Alcohol-related harm in emergency departments: a
prospective, multi-centre study
, Andrew Gosbell
, Katie Moore
, Angela Wadsworth
& Daniel M. Fatovich
School of Clinical Sciences at Monash Health, Monash University, VIC, Australia,
Australasian College for Emergency Medicine, West Melbourne, VIC, Australia,
Road Trauma and Emergency Medicine, Australian National University Medical School, The Canberra Hospital, Australia
and Centre for Clinical Research in Emergency
Medicine, Royal Perth Hospital, University of Western Australia, Australia
Background and aims
Emergency department (ED) alcohol-related presentation data are not routinely collected in
Australia and New Zealand. It is likely that previous research has underestimated the numbers of patients presenting with
alcohol-related conditions. This study aimed to quantify the level of alcohol harm presenting to EDs in Australia and New
Zealand [Correction added on 23 Jan 2018, after ﬁrst online publication: The ‘aims’ section was missing and is updated in
Multi-centre, prospective study. Patients were screened prospectively for alcohol-related presenta-
tions during a 7-day period in December 2014. Part 1 involved screening to determine alcohol-positive ED presentations
and datacollection of patient demographic and clinical information. Part 2 involved a consent-based survey conducted with
patients aged ≥ 14years to perform AlcoholUseDisorders Identiﬁcation Test (AUDIT) scores.
and New Zealand, representing differing hospital role delineations.
A total of 8652 patients aged ≥ 14 years
attended and 8435 (97.5%) were screened.
The main outcome measure was the proportion of patients
who had an alcohol-related presentation termed ‘alcohol-positive’, using pre-deﬁned criteria. It included injuries, intoxica-
tion, medical conditions and injuries caused by an alcohol-affected third party. Secondary outcomes included demographic
and clinical information, the type of alcohol-related presentations and AUDIT scores.
A total of 801 [9.5%; 95%
conﬁdence interval (CI) = 8.9–10.1%] presentations were identiﬁed as alcohol-positive, ranging between 4.9 and 15.2%
throughout sites. Compared with alcohol-negative patients, alcohol-positive patients were more likely to be male [odds ratio
(OR) = 1.90, 95%CI = 1.63–2.21], younger (median age 37 versus46 years, P < 0.0001), arrive byambulance (OR= 1.94,
95% CI = 1.68–2.25) or police/correctional vehicle (OR = 4.56, 95% CI = 3.05–6.81) and require immediate treatment
(OR = 3.20, 95% CI= 2.03–05.06). The median AUDIT score was 16 (interquartile range = 10–24).
one in 10 presentations to emergency departments in Australia and New Zealand are alcohol related.
Keywords Alcohol, alcohol policy, alcohol-related presentations, Australasia, emergency department, public health.
Correspondence to: Diana Egerton-Warburton, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia.
Submitted 30 April 2017; initial review completed 27 July 2017; ﬁnal version accepted 8 November 2017
Alcohol is a major cause of death and disability interna-
tionally, resulting in an estimated 5.9% of all deaths and
5.1% of total disability-adjusted life years . This equates
to 3.3 million deaths annually from alcohol-related harm.
Alcohol-related harm also results in a signiﬁcant burden
of morbidity and social problems and is linked to over
200 disease and injury conditions .
Emergency departments (EDs) are at the frontline of
treating the health and social consequences of alcohol-
related harm. There is evidence extrapolated from the US
National Alcohol Survey that alcohol-related presentations
to EDs in the United States are increasing . Most
research has been limited to patients with alcohol-related
acute injuries; surprisingly little is known about the nature
senting to EDs, with estimates ranging from 0.8 to 9% of to-
tal presentations [4–6]. Most studies conducted have been
single-site, retrospective and/or based on diagnosis coding
or aetiological fractions , all of which are likely to
under-estimate harm. Few studies have collected data on
© 2017 Society for the Study of Addiction Addiction, 113,623–632