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.
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