Abstract
Study objective
Some contend that patients with acute alcohol or illicit substance intoxication should
be treated in outpatient detoxification centers rather than in the ED. However, these
patients often have underlying acute medical needs. We sought to determine the frequency
of medical interventions required by ED patients with alcohol or illicit substance
intoxication.
Methods
This was a prospective observational study of consecutive ED patients presenting to
an urban tertiary care ED with altered mental status due to alcohol or illicit substance
use. We performed data collection for patients deemed to be low-risk for complications,
as defined by receiving care in an intoxication observation unit. Trained staff observed
and recorded all medical interventions, including medications administered, diagnostic
testing, procedures performed, and airway interventions. The incidence of agitation
was recorded using the Altered Mental Status Scale (AMSS, ordinal scale from −4 to
+4, where +4 is most agitated). The data analysis is descriptive.
Results
This analysis included 2685 encounters (1645 unique patients; median age 39; 73% male)
from January to May 2019. Average breath alcohol concentration was 0.20 g/dL (range
0.00–0.47). There were 89% encounters with alcohol intoxication, and in 17% encounters
the patient was suspected or known to have drug intoxication (either alone or in conjunction
with alcohol use). On arrival to the ED, 372 (14%) had agitation (AMSS +1 or higher)
and 32 (1%) were profoundly agitated (AMSS +4). In total, 1526 (56%) received at least
one intervention that could not be provided by a local detoxification or sobering
facility. Of the study population, 955 (36%) received a sedating medication, 903 (34%)
required physical restraints for patients or staff safety, 575 (21%) underwent imaging
studies, 318 (12%) underwent laboratory testing, 367 (13%) received another intervention
(IV access, EKG, splinting, wound care, etc). Additionally, 111 (4%) patients received
an airway intervention (19 intubation, 23 nasal airway, 85 supplemental oxygen) and
275 (10%) required repositioning to protect the airway. There were 168 (6%) patients
admitted to the hospital.
Conclusion
In this population of relatively low-risk ED patients with drug and alcohol intoxication,
a substantial proportion of patients received medical interventions.
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Article Info
Publication History
Published online: January 01, 2021
Accepted:
December 29,
2020
Received in revised form:
December 23,
2020
Received:
October 26,
2020
Identification
Copyright
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