Association between Alcohol Screening Results and Hospitalizations for Trauma in Veterans Affairs Outpatients

• Published in: The American journal of drug and alcohol abuse 2012-01, Vol.38 (1), p.73-80
• Main Authors: Williams, Emily C., Bryson, Chris L., Sun, Haili, Chew, Ryan B., Chew, Lisa D., Blough, David K., Au, David H., Bradley, Katharine A.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Alcohol; Alcohol Abuse; Alcohol consumption; Alcohol Drinking - adverse effects; Alcohol related disorders; alcohol screening; Alcohol use; Alcoholism; Alcoholism - diagnosis; Alcoholism - epidemiology; AUDIT-C; brief alcohol counseling intervention; Brief interventions; Comorbidity; Consumption; Drinking Behavior; Female; Hazards; Hospitalization; Hospitalization - statistics & numerical data; Hospitals; Humans; Injuries; Male; Medical screening; Medicare; Medicine; Middle Aged; Outpatients; Outpatients - statistics & numerical data; Patient admissions; Patients; Primary care; Risk; Risk factors; Screening; Severity; Smoking; Substance use disorder; Surveys and Questionnaires; Tests; Trauma; Veterans; Veterans - statistics & numerical data; Veterans Health; Wounds and Injuries - epidemiology
• ISSN: 0095-2990; 1097-9891
• DOI: 10.3109/00952990.2011.600392

Background: Alcohol consumption is a risk factor for traumatic injury, but it is unknown whether responses to alcohol screening questionnaires administered routinely in primary care are associated with subsequent hospitalization for traumatic injury. Objective: We evaluated the association between alcohol screening scores and the risk for subsequent hospitalizations for trauma among Veterans Affairs (VA) general medicine patients. Method: This study included VA outpatients (n = 32,623) at seven sites who returned mailed surveys (1997-1999). Alcohol Use Disorders Identification Test Consumption (AUDIT-C) scores grouped patients into six drinking categories representing nondrinkers, screen-negative drinkers, and drinkers who screened positive for mild, moderate, severe, and very severe alcohol misuse (scores 0, 1-3, 4-5, 6-7, 8-9, 10-12, respectively). VA administrative and Medicare data identified primary discharge diagnoses for trauma. Cox proportional hazard models were used to estimate the risk of trauma-related hospitalization for each drinking group adjusted for demographics, smoking, and comorbidity. Results: Compared with screen-negative drinkers, patients with severe and very severe alcohol misuse (AUDIT-C 8-9 and ≥10) were at significantly increased risk for trauma-related hospitalization over the follow-up period (adjusted hazard ratios AUDIT-C: 8-9 2.06, 95% confidence interval (CI) 1.31- 3.24 and AUDIT-C≥10 2.13, 95% CI 1.32-3.42). Conclusions: Patients with severe and very severe alcohol misuse had a twofold increased risk of hospital admission for trauma compared to drinkers without alcohol misuse. Scientific Significance: Alcohol screening scores could be used to provide feedback to patients regarding risk of trauma-related hospitalization. Findings could be used by providers during brief alcohol-related interventions with patients with alcohol misuse.