Abstract
Background
Approximately one-quarter of emergency department (ED) visits for alcohol withdrawal result in unscheduled 1-week ED return visits, but it is unclear what patient and clinical factors may impact this outcome
Methods
From January 1, 2015, to December 31, 2018, at three urban EDs in Vancouver, Canada, we studied patients who were discharged with a primary or secondary diagnosis of alcohol withdrawal. We performed a structured chart review to ascertain patient characteristics, ED treatments, and the outcome of an ED return within 1 week of discharge. We used univariable and multivariable Bayesian binomial regression to identify characteristics associated with being in the upper quartile of 1-week ED revisits.
Results
We collected 935 ED visits among 593 unique patients. Median age was 45 years (interquartile range 34 to 55 years) and 71% were male. The risk of a 1-week ED revisit was 15.0% (IQR 12.3; 19.5%). After adjustment, factors independently associated with a high risk for return included any prior ED visit within 30 days, no fixed address, initial blood alcohol level > 45 mmol/L, and initial Clinical Institute Withdrawal Assessment—alcohol revised score > 23. These factors explained 41% of the overall variance in revisits.
Conclusion
Among discharged ED patients with alcohol withdrawal, we describe high-risk patient characteristics associated with 1-week ED revisits, and these findings may assist clinicians to facilitate appropriate discharge planning with access to integrated follow-up support.
Résumé
Contexte
Environ un quart des visites aux urgences pour sevrage alcoolique se traduit par un retour non programmé aux urgences pendant une semaine, mais les facteurs cliniques et relatifs aux patients qui peuvent avoir une incidence sur ce résultat ne sont pas clairs.
Méthodes
Du 1er janvier 2015 au 31 décembre 2018, dans trois urgences urbaines de Vancouver, au Canada, nous avons étudié les patients qui sont sortis avec un diagnostic primaire ou secondaire de sevrage alcoolique. Nous avons procédé à une analyse structurée des dossiers afin de déterminer les caractéristiques des patients, les traitements aux urgences et l'issue d'un retour aux urgences dans la semaine suivant la sortie. Nous avons utilisé une régression binomiale bayésienne univariable et multivariable pour identifier les caractéristiques associées au fait d'être dans le quartile supérieur des visites aux urgences à une semaine.
Résultats
Nous avons recueilli 935 visites aux urgences parmi 593 patients uniques. L'âge médian était de 45 ans (intervalle interquartile de 34 à 55 ans) et 71 % étaient des hommes. Le risque d'une nouvelle visite aux urgences à une semaine était de 15,0% (IQR 12,3 ; 19,5%). Après ajustement, les facteurs indépendamment associés à un risque élevé de retour comprenaient toute visite antérieure à l’urgence dans les 30 jours, aucune adresse fixe, le taux d’alcoolémie initial > 45 mmol/L, et l’évaluation initiale du sevrage de l’Institut clinique – cote d’alcoolémie révisée > 23. Ces facteurs expliquaient 41 % de la variance globale des visites.
Conclusions
Parmi les patients sortants des urgences en sevrage alcoolique, nous décrivons les caractéristiques des patients à haut risque associés à la réadmission aux urgences après une semaine de sevrage alcoolique. Ces résultats peuvent aider les cliniciens à planifier de manière appropriée la sortie de l'hôpital et à accéder à un suivi intégré.
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Data availability
De-identified data herein are accessible to other interested parties by application to the corresponding author.
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FS conceived the study and designed it with assistance from DL, GI, and BG. EG provided the initial dataset. FS, IS, SD, AY, and IC collected data. DB and AK adjudicated seizure patients. BG and EG reviewed patients with concurrent issues. DL performed Bayesian analysis. SB and AK provided content information from an addictions viewpoint. FS drafted the manuscript and all authors approved. FS takes overall responsibility.
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Scheuermeyer, F.X., Lane, D., Grunau, B. et al. Risk factors associated with 1-week revisit among emergency department patients with alcohol withdrawal. Can J Emerg Med 25, 150–156 (2023). https://doi.org/10.1007/s43678-022-00414-w
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DOI: https://doi.org/10.1007/s43678-022-00414-w