CME: Screening Trauma Patients for Drinking Behavior

CME: Screening Trauma Patients for Drinking Behavior
Author Information (click to view)

Mark Mitchell, DO, FACOEP-D, FACEP

President
American College of Osteopathic Emergency Medicine
Co-Founder and CEO
Choice Customer Care

Mark Mitchell, DO, FACOEP-D, FACEP, has indicated to Physician’s Weekly that he has or has had no financial interests to report.

Figure 1 (click to view)
Target Audience (click to view)

This activity is designed to meet the needs of physicians.

Learning Objectives(click to view)

Upon completion of the educational activity, participants should be able to:

 

  • Discuss a study that compared the Alcohol Use Disorders Identification Test and results from blood alcohol level tests in screening trauma patients for drinking behavior.

Method of Participation(click to view)

Statements of credit will be awarded based on the participant reviewing monograph, correctly answer 2 out of 3 questions on the post test, completing and submitting an activity evaluation.  A statement of credit will be available upon completion of an online evaluation/claimed credit form at www.akhcme.com/pwApr1.  You must participate in the entire activity to receive credit.  If you have questions about this CME/CE activity, please contact AKH Inc. at dcotterman@akhcme.com.

Credit Available(click to view)

AKH

CME Credit Provided by AKH Inc., Advancing Knowledge in Healthcare

Physicians
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AKH Inc., Advancing Knowledge in Healthcare and Physician’s Weekly’s.  AKH Inc., Advancing Knowledge in Healthcare is accredited by the ACCME to provide continuing medical education for physicians.

 

AKH Inc., Advancing Knowledge in Healthcare designates this enduring activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Commercial Support(click to view)

There is no commercial support for this activity.

Disclosures(click to view)

It is the policy of AKH Inc. to ensure independence, balance, objectivity, scientific rigor, and integrity in all of its continuing education activities. The author must disclose to the participants any significant relationships with commercial interests whose products or devices may be mentioned in the activity or with the commercial supporter of this continuing education activity. Identified conflicts of interest are resolved by AKH prior to accreditation of the activity and may include any of or combination of the following: attestation to non-commercial content; notification of independent and certified CME/CE expectations; referral to National Author Initiative training; restriction of topic area or content; restriction to discussion of science only; amendment of content to eliminate discussion of device or technique; use of other author for discussion of recommendations; independent review against criteria ensuring evidence support recommendation; moderator review; and peer review.

Disclosure of Unlabeled Use & Investigational Product(click to view)

This educational activity may include discussion of uses of agents that are investigational and/or unapproved by the FDA. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer(click to view)

This course is designed solely to provide the healthcare professional with information to assist in his/her practice and professional development and is not to be considered a diagnostic tool to replace professional advice or treatment. The course serves as a general guide to the healthcare professional, and therefore, cannot be considered as giving legal, nursing, medical, or other professional advice in specific cases. AKH Inc. specifically disclaim responsibility for any adverse consequences resulting directly or indirectly from information in the course, for undetected error, or through participant’s misunderstanding of the content.

Faculty & Credentials(click to view)

FACULTY DISCLOSURES

Keith D’Oria – Editorial Director
Discloses no financial relationships with pharmaceutical or medical product manufacturers.
Mark Mitchell, DO, FACOEP-D, FACEP
Discloses no financial relationships with pharmaceutical or medical product manufacturers.
AKH and PHYSICIAN WEEKLY’S STAFF/REVIEWERS

Dorothy Caputo, MA, BSN, RN- CE Director of Accreditation
Discloses no financial relationships with pharmaceutical or medical product manufacturers.

AKH planners and reviewers have no relevant financial relationships to disclose.

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Mark Mitchell, DO, FACOEP-D, FACEP (click to view)

Mark Mitchell, DO, FACOEP-D, FACEP

President
American College of Osteopathic Emergency Medicine
Co-Founder and CEO
Choice Customer Care

Mark Mitchell, DO, FACOEP-D, FACEP, has indicated to Physician’s Weekly that he has or has had no financial interests to report.

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Using a brief questionnaire appears to be more helpful than looking only at blood alcohol levels for determining-risk drinking behavior among adult trauma patients, according to a study.
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Acute alcohol consumption has been identified as a risk factor for traumatic injuries and can worsen outcomes for many patients. Some investigations have shown that up to 50% of all trauma patients have alcohol detected in their bloodstream when they are admitted to the hospital, and many of these individuals will present again to the same institution with a new injury within 1 year. “Many traumatic injuries are secondary events to patients being intoxicated from drinking alcohol,” says Mark Mitchell, DO, FACOEP-D, FACEP. “Considering the interaction between alcohol and trauma, screening and interventions for at-risk drinking behavior are an important public health issue.”

Recent studies have shown that some trauma centers in the United States have benefited from developing brief substance abuse intervention programs. “When patients are hospitalized with traumatic injuries, this represents a potential opportunity for psychosocial interventions like substance abuse screening,” says Dr. Mitchell. Research suggests that most patients are willing to participate in a brief intervention and some studies have linked these interventions to a significant reduction in hospital admissions for traumatic injuries. In some cases, the positive effects have lasted for several years after the brief intervention was initiated.

 

Comparing Approaches

Experts have developed several reference guides to help hospitals implement brief screening and intervention programs, but these tools are usually selected based on the needs of a particular institution. “Many hospitals use blood alcohol levels to determine at-risk drinking in trauma patients,” says Dr. Mitchell. The Alcohol Use Disorders Identification Test (AUDIT) is another screening method that offers a cheap and easy alternative to using only blood alcohol levels. AUDIT was originally intended for use in primary care, but its value in the ED and trauma unit has been validated by recent studies.

Few direct comparisons have been made between AUDIT and results from blood alcohol level tests in trauma patients. To address this issue, researchers from the Loyola University Medical Center published a study in the Journal of the American Osteopathic Association that compared these approaches. “They wanted to see if AUDIT provided more insights into problematic drinking behavior than simply looking at blood alcohol levels,” Dr. Mitchell says.

In the study, investigators retrospectively reviewed records for all trauma patients aged 18 and older who were admitted to a level I trauma center over the course of about 1 year. Patients were included in the study if they had undergone both blood alcohol level testing and AUDIT on admission. A blood alcohol level higher than 0 g/dL and an AUDIT score equal to or above 8 (out of a possible 40) were considered positive for at-risk drinking.

 

Intriguing Findings

Results of the study showed that patients who were admitted for trauma were predominantly male and were, on average, about 40 years old. Of patients with records containing data on both blood alcohol levels and AUDIT scores, more than 40% had a positive blood alcohol level while 35% had a positive AUDIT score. About 24% met criteria from the National Institute on Alcohol Abuse and Alcoholism for at-risk drinking behavior.

The sensitivity and specificity of having a positive AUDIT score identify at-risk drinking were 83% and 81%, respectively. These results compared favorably to that of the sensitivity and specificity of having a positive blood alcohol level identify at-risk drinking, which registered at 61% and 62%, respectively. Increasing blood alcohol levels and AUDIT scores were linked to a significantly higher odds ratio (OR) of engaging in at-risk drinking. However, a more robust correlation was seen with the OR for increasing AUDIT scores (Figure).

“The findings suggest that traditional screening for at-risk drinking in trauma settings using blood alcohol levels alone may not be the best,” says Dr. Mitchell. “Doing so only offers a snapshot of patients’ recent drinking behaviors, but these test results can be influenced by a variety of other factors.” Some of these factors include the volume of alcohol consumed, time since ingestion, how an individual’s body absorbs alcohol, and consumption of a meal with alcohol. All of these factors can make it difficult to correlate acute blood alcohol levels with at-risk drinking.

 

Consider the Overall Goal

If the goal is to screen for and prevent recidivism, Dr. Mitchell says clinicians need to use tools like AUDIT in addition to blood alcohol levels to get a better grasp of problematic drinking behaviors. “Although routine testing for blood alcohol levels may have a role when managing trauma cases, this test should not be viewed as routine for determining at-risk drinking,” he says. “AUDIT uses an osteopathic, whole-person approach to preventing future trauma and is a relatively brief and easy test to administer and adds little time or costs to implement. After using AUDIT, patients should be directed to a brief intervention to reduce trauma recidivism when indicated.”

 

Mark Mitchell, DO, FACOEP-D, FACEP  is President of the American College of Osteopathic Emergency Medicine and Co-Founder and CEO Choice Customer Care. Dr. Mitchell has indicated to Physician’s Weekly that he has or has had no financial interests to report.

Readings & Resources (click to view)

Plackett TP, Ton-That HH, Mueller J, Grimley KM, Kovacs EJ, Esposito TJ. Screening for at-risk drinking behavior in trauma patients. J Am Osteopath Assoc. 2015;115:376-382. Available at: http://jaoa.org/article.aspx?articleid=2300621.

Gentilello LM, Ebel BE, Wickizer TM, Salkever DS, Rivara FP. Alcohol interventions for trauma patients treated in emergency departments and hospitals: a cost benefit analysis. Ann Surg. 2005;241:541-550.

D’Onofrio G, Degutis LC. Preventive care in the emergency department: screening and brief intervention for alcohol problems in the emergency department: a systematic review. Acad Emerg Med. 2002;9:627-638.

Hadjizacharia P, O’Keeffe T, Plurad DS, et al. Alcohol exposure and outcomes in trauma patients. Eur J Trauma Emerg Surg. 2011;37:169-175.

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