Introduction Emergency department (ED) visits for alcohol intoxication are frequently uncomplicated, resulting in a discharge without significant medical intervention. Our objective was to systematically define a necessary ED visit (NEDV) for an intoxicated patient from an expert panel and then use these criteria to identify predictors of a NEDV and to estimate the rates of a NEDV. Methods We recruited an expert Delphi panel from The National Sobering Collaborative, a national society and conference on alternative care models for alcohol intoxication. A Delphi process involving two online surveys was used to build consensus on defining a NEDV for intoxication. A retrospective chart review of patients at a high volume academic urban ED was then performed to evaluate rates and predictors of a NEDV, as defined by the results of the expert panel. Subjects were patients arriving by EMS with an initial impression of alcohol intoxication. Results Five experts participated in the Delphi process. Four definitions of a NEDV, expanding upon each other, were generated from the Delphi panel. Admission only definition: NEDV if admitted. Hard definition: if admitted, received consult, or received procedure. Medium definition: any components of the hard definition or received imaging. Soft definition: any components of the medium definition or received lab tests. Five hundred and five charts of ED visits were reviewed. Rates of a NEDV ranged from: 8.3% to 42.4% depending on the definition. Chest pain, head trauma, and respiratory distress had the highest odds ratios of predicting a NEDV. Conclusions Multiple definitions derived from the Delphi Method were adopted to define a NEDV for alcohol intoxication. In doing so, we found rates of NEDV ranging from 8% to 42%. These rates are lower to comparable studies that evaluated final diagnoses as opposed to initial impressions of alcohol intoxication. Our analysis also yielded clinical predictors of a NEDV that can be assessed on scene by first responders.
Tam, Austin,
"Defining a Necessary Emergency Department Visit For Alcohol Intoxication"
(2019).
Biology and Medicine Theses and Dissertations.
Brown Digital Repository. Brown University Library.
https://doi.org/10.26300/pxmb-ea57
