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Alcohol and Drug Use Amongst Young Attenders to A+E   Back Bookmark and Share

Author : R Eager, D Barton

Sir Alcohol and drug use are amongst the most common factors identifiable in the Emergency Department patient population. We carried out a three-month prospective study of all patients up to the age of thirty years who attended the emergency department. A standard questionnaire was completed on young patients presenting with alcohol or drug use, both recreational and deliberate self-harm (DSH). All appropriate attendances were identified by extraction of patient lists for the study period from the hospital information system. Cases in which substance use was thought to be a contributing (rather than a causative) factor, for example assaults, were excluded.

Results
During the study period 98 attendances matched the inclusion criteria from a total patient attendance of 6799. Three patients had attended twice. This equates to an incidence of 14.1 per 1000 attendances with a mean age of 21.3 years for patients with DSH (22.1 years for males, 20.9 years for females) and 20.6 years for non-DSH patients (21.4 years for males, 18.5 years for females). Details of results are outlined in Table 1.

Table 1 Reason for Attendance to A+E according to age and sex
 Female 14-19 YearsFemale 20-25 YearsFemale 26-30 YearsMale 14-19 YearsMale 20-25 YearsMale 26-30Years Total
Alcohol Alone731128637
DSH69251427
DSH+Alcohol3200117
Illicit Drugs23137218
Illicit Drugs +DSH0101103
Illicit Drugs + Alcohol0100405
Unknown Drug0001001

The most common drugs taken in isolation for DSH were paracetamol (7 cases) and benzodiazepines (4 cases). Other drugs taken included tri-cyclic antidepressants, anti-psychotics and antibiotics. Twenty-six of the ninety-eight attendances followed use of illicit drugs. Of these, eighteen were for recreational use, principally heroin and ecstasy. Sixteen cases involved use of a single drug and two cases involved ingestion of two different types of illicit drugs. There were three cases of illicit drug use in DSH, in addition to five patients in association with alcohol. The majority of cases required a period of observation (see Table 2). Referral for admission occurred in 20 cases of DSH and 8 of alcohol use. There were 3 acts of aggression towards staff in the form of verbal abuse and threatening behaviour.

Table 2 Outcomes of Patient Attendances
 FemalesMalesTotal
With DSH   
Referred Medical11617
Admitted Psychiatry213
Discharge after observation and psychiatric review8614
Self Discharge213
With Alcohol or Drugs   
Discharge after observation and/or treatment142236
Self Discharge21315
Removed by Police112
Admitted Medical123
Admitted Surgical033
Admitted Orthopaedic022

Discussion
Alcohol and drug use has been implicated as one of the leading causes of attendances to emergency departments. Our study shows that alcohol and drug use is a significant problem amongst the young population of North Dublin. Studies in the United Kingdom (UK)1and Northern Ireland2 estimated that drug use is related to 18.3 per 1000 attendances, and alcohol to 20% of overall attendances respectively. Our study estimates the incidence in our catchment area as 14.1 per 1000 attendances although this is probably an under-estimate due to the exclusion of presentations such as assault.

Alcohol causes significant morbidity and is a cause of regular attendance to emergency departments. One study looking at repeat attenders found that the most common presenting complaints were overdose (27.4%), minor injuries (19%) and alcohol intoxication (14%)3. The management of these patients is time-consuming and costly.

Deliberate self-harm was also shown to be a problem in our study. In comparison to alcohol use, it has greater resource implications, as patients often need a period of observation together with investigation, and review by medical and psychiatric on-call services. The use of observation or short stay wards under the control of consultants in Emergency Medicine are widely used in the UK for these patients4. Our study supports the need for such units in Irish emergency departments. Consultants in Emergency Medicine would care for such patients reducing the workload of on-call medical teams, and patients could be accommodated in beds rather than hospital trolleys in the main treatment area. We believe that the provision of such facilities should be an essential component of any review of emergency services.

Twenty-six of the ninety-eight attendances followed use of illicit drugs in our study. The presentation of illicit drug use to A+E was examined in one London hospital5. Ecstasy related problems were the pr

   
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