Reference: Harrison et al. Mortality in adolescents and young adults following a first presentation to the emergency department for alcohol. AEM March 2024.
Date: March 27, 2024
Guest Skeptic: Dr. Kirsty Challen is a Consultant in Emergency Medicine at Lancashire Teaching Hospitals.
Case: It’s a Friday evening at the end of the academic year in the Paediatric Emergency Department (ED) and you are with the parents of a 15-year-old girl who has been brought in acutely intoxicated from an unofficial “School’s Out” party. Although your patient has recovered and is now fit for discharge, her parents are very worried that this may mean she is at more risk in the future.
Background: We know that alcohol is a major cause of mortality and morbidity across the world [1] and that ED attendance due to it is rising [2,3]. We also know that adults who attend ED with alcohol-related problems are at an increased risk of death in the following year [4]– in fact, we discussed exactly that in SGEM#313 where we agreed that increasing frequency of alcohol-associated ED visits was associated with increasing mortality.
However, we haven’t previously looked at the effect of alcohol in this specific vulnerable age group.
CLINICAL QUESTION: IS A FIRST ED PRESENTATION RELATED TO ALCOHOL ASSOCIATED WITH INCREASED MORTALITY IN ADOLESCENTS AND YOUNG ADULTS?
Reference: Harrison et al. Mortality in adolescents and young adults following a first presentation to the emergency department for alcohol. AEM March 2024.
Population: Patients aged 12-29 with ≥1 ED visit in Ontario 2009-15.
Excluded: Patients not resident in Ontario, those who were not eligible for OHIP 2 years before and 3 years after, and those with an alcohol-related ED visit in the 2 years before study commencement.
Intervention: Any visit related to alcohol
Comparison: No visits related to alcohol
Outcomes:
Primary Outcome(s): Mortality at 1 year
Secondary Outcomes: Mortality at 3 years, cause of death, predictors of death.
Type of Study: Retrospective cohort study.
Dr. Daniel Myran
This is an SGEM HOP and we are pleased to have the lead author Dr. Daniel Myran on the show. Dr. Myran is the Canada Research Chair, Social Accountability, University of Ottawa Investigator, Assistant Professor, Department of Family Medicine, University of Ottawa, Associate Scientist, Ottawa Hospital Research Institute with a Cross Appointed School of Epidemiology and Public Health, University of Ottawa
Authors’ Conclusions: "Incident ED visits due to alcohol in adolescents and young adults are associated with a high risk of 1-year mortality, especially in young adults, those with concurrent mental health or substance use disorders, and those with a more severe initial presentation."
Quality Checklist for Observational Cohort Studies:
Did the study address a clearly focused issue? Yes
Did the authors use an appropriate method to answer their question? Yes
Was the cohort recruited in an acceptable way? Yes
Was the exposure accurately measured to minimize bias? Unsure
Was the outcome accurately measured to minimize bias? Yes
Have the authors identified all-important confounding factors? No
Was the follow-up of subjects complete enough? Yes
How precise are the results? The confidence intervals are well away from zero, so precise enough.
Do you believe the results? Yes
Can the results be applied to the local population? Yes and unsure
Do the results of this study fit with other available evidence? Yes
Funding? Canadian Institutes of Health Research, Ontario Ministry of Health, Ontario Ministry of Long-Term Care. One author received speaker fees from pharma for unrelated subjects.
Results: There were 71,778 alcohol-related attendances out of 2,340,097 total attendances in the study period. Of the alcohol-related attendances, 56% were male, 25% in the lowest income quintile,
