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Thématique :
- Foie
Originalité :
Intermédiaire
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Docteur Jean-Louis PAYEN
Coup de coeur :
 
 
Journal of Hepatology
  2017/09  
 
  2017 Sep;67(3):559-567.  
  doi: 10.1016/j.jhep.2017.04.017.  
 
  Universal screening for alcohol misuse in acute medical admissions is feasible and identifies patients at high risk of liver disease  
 
  Westwood G, Meredith P, Atkins S, Greengross P, Schmidt PE, Aspinall RJ  
  https://www.ncbi.nlm.nih.gov/pubmed/28756907  
 
 

Abstract

BACKGROUND & AIMS:

Many people who die from alcohol related liver disease (ARLD) have a history of recurrent admissions to hospital, representing potential missed opportunities for intervention. Universal screening for alcohol misuse has been advocated but it is not known if this is achievable or effective at detecting individuals at high risk of ARLD.

METHODS:

We systematically screened all admissions to the Acute Medical Unit (AMU) of a large acute hospital using an electronic data capture system in real time. Patients at an increasing risk of alcohol harm were referred for either brief intervention (BI) or further assessment by an Alcohol Specialist Nursing Service (ASNS). Additional data were recorded on admission diagnoses, alcohol unit consumption, previous attendances, previous admissions, length of stay and mortality.

RESULTS:

Between July 2011 and March 2014, there were 53,165 admissions and 48,211 (90.68%) completed screening. Of these, 1,122 (2.3%) were classified as "increasing", and 1,921 (4.0%) as "high" risk of alcohol harm. High risk patients had more hospital admissions in the three previous years (average 4.74) than the low (3.00) and increasing (2.92) risk groups (p<0.001). The high risk patients also had more frequent emergency department (ED) attendances (7.68) than the lower (2.64) and increasing (3.81) groups (p<0.001 for both). A total of 1,396 (72.6%) of the high risk group were seen by the ASNS and 1,135 (81.2%) had an Alcohol Use Disorders Identification Test (AUDIT) score over 20 with 527 (37.8%) recording the maximum value of 40. Compared to the other groups, high risk patients had a distinct profile of admissions with the most common diagnoses being mental health disorders, gastro-intestinal bleeding, poisoning and liver disease.

CONCLUSIONS:

Universal screening of admissions for alcohol misuse is feasible and identifies a cohort with frequent ED attendances, recurrent admissions and an elevated risk of ARLD. An additional group of patients at an increasing risk of alcohol harm can be identified in a range of common presentations. These patients can be targeted with interventions to reduce the burden of alcohol related harm. Lay summary: Many people who die from alcohol related liver disease (ARLD) have a recent history of recurrent admissions to hospital. These admissions may represent missed opportunities to intervene earlier and offer effective therapies for alcohol misuse. Unfortunately, we know that patients are often missed because medical staff may not routinely ask about alcohol consumption. In our study of over 50,000 admissions, we have demonstrated the feasibility of offering screening for alcohol misuse to all medical admissions to hospital and delivered this 24hours a day, 7days a week, with automatic referral to treatment services. We have shown that it is possible to identify those people who are at the highest risk of dependency, those who have attended the emergency department the most and those who are at an increased risk of ARLD. We hope this study will lead to improved detection and management of alcohol problems in acute hospitals.

 

 
Question posée
 
Le dépistage « universel » de consommation excessive d'alcool aux admissions médicales d’une structure hospitalière est réalisable. Elle identifie les patients présentant un risque élevé de maladie du foie.
 
Question posée
 
Ce dépistage « universel » lors de l’admissions pour consommation excessive d'alcool a été possible et a identifié une cohorte avec des admissions récurrentes et un risque élevé de pathologies hépatiques. Ainsi, un groupe de patients présentant un risque lié à la consommation excessive d'alcool peut être identifié. Ces patients peuvent bénéficier d’interventions afin réduire le la consommation et ainsi les dommages liés à l'alcool.
 
Commentaires

Incontestablement, ce travail doit inspirer notre pratique notamment en France.

 
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