Sunday, 6 May 2018

Unsuspected Critical Illness Among ED Patients Presenting for Acute Alcohol Intoxication


During my ED training, I was taught the maxim; nobody is ever "just drunk." Of course, this was meant to emphasize caution in recklessly labelling patients as such. Some may have subdurals, infections or other bad illness.

These authors attempted to quantify the proportion of patients who were thought to be just drunk but who ended up requiring critical care resources. In addition, they sought to find clinical features that might be associated with the need for these resources.

Enter Minneapolis, Minnesota. (Evidently, a lot of people resort to drinking here.) Their ED has a “dedicated intoxication unit” where these presumed low risk patients are grouped.

Over five years, they put over 35,000 patients through this area. One patient was readmitted 227 times!

Of these low risk patients, what proportion of them ended up requiring critical care resources?

1%

Abnormal vital signs, hypoglycaemia and parenteral sedation were associated with this outcome. This has face validity i.e. makes sense.

However, this study had substantial limitations.

It was a retrospective review of EHR data which we know to be rather unreliable. It also rested on subjectivity in the definition of their study population and other assumptions.

At best the 1% estimate is a ballpark figure.

But the accuracy doesn’t matter. The overall message has not changed; a small proportion of patients who you suspect to be “just drunk” will really have something bad. Pay attention to vital signs and overall be cautious.

Where have I heard this before?


Covering:

Klein LR, Cole JB, Driver BE, et al. Unsuspected CriticalIllness Among Emergency Department Patients Presenting for Acute AlcoholIntoxication. Ann Emerg Med 2018;71:279-288.
Image result for just drunk




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