Transcript No Slide Title

The Impact of alcohol on
admissions to Scottish
Intensive Care Units : A
National Service
Evaluation
Dr Peter O’Brien
Specialist Registrar
National Service Evaluation
• Proposed by Dr Tim Geary, Dr Sara
Ramsay
• Approved by SICSAG – Spring 2009
• H1N1- delay
• Local co-ordinators via SICSAG consultant
leads
• 23 units
• Ethics / Caldicott guardianship
Methods
•
•
•
•
Prospective service evaluation
October 2009
Inclusion criteria – all adult admissions
Exclusion critieria
• Paediatric patients (<16yr)
• Readmissions
• Tertiary referrals (unless not admitted to
ICU at base hospital)
Data collection
• Demographics
• Three themes regarding alcohol
– Direct influence
• Acute intoxication
• Chronic alcohol related disease
– Indirect influence
– Secondary influence
• Chronic alcohol related disease
• Documented alcohol dependance
Data collection - outcomes
• Wardwatcher™ database
– ICU mortality
– Hospital mortality
– ICU length of stay
– Ventilator days
– Hospital length of stay
Results – Total admissions
• Sample size – 771 patients
• No. alcohol related – 196 (25.4%)
• No. chronic alcohol related – 171 (22.2%)
Unplanned admissions
• Sample size – 642 patients
• No. alcohol related – 196 (30.5%)
• No. chronic alcohol related – 171 (26.6%)
Total admissions - demographics
Number (%)
Alcohol
Non-alcohol
196 (25.4)
575 (74.6)
p value
Age (yrs)
51 (38 – 63)
Median (IQR)
63 (48 – 73)
p < 0.001
No. Male (%) 140 (71.4)
291 (50.6)
p = 0.009
APACHE II
19 (13 – 24)
Median (IQR)
16.5 (12 – 22)
p = 0.061
Ayr Bord D&G Fife
Total
For
Val
GG
Gram High Lan Loth Tay
&C
54 41 29 40 28 209 45 33 93 163 36
Alcohol
related?
11
7
5
14
6
72 12
7
20 35
7
Chronic
alcohol
related
disease?
9
7
4
13
5
60 11
5
20 31
6
35
30
25
%
20
Alcohol related
15
Chronic alcohol
Related disease
10
5
0
% Total admissions – alcohol related
40
35
30
%
25
20
15
Alcohol related
Chronic alcohol
Related disease
10
5
0
% Unplanned admissions – alcohol related
% Alcohol
related
Unplanned
Admissions
27%
26%
23%
36%
21%
36%
26%
24%
28%
26%
22%
ICU mortality
(%)
Hospital
Mortality (%)
SMR
Ventilator days
Median (IQR)
ICU LOS (Dys)
Median (IQR)
Hospital LOS
(Dys) Median
(IQR)
Alcohol
(n=196)
Non-alcohol
(n= 575)
p value
35 (18)
90 (16)
p = 0.541
51 (26.0)
133 (23.1)
p = 0.541
0.8
0.8
2 (1-6)
1 (0-4)
p <0.001
2.5 (0.9-6.1)
2.2 (0.9-5.0)
p = 0.673
11 (4-29)
14 (6-27)
p = 0.202
Literature review
• Marik P, Mohedin B
– Prospective cohort study
– Detroit, USA
– Urban medical ICU
– 200 consecutive adms
– 21% directly related to alcohol
– Tended to be younger and male
Alcohol & Alcoholism. 1996;31(4):393-6
• Uusaro et al
– Finland
– Medical/surgical adult ICU
– Prospective cohort study over 1 year
– Relationship between alcohol and
admission in 24% (215/893)
– Reported longer ICU LOS
– No difference in ICU or Hospital mortality
Acta Anaesthesiol Scand 2005;49:1236-1240
• Mostafa SM, Murthy BVS
– Liverpool
– Mixed medical/surgical ICU
– Prospective cohort study over 12 months
– 28% (89/317) directly associated with
alcohol consumption
– Median APACHE II 19 (4-35)
Euro J Anaes 2002;19:193-196
Limitations
• Only 1 month snap-shot
• True burden of alcohol unknown as not every
referral is admitted to ICU
• H1N1
• Small sample size
Summary
• 25.4% of all adult admissions to Scottish ICUs in
Oct 2009 were associated with alcohol
• 30.5% of unplanned admissions
• Regional variation exists within Scotland
• Primarily associated with younger males
• Associated with longer duration of ventilation
• No difference in ICU/ Hospital length of stay,
ICU/Hospital mortality
Acknowledgments
SICSAG committee
Angela Kellacher
Brian Cook
Gary Reilly
Scott McNeill
Michelle Shaw
Liam O’Neill
Mustafa Ayman
Philip Rae
Austin Rattray
Christopher Wright
Clare Newton-Dunn
Clare Felderhof
Derek McLaughlan
Ramy Labib
Ed James
Fiona Anderson
Iain McCullagh
Jamie Hornsby
Pamela Dean
Juliana Sisk
Ingo Abo Zeid
Robert Docking
Kathyn Dunne
Neil Glassford
Claire Tordoff
160
Alcohol related
140
Non-alcohol
120
Acute Intox
100
Freq
80
60
40
20
0
<20 20-29 30-39 40-49 50-59 60-69 70-79 80-89 >90
Age