The Impact of alcohol on admissions to Scottish Intensive

Care Units : A National Service

EvaluationDr Peter O’BrienSpecialist 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%)

Alcohol Non-alcohol p value

Number (%) 196 (25.4) 575 (74.6)

Age (yrs)Median (IQR)

51 (38 – 63) 63 (48 – 73) p < 0.001

No. Male (%)

140 (71.4) 291 (50.6) p = 0.009

APACHE IIMedian (IQR)

19 (13 – 24) 16.5 (12 – 22)

p = 0.061

Total admissions - demographics

Ayr Bord D&G FifeForVal

GG & C

Gram High Lan Loth Tay

Total 54 41 29 40 28209

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

% Total admissions – alcohol related

% Alcohol related

Chronic alcoholRelated disease

% Unplanned admissions – alcohol related

Alcohol related

Chronic alcoholRelated disease

26%27%

23%

22%

28%

26%

36%

24%

26%

21%36%

% Alcohol related UnplannedAdmissions

Alcohol (n=196)

Non-alcohol (n= 575)

p value

ICU mortality (%)

35 (18) 90 (16) p = 0.541

Hospital Mortality (%)

51 (26.0) 133 (23.1) p = 0.541

SMR 0.8 0.8Ventilator daysMedian (IQR)

2 (1-6) 1 (0-4) p <0.001

ICU LOS (Dys)Median (IQR)

2.5 (0.9-6.1)

2.2 (0.9-5.0)

p = 0.673

Hospital LOS (Dys) Median (IQR)

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

Gary ReillyScott McNeillMichelle ShawLiam O’NeillMustafa AymanPhilip RaeAustin RattrayChristopher Wright

Clare Newton-DunnClare FelderhofDerek McLaughlanRamy LabibEd JamesFiona AndersonIain McCullaghJamie Hornsby

Pamela DeanJuliana SiskIngo Abo ZeidRobert DockingKathyn DunneNeil GlassfordClaire Tordoff

SICSAG committeeAngela KellacherBrian Cook

Freq

Age