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Dr Peter O’Brien Specialist Registrar

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

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Dr Peter O’Brien Specialist Registrar

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  1. The Impact of alcohol on admissions to Scottish Intensive Care Units : A National Service Evaluation Dr Peter O’Brien Specialist Registrar

  2. 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

  3. 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)

  4. 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

  5. Data collection - outcomes • Wardwatcher™ database • ICU mortality • Hospital mortality • ICU length of stay • Ventilator days • Hospital length of stay

  6. 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%)

  7. Total admissions - demographics

  8. % Alcohol related Chronic alcohol Related disease % Total admissions – alcohol related

  9. Alcohol related Chronic alcohol Related disease % Unplanned admissions – alcohol related

  10. % Alcohol related Unplanned Admissions 27% 26% 23% 36% 21% 36% 26% 26% 22% 28% 24%

  11. 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

  12. 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

  13. 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

  14. Limitations • Only 1 month snap-shot • True burden of alcohol unknown as not every referral is admitted to ICU • H1N1 • Small sample size

  15. 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

  16. SICSAG committee Angela Kellacher Brian Cook Acknowledgments 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

  17. Freq Age

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