Alcoholism in the emergency department: An epidemiologic study

Objective: To describe the epidemiology of alcoholism in ED patients. Metho ds: Over a two-month period, every adult patient brought by ambulance to th e ED of a large municipal hospital was prospectively enrolled by questionna ire. Data collected included demographics, previous ED use, triage complain t-related diagnoses, hospital admission rates, and ethanol levels (if deter mined). The CAGE alcoholism questions were administered to all patients by trained assistants. The only exclusion criterion was the inability to commu nicate while in the ED. A chi-square analysis was used to compare categoric al variables. Results: A total of 2,658 patients were enrolled in the study ; 226 were unable to respond to the CAGE questions. Five hundred eighty-eig ht of the remaining 2,432 patients (24%) were defined as being alcoholic by an affirmative response to at least two of the CAGE questions. All four qu estions were answered affirmatively by 17% of the total patients. Alcoholic patients were more likely to be male (88% vs 60%), unemployed (87% vs 71%) , undomiciled (46% vs 20%), polysubstance users (52% vs 25%), and tobacco u sers (77% vs 41%), and to have had an ED visit in the previous six months ( 51% vs 35%) (p < 0.001 for all tests). Ethanol levels ranged from zero to 5 73 mg/dL. Whereas no positive response to a single CAGE question was predic tive of a final diagnosis of alcoholism, a blood ethanol level more than 30 0 mg/dL predicted an affirmative response to at least two CAGE questions in 97% of cases. Conclusions: Alcoholism should be presumed to be present in a substantial number of patients who present to urban EDs by ambulance.