Is sobriety from alcohol necessary for evaluation of patients presenting with suicidal ideation?

BackgroundIt is commonly assumed that patients intoxicated with alcohol are unreliable with respect to their statements of suicidal intent, however no prior literature evaluates the impact of sobriety on suicidal ideation (SI). In typical emergency department (ED) settings, a common practice is to wait until intoxicated suicidal individuals have reached a legally sober limit (ethanol level less than 80 mg/dL) to evaluate safety. We are not aware of any study that establishes the diagnostic reliability of the clinical suicidal ideation evaluation as a function of alcohol intoxication.MethodsThis study is a retrospective review of medical records for patients evaluated in a pre-COVID Midwestern ED for one calendar year. Cases were generated for review based on criteria of having a Psychiatric SW (Social Work) consult and blood alcohol level drawn while in the ED on every Wednesday and Friday of 2017 which produced 1084 cases for review. Chi-square analysis was used for comparison of variables of suicidal ideation with or without alcohol intoxication as defined by blood alcohol level (BAL) ≥80 mg/dL.ResultsIn reference to our initial hypothesis, patients presenting with suicidal ideation and concurrent alcohol intoxication were no longer reporting suicidal ideation at sobriety in 69% of cases, compared to 38% for patients without alcohol levels on presentation. Chi-square analysis demonstrated p=0.000012.ConclusionThe goal of the present study was to demonstrate, with empirical data, a relationship between alcohol intoxication and suicidal ideation. Our data suggests that patients presenting to the ED with complaints related to suicidal behavior who are found to have concurrent alcohol intoxication are more likely to deny suicidal ideation when sober than patients with similar presenting complaints and no alcohol intoxication.

Aspiration risk in relation to Glasgow Coma Scale score and clinical parameters in patients with severe acute alcohol intoxication: a single-centre, retrospective study

ObjectivesIn alcohol intoxicated patients, the decision for or against airway protection can be challenging and is often based on the Glasgow Coma Scale (GCS). Primary aim of this study was to analyse the aspiration risk in relation to the GCS score and clinical parameters in patients with severe acute alcohol monointoxication. Secondary aim was the association between the blood alcohol level and the GCS score.SettingSingle-centre, retrospective study of alcoholised patients admitted to a German intensive care unit between 2006 and 2020.ParticipantsA total of n=411 admissions were eligible for our analysis.Clinical measures and analysisThe following data were extracted: age, gender, admission time, blood alcohol level, blood glucose level, initial GCS score, GCS score at admission, vital signs, clinical signs of aspiration and airway management measures. The empirical distribution of continuous and categorical data was calculated. Binary multivariable logistic regression analysis was used to identify possible risk factors for aspiration.ResultsThe mean age was 35 years. 72% (n=294) of the admissions were male. The blood alcohol level (mean 2.7 g/L±1.0, maximum 5.9 g/L) did not correlate with the GCS score but with the age of the patient. In univariate analysis, the aspiration risk correlated with blood alcohol level, age, GCS score, oxygen saturation, respiratory rate and blood glucose level and was significantly higher in male patients, on vomiting, and in patients requiring airway measures. Aspiration rate was 45% (n=10) in patients without vs 6% (n=3) in patients with preserved protective reflexes (p=0.0001). In the multivariate analysis, only age and GCS score were significantly associated with the risk of aspiration.ConclusionAlthough in this single-centre, retrospective study the aspiration rate in severe acute alcohol monointoxicated patients correlates with GCS and protective reflexes, the decision for endotracheal intubation might rather be based on the presence of different risk factors for aspiration.

Alcohol and trauma: the influence of blood alcohol levels on the severity of injuries and outcome of trauma patients - a retrospective analysis of 6268 patients of the TraumaRegister DGU®

Background Blood alcohol level (BAL) has previously been considered as a factor influencing the outcome of injured patients. Despite the well-known positive correlation between alcohol-influenced traffic participation and the risk of accidents, there is still no clear evidence of a positive correlation between blood alcohol levels and severity of injury. The aim of the study was to analyze data of the TraumaRegister DGU® (TR-DGU), to find out whether the blood alcohol level has an influence on the type and severity of injuries as well as on the outcome of multiple-trauma patients. Methods Datasets from 11,842 trauma patients of the TR-DGU from the years 2015 and 2016 were analyzed retrospectively and 6268 patients with a full dataset and an AIS ≥ 3 could be used for evaluation. Two groups were formed for data analysis. A control group with a BAL = 0 ‰ (BAL negative) was compared to an alcohol group with a BAL of ≥0.3‰ to < 4.0‰ (BAL positive). Patients with a BAL > 0‰ and < 0.3‰ were excluded. They were compared with regard to various preclinical, clinical and physiological parameters. Additionally, a subgroup analysis with a focus on patients with a traumatic brain injury (TBI) was performed. A total of 5271 cases were assigned to the control group and 832 cases to the BAL positive group. 70.3% (3704) of the patients in the control group were male. The collective of the control group was on average 5.7 years older than the patients in the BAL positive group (p < .001). The control group showed a mean ISS of 20.3 and the alcohol group of 18.9 (p = .007). In terms of the injury severity of head, the BAL positive group was significantly higher on average than the control group (p < 0.001), whereas the control group showed a higher AIS to thorax and extremities (p < 0.001). The mean Glasgow Coma Scale (GCS) was 10.8 in the BAL positive group and 12.0 in the control group (p < 0.001). Physiological parameters such as base excess (BE) and International Normalized Ratio (INR) showed reduced values ​​for the BAL positive group. However, neither the 24-h mortality nor the overall mortality showed a significant difference in either group (p = 0.19, p = 0.14). In a subgroup analysis, we found that patients with a relevant head injury (AIS: Abbreviated Injury Scale head ≥3) and positive BAL displayed a higher survival rate compared to patients in the control group with isolated TBI (p < 0.001). Conclusions This retrospective study analyzed the influence of the blood alcohol level in severely injured patients in a large national dataset. BAL positive patients showed worse results with regard to head injuries, the GCS and to some other physiological parameters. Finally, neither the 24-h mortality nor the overall mortality showed a significant difference in either group. Only in a subgroup analysis the mortality rate in BAL negative patients with TBI was significantly higher than the mortality rate of BAL positive patients with TBI. This mechanism is not yet fully understood and is discussed controversially in the literature.

Corelations and Interferences of Blood Alcohol Levels Measured By Cordebard and Gascromatography-Headspace Methods

Ethanol (ethyl alcohol) is an organic compound belonging to the alcohol class, being the main alcohol found in alcoholic beverages. It is a volatile, fl ammable and colorless liquid, with a characteristic odor, being considered one of the oldest drugs consumed by humans. Taking into account the prevalence of alcohol intoxication among drivers, and also among criminal offenders, it was deemed necessary to accurately determine the blood alcohol level detected in the biological samples taken from the suspects, considering the justice system requirements regarding the application of retributive measures in direct proportion to the detected blood alcohol level. The method currently used in Romania is the modified Cordebard Nitrochromic method, which comes with certain limitations, such as the variable homogeneity of the samples that induces sampling errors, thus resulting in blood alcohol levels below the real values. For these reasons, it is deemed necessary to align the methods of ethyl alcohol dosing at a national level and to the analytical requirements of the European Union exigencies, imposing the need to adopt a new method that eliminates as many sources of error as possible, a viable candidate at the moment being the Gascromatographic-Headspace method.