following trauma 1 and is associated with repeated trauma admissions 2 and a higher risk of complications. 3 Alcohol screening for trauma patients may be useful as an opportunity for brief intervention measures that aim to reduce further risk through prevention strategies. Lau and colleagues investigated blood alcohol testing in their observational study of 14 221 major trauma patients from Victoria, Australia, from 2018 to 2021. 4 In their study, 32% of patients had a blood alcohol test. ...
Alcohol use is common among patients admitted to hospital following trauma1 and is associated with repeated trauma admissions and a higher risk of complications. Alcohol screening for trauma patients may be useful as an opportunity for brief intervention measures that aim to reduce further risk through prevention strategies. Lau and colleagues investigated blood alcohol testing in their observational study of 14 221 major trauma patients from Victoria, Australia, from 2018 to 2021.4 In their study, 32% of patients had a blood alcohol test. It was noted that alcohol tests for trauma patients were more likely to be undertaken according to some patient characteristics such as age, socioeconomic deprivation, pre-existing mental health conditions, substance abuse and smoking. The authors conclude that such discrepancies represent implicit human bias, which may hamper efforts to provide appropriate strategies for risk reduction. Importantly, there is a risk of actual or perceived prejudice, judgement, stigma and discrimination based on some patient characteristics. There may also be an element of ‘victim blaming’ that is especially problematic when combined with patient characteristics.
... 1 In 2020, 1.8% of all emergency department (ED) visits in the US were related to alcohol. 2 This is only a minimum estimate of how often alcohol and acute health care intersect, as alcohol use is also commonly discovered in patients presenting for other reasons, such as traumatic injury. 3 Due to the frequency of alcohol use in patients intersecting with health care, it is important to understand when drugs have a significant interaction with alcohol. ...
Introduction:
There is controversy over the existence of a metronidazole-induced disulfiram-like reaction. Uncontrolled case reports suggest metronidazole can cause a severe disulfiram-like reaction in combination with ethanol. Criticism of these cases suggest the observed effects appear to be as likely caused by ethanol as by a drug interaction. Controlled experimental data refute these reports, demonstrating metronidazole does not increase acetaldehyde and cannot reliably produce disulfiram-like reactions. The purpose of this study is to retrospectively assess the incidence of clinical effects consistent with a disulfiram-like reaction in a population of patients with confirmed ethanol use who received metronidazole. As alcohol may also be responsible for the effects seen, the incidence of effects is assessed against a control group matched for age, sex, and ethanol concentration.
Methods:
A retrospective chart review was performed from December 1, 2010, through December 31, 2020 on emergency department patients with ethanol use confirmed via detectable ethanol concentration who received metronidazole while ethanol was predicted to still be present in the serum. A matched comparator group with the same ethanol concentrations, as well as sex and age, was generated for comparison. The incidence of disulfiram-like reaction symptoms documented in the medical record was compared between groups.
Results:
Thirty-six patients were included in the study: 18 in the metronidazole group and 18 in the ethanol concentration matched control group. The mean age in both groups was 46 years. The metronidazole group was 50% male, and the mean ethanol concentration was 0.21 g/dL. The control group was 44.4% male. There was significantly less hypertension in the metronidazole group compared to the control group (16.7% vs 61.1%, P $lt; 0.0001). There were no other significant difference in disulfiram-like effects between the two groups. No patients who received metronidazole and had a detectable ethanol concentration had a suspected disulfiram-like reaction documented in the medical record.
Conclusions:
This data set further supports the lack of a disulfiram-like reaction when metronidazole is used in patients with recent ethanol use in the acute care setting. Additionally, it highlights that the clinical effects of a disulfiram-like reactions may be present at baseline from ethanol ingestion or underlying disease regardless of metronidazole use. These findings are consistent with well-controlled human and animal data demonstrating no increase in acetaldehyde concentrations or disulfiram-like symptoms when metronidazole is co-administered with ethanol. In patients where metronidazole is indicated as the superior agent, its use should not be avoided due to concern about an interaction with ethanol.
Background
Alcohol use is a contributing factor in many cases of traumatic injury. There is conflicting evidence on the impact of alcohol use at the time of physical trauma on severity of injury and hospital course. Similarly, the significance of alcohol use disorder on outcomes in hospitalized trauma patients is unclear. This scoping review aims to provide a concise overview of the current literature surrounding peri-trauma alcohol use and alcohol use disorder on injury severity, in-hospital complications, patient outcomes, and long-term health impact of alcohol use in trauma. We will also explore the associated healthcare costs of this patient population.
Methods
A systematic search of the following databases MEDLINE, EMBASE, and Cochrane Library will be completed to extract all studies that meet our inclusion criteria from January 2000 onwards. Case reports will be excluded. Two reviewers will screen all citations, abstracts, and full text articles. A third reviewer will act as tiebreaker at each stage of the screening process. A narrative synthesis without meta-analysis will be conducted and assessed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines.
Discussion
This review will contribute to the literature by providing a concise overview of the current data on the impact of alcohol on outcomes following trauma. We will explore the overall themes in the literature, limitations, and future directions to focus forthcoming research in this patient population.
