Wzorzec-przegl d lekarski-XX-2001

ORIGINAL PAPERS – PRACE ORYGINALNE
Jacek SEIN ANAND1
Zygmunt CHODOROWSKI1
Hanna KUJAWSKA1
Roman KOROLKIEWICZ2
Mariusz STASIAK3
Some clinical aspects of alcohol consumption
in trauma patients
Wybrane aspekty kliniczne nadu¿ywania alkoholu
etylowego wœród pacjentów po urazach
1 Clinic of Internal Diseases
and Acute Poisonings
Medical University of Gdañsk, Poland
Head: Prof. Zygmunt Chodorowski MD PhD
1 st
Department of Pharmacology
Medical University of Gdañsk, Poland
Head: Prof. Jacek Petrusewicz MD PhD
2
Clinic of Traumatology
Medical University of Gdañsk, Poland
Head: Prof. Jerzy Lasek MD PhD
3
Additional key words:
ethanol
trauma
CAGE
AUDIT
brief intervention
Dodatkowe s³owa kluczowe:
alkohol etylowy
uraz
CAGE
AUDIT
krótka interwencja
Address for correspondence:
Jacek Sein Anand MD, PhD
1st Clinic of Internal Diseases
and Acute Poisonings
Medical University of Gdañsk
ul. Dêbinki 7, 80-211 Gdañsk, Poland
phone/fax: (+48) 58 349-29-32;
phone: (+48) 58 349-28-31
e-mail: [email protected]
Przegl¹d Lekarski 2005 / 62 / 6
The aim of the study was the evaluation of alcohol consumption pattern,
clinical outcome of alcohol misuse
patients admitted to traumatology
ward as well as estimation of usage of
brief intervention strategy. The
analyzed group consisted of 137 patients (49 females and 88 males) aged
from 17 to 95 (mean 47.8 ± 21.3) years
hospitalized in 2004. All the patients
were asked to complete the AUDIT and
CAGE tests and were divided into
groups according to alcohol consumption. There were analyzed alcohol consumption patterns, patient's medical
history and also diagnosis of alcohol
misuse. Almost half of the men (45.5%)
hospitalized in the traumatology ward
had been drinking in hazardous pattern in comparison with 4.1% of
women. The most numerous population in this cohort were patients <35year-old (38.1%). Both, the group of
patients with hazardous alcohol consumption (HAC) (>7 pts. according to
AUDIT) and the group of alcohol addicted patients (>1 pts according to
CAGE) were mainly represented by
males. The anamnesis concerning the
alcohol consumption was conducted
by the surgeons in only 1 (0.7%) case,
but without using any tests. Brief intervention was not used even among
those patients who were drunk on admission. Conclusions: There were
45.5% of hazardous drinking males
and 4.1% of females among patients
admitted to the traumatology ward.
None of the surgeons used the screening test to evaluate the drinking misuse of the patients. The brief intervention was not used by the medical staff
despite its low cost and high effectiveness.
Introduction
The aim of the study was the evaluation
of alcohol consumption pattern, clinical outcome of alcohol misuse patients admitted
to traumatology ward as well as estimation
of the usage of brief intervention strategy.
Celem pracy by³a ocena ró¿nych
modeli spo¿ywania etanolu wœród pacjentów przyjmowanych do jednego z
oddzia³ów chirurgii urazowej województwa pomorskiego, a tak¿e okreœlenie czêstoœci stosowania przesiewowych testów s³u¿¹cych do badañ
uzale¿nienia od alkoholu oraz ocena
czêstoœci stosowania metody krótkiej
interwencji. Badaniem objêto 137 osób
w tym 49 kobiet oraz 88 mê¿czyzn w
wieku od 17 do 95 lat (œrednia 47,8 ±
21,3), hospitalizowanych w 2004 r. Pacjentów badano za pomoc¹ testów
AUDIT i CAGE oraz analizowano ich
dokumentacjê medyczn¹ pod wzglêdem m.in. stosowania metody krótkiej
interwencji. Niemal po³owa hospitalizowanych mê¿czyzn (45,5%) prezentowa³a ryzykowny model spo¿ywania
etanolu (HAC) w porównaniu do 4,1%
badanych kobiet. Najliczniejsz¹ grup¹
wiekow¹ wœród chorych z HAC by³y
osoby <35 roku ¿ycia (38,1%). Wœród
osób pij¹cych w sposób ryzykowny (>7
pkt. wg AUDIT) i uzale¿nionych (>1 pkt.
wg CAGE) zdecydowanie dominowali
mê¿czyŸni. Wywiad lekarski dotycz¹cy spo¿ywania alkoholu by³ przeprowadzony w oddziale tylko u jednej osoby (0,7%), zaœ ¿aden z chirurgów nie
przeprowadzi³ przesiewowych testów
AUDIT lub CAGE, a tak¿e nie stosowa³
metody krótkiej interwencji nawet
wœród chorych przyjêtych w stanie
upojenia alkoholowego. Wnioski:
Wœród pacjentów przyjêtych do oddzia³u traumatologii znalaz³o siê 45,5%
mê¿czyzn i 4,1% kobiet pij¹cych w sposób ryzykowny. ¯aden z chirurgów nie
u¿ywa³ przesiewowych testów pozwalaj¹cych na okreœlenie rodzaju uzale¿nienia od alkoholu. Personel medyczny nie stosowa³ metody krótkiej interwencji pomimo niskiego kosztu oraz
wysokiej jej skutecznoœci.
Material and methods
All the patients admitted to the one of Pomeranian
traumatology wards in 2004 were asked to complete the
AUDIT (Alcohol Use Disorder Identification Test) and
CAGE (Cut Angry Guilty Eye opener) tests. The patient's
medical history, conducted therapy, and alcohol consumption pattern performed by the surgeons were also
analyzed.
365
Table I
Division of the patients according to sex and age groups as well as AUDIT test's result.
Podzia³ pacjentów ze wzglêdu na p³eæ i wiek oraz wynik testu AUDIT.
AUDIT
score
0–7
>7
Total
<35
11
(23.4%)
0
(-)
11
(22.5%)
Female (age in yrs)
36–49
50–64
>65
5
9
22
(10.6%)
(19.2%)
(46.8%)
1
1
0
(50%)
(50%)
(-)
6
10
22
(12.2%)
(20.4%)
(44.9%)
Table II
Sex and alcohol addiction in CAGE test.
P³eæ a uzale¿nienie od alkoholu.
According to AUDIT test, the patients were assigned
into two groups: patients with non-hazardous alcohol
consumption (NHAC) (0-7 points) and patients with hazardous alcohol consumption (HAC) (above 7 points). The
CAGE test divided the patients in two cohorts: addicted
(>1 point), and non-addicted patients (0-1 point).
From 163 patients admitted to the ward 10 persons
refused to fill the forms, and 16 were in clinical condition
which excluded them from the study.
Examination was carried out among 137 (84%)
patients, including 49 females (35.8%) in the age range
17-95 (mean 57.1 ± 22,2) and 88 men (64.2%) in the
age range 17-94 (mean 42.6 ± 18.9). The obtained data
were statistically analyzed according to chi square and
t-Student's tests.
Results
Fourteen patients (2 females) were
drunk on admission with blood alcohol level
1.1 g/L ± 1.14. About half of these patients
(51.7%) demonstrated the hazardous pattern of drinking, and 35.7% were alcohol
addicted. Alcohol addicts had higher blood
alcohol level on admission than non addicted
persons (2.4 g/L vs. 1.0 g/L; p<0.01; tStudent's test).
Table I presents division of the patients
according to sex and AUDIT score. These
data revealed that 45.5% of males admitted
to the traumatology ward had been drinking
alcohol in hazardous pattern in comparison
with 4.1% of females (p<0.001; chi square
test). The males were a dominant group (40;
95.2%) among people who reached 7 or
more points in AUDIT scale. The most numerous population in this cohort were patients below 35-year-old (38.1%). Patients
above 65-year-old were only 7.1%. In every
analyzed group there was predominance in
patients drinking in hazardous pattern in
comparison with people alcohol addicted
according to AUDIT test.
The opposite dependence was observed
in NHAC patients. In this group the most
dominant population were people above 65year-old (34.7%), however, younger patients
(<35 years) were underepresented (28.4%).
Table II shows the existence of the correlation between sex and alcohol addiction
in CAGE test.
There is a significant increase in number of alcohol addicted males (91.3%) in
comparison with females (8.7%) (p<0.01; chi
square test).
The clinical evaluation showed that the
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Total
47
(100%)
2
(100%)
49
(100%)
<35
16
(33.4%)
16
(40.0%)
32
(36.6%)
36–49
17
(35.4%)
11
(27.5%)
28
(31.8%)
Male (age in yrs)
50–64
>65
4
11
(8.3%)
(22.9%)
10
3
(25.0%)
(7.5%)
14
14
(15.9%)
(15.9%)
Total
48
(100%)
40
(100%)
88
(100%)
Together
95
(69.3%)
42
(30.7%)
137
(100%)
CAGE score
Fem ale
M ale
Total
0-1
47 (41.2%)
67 (58.8%)
114 (100%)
>1
2 (8.7%)
21 (91.3%)
23 (100%)
Total
49 (35.8%)
88 (64.2%)
137 (100%)
–
–
p<0.01
–
Injury Severity Score (ISS) (8.1±4.5) was
similar in NHAC and HAC patients. There
was also no difference between the length
of hospitalization, clinical course, clinical
outcome, and pulmonary and wound infection in these groups.
The only exception was limited to patients drunk on admission. There was a significant increase in number of pulmonary
and wound infection in HAC and drunken
subjects in comparison with NHAC and sober patients (p<0.05; chi square test).
50% of HAC patients had previous injuries in comparison with 25% of NHAC persons (p<0.05; chi square test).
The anamnesis concerning the alcohol
consumption was conducted by the surgeons in only 1 (0.7%) case, but without
using any tests.
Brief intervention was not used even
among those patients who were drunk on
admission. Delirium tremens was diagnosed
in 4 patients and was treated in traumatology ward by the psychiatrist consultant.
Discussion
Alcohol use disorders are a recognized
cause of significant morbidity and mortality
all over the world. Screening for alcohol consumption pattern as well as broad introduction of brief intervention strategies can reduce alcohol intake, hospital admission and
readmission rate [4].
Alcohol misuse is a heterogenous disturbance which includes alcohol abuse or
dependence, as well as heavy, hazardous,
or harmful drinking [11]. Although alcohol
abuse and dependence have received the
greatest attention, the focus has changed
in the last years because heavy, hazardous
and harmful drinking are more common, and
may be more responsive to treatment especially when early diagnosed [11]. Hazardous drinking is defined as a quantity or pattern of alcohol consumption that places individuals at risk of adverse health events and
is recognized by the World Health Organization (WHO) as a distinct disorder [11].
Among existing alcohol screening instruments, the AUDIT performed best for identifying Accident and Emergency Wards
(AED) treated patients with alcohol use disorders [8]. The AUDIT questionnaire is also
recommended by the WHO as a brief
Przegl¹d Lekarski 2005 / 62 / 6
screening instrument for the detection of
hazardous and harmful alcohol consumption [2,9,11]. The CAGE questionnaire is
probably the best known screening test for
alcoholism [5], however, many authors concluded that it is not a clinically useful tool
when used alone to exclude the possibility
of a hazardous drinking disorder [1,11].
There is ample evidence that a large
number of AED attendances are associated
both with dependent drinking and with single
episodes of alcohol intoxication, which can
result in accidents, fights, and other traumatic events requiring hospital care [14].
Rates of problem drinkers in clinical samples
vary between 28-43% for males and 3.64.8% among females, and is similar to data
obtained in our study [9,10].
According to McCuskar et al. drinking
problem in patients is often unrecognized
by the doctors [9]. In our study none of the
surgeons used the screning tests to diagnose the alcohol misuse, though the time
required to administer the CAGE or AUDIT
tests varies only from 1 to 5 minutes
[2,3,11,12].
The brief intervention (BI) was the other
problem found in this study. A major attraction of BI is the possibility of providing effective treatment at minimal cost [11,15].
None of the surgeons in the investigated
traumatology ward used BI despite the fact
that patients during the crisis are more willing to accept help [7], and its effectiveness
in trauma patients was confirmed in many
prospective randomised studies [6,7,13].
Conclusions
There were 45.5% of hazardous drinking males and 4.1% of females among patients admitted to a traumatology ward.
None of the surgeons used the screening tests to evaluate the alcohol drinking
misuse of the patients.
The brief intervention was not used by
the medical staff of traumatology ward despite its low cost and high effectiveness.
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