RESUMO
In this paper, our goal is to report relative risks of the impact of alcohol consumption 6 hours prior to medical emergencies presenting in the emergency department for 8,346 patients in seven countries using data from the Emergency Room Collaborative Alcohol Analysis Project. We found that alcohol increased the risk of a medical emergency by 2.17 times (confidence interval: 1.78-2.65), and those without a regular pattern of heavy drinking and those younger showed a greater risk. Acute alcohol is associated not only with injury but also with medical emergencies. More studies are needed on the acute role of alcohol in medical emergencies, preferably with data on the type of medical emergencies.
Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Emergências/epidemiologia , Adulto , Fatores Etários , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , RiscoRESUMO
OBJECTIVE: The Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV), and the International Statistical Classification of Diseases and Related Health Problems, 10th Edition (ICD-10), alcohol use disorders (AUDs) classifications offer competing and somewhat overlapping diagnostic tools for assessing alcohol dependence and harms/abuse. Both systems are in active stages of development in anticipation of their next respective iterations. Although much psychometric work has been done studying DSM-IV criteria, efforts toward the ICD-11 have been less prevalent. METHOD: Data from 3,191 drinkers in seven emergency department sites in four countries (United States, Mexico, Argentina, and Poland) were used to study the psychometric properties of the combined ICD-10 dependence and harms criteria. Comparisons with the proposed set of DSM-5 criteria and diagnostic thresholds are also included. RESULTS: Item response theory analyses of the combined ICD-10 dependence and harms criteria suggested a single underlying factor, both overall and for each site separately, with only moderate differential item functioning across sites. Overall agreement between the summative combined ICD-10 dependence and harms criteria and the proposed 11-criteria DSM-5 scale was very high (r = .97), as was agreement between proposed diagnostic threshold levels of 0-1 (negative AUD), 2-3 (moderate AUD), and 4 or more (severe AUD) criteria endorsed (κ = .84). Although disagreement between the two three-level diagnoses was only 5.5% of the sample, a majority of these were because of differences between endorsement rates of abuse versus harms criteria. CONCLUSIONS: Although there is support for efforts to align the two schemes, results are consistent with other studies finding the largest differences between the two systems emanating from differences between the abuse and harms domains. More research is needed before differences between the two systems can be reconciled.
Assuntos
Alcoolismo/diagnóstico , Manual Diagnóstico e Estatístico de Transtornos Mentais , Serviço Hospitalar de Emergência/estatística & dados numéricos , Classificação Internacional de Doenças , Transtornos Relacionados ao Uso de Álcool/diagnóstico , Transtornos Relacionados ao Uso de Álcool/epidemiologia , Alcoolismo/epidemiologia , Argentina , Humanos , México , Polônia , Prevalência , Psicometria/estatística & dados numéricos , Estados UnidosRESUMO
BACKGROUND: Current research suggests that Diagnostic and Statistical Manual of Mental Disorder (DSM)-IV alcohol abuse and dependence form a unidimensional continuum in emergency department (ED) patients in 4 countries: Argentina, Mexico, Poland, and the United States. In this continuum of alcohol use disorder (AUD), there are no clear-cut distinctions between the criteria for dependence and abuse in the severity dimension based on prior results from item response theory (IRT) analysis. Nevertheless, it is desirable to find a threshold for identifying cases for clinical practice and cut-points of clinical utility in this continuum to distinguish between patients more or less affected by an AUD, using a scale of symptoms count. METHODS: Data from 5,193 patients in 7 ED sites in the same 4 countries (3,191 current drinkers) were used to study the structure, threshold, and possible cut-points for the diagnoses of AUD. RESULTS: The proposed changes in the DSM-V, dropping the abuse item "legal problems" and adding an item on "craving," did not impact the IRT performance and unidimensionality of AUD in this sample. With a total set of 11 items (deleting "legal problems" and adding "craving" to the current set of DSM criteria), an endorsement of 2 or more criteria can be used as the threshold to define those with an AUD in clinical practice. Furthermore, we can distinguish at least 2 levels of clinical severity, 2 to 3 criteria (moderate), and 4 or more criteria (severe). CONCLUSIONS: A dimensional approach to AUD using the proposed new set of criteria for the DSM-V can be used to propose a threshold and levels of severity. More research in different populations and countries is needed to further substantiate a threshold and cut-points that could be used in new formulations of substance use disorders.
Assuntos
Alcoolismo/diagnóstico , Alcoolismo/terapia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Serviços Médicos de Emergência/normas , Serviço Hospitalar de Emergência/normas , Alcoolismo/epidemiologia , Bases de Dados Factuais/normas , Serviços Médicos de Emergência/métodos , Feminino , Humanos , Masculino , Reprodutibilidade dos TestesRESUMO
OBJECTIVE: Adding a craving criterion--presently in the International Classification of Diseases, 10th Revision, diagnosis of alcohol dependence--has been under consideration as one possible improvement to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), and was recently proposed for inclusion by the DSM Substance-Related Disorders Work Group in the Fifth Revision of diagnostic criteria for alcohol use disorders. To inform cross-cultural applicability of this modification, performance of a craving criterion was examined in emergency departments in four countries manifesting distinctly different culturally based drinking patterns (Mexico, Poland, Argentina, United States). METHOD: Exploratory factor analysis and item response theory were used to examine psychometric properties and individual item characteristics of the 11 DSM-IV abuse and dependence criteria with and without craving for each country separately. Differential item functioning analysis was performed to examine differences in the difficulty of endorsement (severity) and discrimination of craving across countries. RESULTS: Exploratory factor analysis found craving fit well within a one-dimensional solution, and factor loadings were high across all countries. Results from item-response theory analyses indicated that both discrimination and difficulty estimates for the craving item were located in the middle of the corresponding discrimination and difficulty ranges for the other 11 items for each country but did not substantially increase the efficiency (or information) of the overall diagnostic scheme. Across the four countries, no differential item functioning was found for difficulty, but significant differential item functioning was found for discrimination (similar to other DSM-IV criteria). CONCLUSIONS: Findings suggest that, although craving performed similarly across emergency departments in the four countries, it does not add much in identification of individuals with alcohol use disorders.
Assuntos
Transtornos Relacionados ao Uso de Álcool/diagnóstico , Transtornos Relacionados ao Uso de Álcool/etnologia , Comportamento Aditivo/diagnóstico , Comportamento Aditivo/etnologia , Comparação Transcultural , Manual Diagnóstico e Estatístico de Transtornos Mentais , Argentina/etnologia , Serviço Hospitalar de Emergência , Humanos , México/etnologia , Polônia/etnologia , Estados Unidos/etnologiaRESUMO
AIMS: To replicate the finding that there is a single dimension trait in alcohol use disorders and to test whether the usual 5+ drinks for men and 4+ drinks for women and other measures of alcohol consumption help to improve alcohol use disorder criteria in a series of diverse patients from emergency departments (EDs) in four countries. DESIGN: Cross-sectional surveys of patients aged 18 years and older that reflected consecutive arrival at the ED. The Composite International Diagnostic Interview Core was used to obtain a diagnosis of DSM-IV alcohol dependence and alcohol abuse; quantity and frequency of drinking and drunkenness as well as usual number of drinks consumed during the last year. SETTING: Participants were 5195 injured and non-injured patients attending seven EDs in four countries: Argentina, Mexico, Poland and the United States (between 1995-2001). FINDINGS: Using exploratory factor analyses alcohol use disorders can be described as a single, unidimensional continuum without any clear-cut distinction between the criteria for dependence and abuse in all sites. RESULTS: from item response theory analyses showed that the current DSM-IV criteria tap people in the middle-upper end of the alcohol use disorder continuum. Alcohol consumption (amount and frequency of use) can be used in all EDs with the current DSM-IV diagnostic criteria to help tap the middle-lower part of this continuum. Even though some specific diagnostic criteria and some alcohol consumption variables showed differential item function across sites, test response curves were invariant for ED sites and their inclusion would not impact the final (total) performance of the diagnostic system. CONCLUSIONS: DSM-IV abuse and dependence form a unidimensional continuum in ED patients regardless of country of survey. Alcohol consumption variables, if added, would help to tap patients with more moderate severity. The DSM diagnostic system for alcohol use disorders showed invariance and performed extremely well in these samples.
Assuntos
Consumo de Bebidas Alcoólicas , Transtornos Relacionados ao Uso de Álcool/diagnóstico , Adulto , Fatores Etários , Consumo de Bebidas Alcoólicas/epidemiologia , Consumo de Bebidas Alcoólicas/psicologia , Transtornos Relacionados ao Uso de Álcool/epidemiologia , Transtornos Relacionados ao Uso de Álcool/psicologia , Argentina/epidemiologia , Estudos Transversais , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , México/epidemiologia , Polônia/epidemiologia , Índice de Gravidade de Doença , Fatores Sexuais , Inquéritos e Questionários , Estados Unidos/epidemiologia , Adulto JovemRESUMO
AIMS: To determine the relative risk (RR) of non-fatal injury associated with alcohol consumption in a series of emergency departments (EDs), possible effect modifiers and the impact of contextual variables on differences across sites. DESIGN: The case-crossover method was used to obtain RR estimates of the effect of alcohol on non-fatal injuries. Meta-analysis was used to evaluate the consistency and magnitude of RR across sites, and the extent to which contextual variables explain differences in effect sizes. PARTICIPANTS: Probability samples of 11,536 injured patients attending 28 EDs studies in 16 countries (1984-2002). The majority of the sample was male (65%) and > 30 years old (53%). MEASUREMENTS: Exposed cases where those that consumed alcohol 6 hours prior to the injury. Usual alcohol consumption served as the control period. FINDINGS: Drinking within 6 hours prior to the injury was reported by 21% of the sample. The estimated (random) pooled relative risk for patients who reported alcohol use within 6 hours prior to injury was 5.69 (95% confidence interval = 4.04-8.00), ranging from 1.05 in Canada to 35.00 in South Africa. Effect size was not homogeneous across studies, as societies with riskier consumption patterns had a higher relative risk for injury. Heavier drinkers also showed lower RR. CONCLUSIONS: Acute alcohol was a risk factor for non-fatal injuries in most sites. Policy measures addressed to the general population are recommended, especially in societies with riskier consumption patterns.