Full length articleDifferentials and trends in emergency department visits due to alcohol intoxication and co-occurring conditions among students in a U.S. public university
Introduction
Numerous studies have identified that excessive alcohol use is a problem in the general college age population. Data from the Substance Abuse and Mental Health Services Administration (SAMHSA) from 2010 demonstrated an increase of 24.3% past-month alcohol users between 16 and 17 year olds and 18–20 year olds, and a 21.1% increase from 18 to 20 year olds to 21–25 year olds (SAMHSA, 2011). More specifically, 18–22 year olds enrolled full time in college had a higher prevalence of past month alcohol use (63.3% versus 52.4%), binge drinking (42.2% versus 35.6%), and heavy drinking (15.6% versus 11.9%) than those not enrolled in full time college. The most commonly presented direct and indirect outcomes of excessive alcohol consumption that are seen in the emergency department (ED) include trauma, injuries, mental health issues, assault, and death.
Alcohol intoxication continues to present a great burden for ED personnel and consumes a significant amount of ED resources. The 2006–2010 national statistics on alcohol-related ED visits and comorbidities reported a rising trend in the rate of alcohol-related ED visits among young people 20–24 years of age from 97 to 120 per 100,00. A significant proportion of ED visits in this age group had co-occurring injuries (38%) or mental health concerns (35%) (NIAAA, 2013). Data from the Drug Abuse Warning Network (DAWN), which captured ED data for alcohol abuse among minors 18–20 years of age, estimated approximately 95,166 visits occurred for underage drinking (alcohol alone or in combination with drugs) in 2005. In 2010, however, underage drinking resulted in 114,722 ED visits, or 848.7 visits per 100,000 in 2010. This corresponds to approximately 21% increase since 2005, showing the increasing prevalence of alcohol-related medical emergencies among those 18–20 years of age (SAMHSA, 2011).
Students are a unique population whose alcohol use and drinking behavior are dependent on a range of personal, inter-personal, and campus-related factors. It is well-established that white students, first year students (Wechsler et al., 1995), and students enrolled in fraternities/sororities (Lo and Globetti, 1995, Presley et al., 2002) have higher rates of episodic heavy drinking than other students, while students who are engaged in athletics have lower rates of risky drinking. In addition, the type of residence and the college size also affect the level of binge drinking (National Institutes of Health, 2002).
While binge drinking is common among college students, most studies on college drinking behavior are self-report surveys, which are subject to reporting bias. Due to legal and social concerns, students tend not to provide honest responses to sensitive questions related to their hazardous drinking behavior, especially when it involves the use of emergency care (National Institutes of Health, 2002). Thus, EDs are in a unique position to provide objective clinical and epidemiological data enabling monitoring of hazardous drinking in college-age students. In addition, given the complex challenges in addressing dangerous alcohol use among college students, characterizing students presenting to the ED for treatment of intoxication is useful in developing adequate and targeted interventions and responses. A clearer understanding of the change over time of ED visits related to alcohol intoxication overall and within each demographic, organizational, and academic sub-group can provide important information to monitor the effectiveness of intervention efforts and determine which student sub-groups should be targeted.
To date, only three US-based, published studies have examined alcohol use and related health consequences amongst college students presenting to hospital EDs (Turner and Shu, 2004, Wright et al., 1998, Wright and Slovis, 1996). These studies indicate that prevalence of ED visits involving alcohol use ranged from 13 to 16 per 100 ED visits, of which trauma was the most common co-occurring health consequence, accounting for 53% (Turner and Shu, 2004) or 69% (Wright et al., 1998) of the total visits. Younger students, freshmen, white, and undergraduate students were more likely than other students to visit ED for alcohol-related reasons. However, these studies had certain limitations, including a limited number of ED visits (n ≤ 1529) and a short study period (i.e., 1–2 years). Therefore, these studies were unable to delineate the trends over time in the use of a hospital ED following alcohol intoxication amongst student populations. Furthermore, the use of a single data source (i.e., ED data) does not adequately capture other important students’ characteristics such as academic programs, organizational affiliation, or extra-curricular activities.
The aim of this study was to examine demographic, organizational, and academic differentials and trends in alcohol intoxication and related health consequences that were identified from diagnostic codes documented in medical records among students who presented to an ED affiliated with a major public hospital in the U.S., through the combined use of the ED database and the University’s Student Information System. This study also evaluated the validity and accuracy of diagnostic codes documented in the patient medical records.
Section snippets
Study population and data sources
The current study was based on a cohort of students from a US public university who visited the university hospital ED during six academic years from 2009 to 10 to 2014–15. Data were created by linking three student datasets: ED’s Patient Registration System, University’s Student Information System (SIS), and the ED’s Clinical Data Repository (CDR).
The ED’s Patient Registration System is a reporting system of students visiting the university hospital ED. It generates a daily report of
Results
There were 9812 student visits to the ED during the study period. After excluding 196 visits with missing diagnoses, 9616 visits (48% males) by 7035 unique students were available for analysis. Over 88% of students were aged 18–24 years (median = 20.7 years), 21% were affiliated with a fraternity or sorority, and 1.7% were members of an athletic team. White students accounted for 60% of the total ED visits, followed by Asian and Pacific Islanders (8%), African American (7.8%), non-American
Significance of the study
To our knowledge, the current study is the first comprehensive evaluation of the differentials and trends in alcohol intoxication and co-occurring conditions among university students presenting to a university hospital ED. There was a significant linear increase in both the number and rate of recorded alcohol intoxication with a larger increase found among female students, students below 20 years of age, Asian students, and athletic students. This rising trend also mirrored the national
Contributors
CH conceived the dataset. AN conceived the study design, performed the analyses, and drafted the manuscript. All authors contributed to interpretation of the results and writing the manuscript. All authors approved the final version of the manuscript before submission. None of the original material contained in this manuscript has been submitted for consideration nor will any of it be published elsewhere.
Role of funding source
Nothing declared
Conflict of interest
All authors declare that they have no conflicts of interest.
References (21)
- et al.
Alcohol use and related harm among older adolescents treated in an emergency department: the importance of alcohol status and college status
J. Stud. Alcohol
(2003) - et al.
Treatment of alcohol intoxication at university health services: examining clinical characteristics, drinking patterns, and adherence with referral
J. Alcohol Drug Educ.
(2009) - et al.
Admissions of patients with alcohol intoxication in the emergency department: a growing phenomenon
Swiss Med. Wkly.
(2014) - et al.
Alcohol intoxication at a university hospital acute medicine unit – with special consideration of young adults: an 8-year observational study from Switzerland
Emerg. Med. J.
(2010) - et al.
Burnout and alcohol abuse/dependence among U.S. medical students
Acad. Med.
(2016) - et al.
Drinking to toxicity: college students referred for emergency medical evaluation
Addict. Sci. Clin. Pract.
(2016) - et al.
The facilitating and enhancing roles Greek associations play in college drinking
Int. J. Addict.
(1995) Alcohol-related Emergency Department Visits and Hospitalizations and Their Co-occurring Drug-related, Mental Health, and Injury Conditions in the United States: Findings from the 2006–2010 Nationwide Emergency Department Sample (NEDS) and Nationwide Inpatient Samples (NIS)
(2010)High-risk Drinking in College: What We Know and What We Need to Learn; Final Report of the Panel on Contexts and Consequences
(2002)- et al.
The burden of alcohol misuse on emergency in-patient hospital admissions among residents from a health board region in Ireland
Addiction
(2004)
Cited by (13)
Risk factors associated with concussions in a college student population
2021, Annals of EpidemiologyCitation Excerpt :A possible explanation is that younger students are experiencing life away from home for the first time and are more likely to engage in risk-taking behavior without parental supervision. A previous study found that younger college students and those affiliated with Greek life had higher rates of alcohol-related visits to the emergency department [17]. While alcohol or drugs were reported in only 27% of concussions in this population, this is likely to be an underestimate.
Medical needs of emergency department patients presenting with acute alcohol and drug intoxication
2021, American Journal of Emergency MedicineCitation Excerpt :There were several other important interventions in this patient population. First, occult trauma is frequently encountered in patients with intoxication [19,20]. We observed that patients in 22% of encounters required at least one radiologic study, most often for trauma, and 16% required wound care.
Development and validation of a risk predictive model for student harmful drinking—A longitudinal data linkage study
2019, Drug and Alcohol DependenceCitation Excerpt :In 2017, for example, the past month use of alcohol (62% vs 56.4%) and mixing alcohol with energy drinks (31.5% vs 26.7%) was higher among US college students as compared to non-college peers (National Institute on Drug Abuse, 2018). In addition, numerous studies have linked student harmful alcohol use to a host of negative personal and campus-wide problems including poor academic performances, high-risk sexual behavior, sexual assault, violence and aggression, serious injuries, driving while intoxicated, and traffic fatalities (Ngo et al., 2018a; NIAAA, 2013; Ansari et al., 2013; Beck et al., 2010; Hingson et al., 2009; Wechsler et al., 2002). Considering these issues, most universities have implemented strict alcohol policies on college campuses.
Trends in incidence and risk markers of student emergency department visits with alcohol intoxication in a U.S. public university—A longitudinal data linkage study
2018, Drug and Alcohol DependenceCitation Excerpt :These studies reported that prevalence of ED visits involving alcohol use ranged from 10 to 16 per 100 ED visits and that the prevalence was higher among younger, first-year, white, and undergraduate students. Notably, the study by (Ngo et al., 2018) using data collected over an extended period documented for the first time the rising trends in the prevalence of student alcohol intoxication associated with ED visits. This study also noted that prevalence of this problem drinking was higher in the student population than in corresponding general populations.
Trends and risk markers of student hazardous drinking: a comparative analysis using longitudinally linked datasets in a public university
2022, Journal of American College Health