Saliva alcohol concentrations in accident and emergency attendances

Objectives-Although alcohol is known to play a key part in accidents,. no U K study has assessed alcohol concentrations in a comprehensive sample of ac cident and emergency (A&E) attenders. This study set out to do this, and ex amine the relation between alcohol concentrations and the severity, type an d circumstances of presentation, and the sociodemographic characteristics o f patients. Methods-A survey was conducted of all new A&E attenders (aged 10 years or o ver). Two 24 hour periods for each day of the week were covered in 6, 7 or 11 hour sessions over a two month period. Alcohol concentrations were asses sed from saliva samples using a disposable device. Data were collected from 638 attenders, of whom 544 provided saliva samples; the remainder refused or were unable to participate. Results-Positive saliva alcohol readings were obtained in 22% of attenders (95%CI 19% to 26%); this increased to 25% if others were included (for exam ple, those who refused to participate but were judged to be intoxicated). A lcohol was associated with 94% of incidents of self harm, 54% of non-specif ic/multiple complaints, 47% of collapses, 50% of assaults, and 50% of patie nts admitted to hospital. Higher concentrations of alcohol were found from Friday to Sunday, between midnight and 0900, and in patients aged 41 to 60. Among people with positive alcohol results, those attending with a compani on had higher concentrations than those attending alone. There were no sign ificant differences between men and women in alcohol concentrations. Discussion-These findings show that alcohol use is an important factor in A &E attendance, but it should not be assumed that there is a causal relation between alcohol use and injury. Several accident related and sociodemograp hic variables were predictive of alcohol use before attending. The overall level of prediction was too weak to permit accurate identification of drink ers for screening purposes, but routine alcohol concentration assessments m ay be justified in the high risk groups identified in this study. A&E depar tments may be convenient and fruitful settings for brief interventions with early problem drinkers.