Screening for harmful alcohol use in Australian trauma settings

Abstract

Introduction: High rates of trauma recidivism associated with alcohol use indicate the need to screen foralcohol consumption and related harm. Routine collection of prevalence data relating to alcohol use inAustralian trauma settings is not undertaken currently, and diverse screening approaches are usedacross different settings. This study sought to examine the feasibility of routine screening for alcoholrelated injury and harmful alcohol use, and determine the prevalence of alcohol related injury and riskyalcohol consumption amongst trauma patients in Western Australia.Methods: A step-down model of screening for alcohol-related injury and harmful alcohol consumptionwas developed and trialled. Over a four month period at a statewide trauma service, 729 non-headinjured trauma patients were screened using a two-item measure in emergency and acute surgicalsettings, and 538 patients who screened positive were subsequently administered a standardised selfreport measure of alcohol consumption.Results: There was a 49% compliance rate with the Emergency Department brief screening protocol foralcohol related injury. Of those screened, 77% were identified by clinical staff as potentially having had analcohol related injury or be engaging in risky drinking regularly. Sixty per cent of the screened patientswho subsequently completed a standardised self report measure were identified as drinking at harmfullevels (41% hazardous; 7% harmful; 12% dependent). Of these, 15% and 24% met the DSM-IV-TR criteriafor alcohol abuse and dependence respectively. Approximately 30% of patients diagnosed with analcohol use disorder were not identified by staff as having an alcohol-related injury or problem. Higheralcohol consumption was significantly associated with greater risk of depression and PTSD.Conclusions: Preliminary findings suggest a high prevalence of alcohol-related injury, and harmfulalcohol consumption. These findings point to an urgent need to develop reliable and economicalscreening protocols for harmful alcohol use across Australian trauma settings and the adoption ofstrategies to ensure their compliance, to enable accurate identification of those most likely to benefitfrom interventions to reduce alcohol related harm.