Alcohol misuse requiring admission to a tertiary referral ICU: resource implications

Abstract

Introduction Alcohol misuse is associated with many conditions requiring ICU management [1]. In 2006/2007, 1.53% of all hospital admissions were related to alcohol misuse (regional audit). We conducted a prospective audit in a tertiary referral adult ICU to ascertain the proportion of ICU capacity used for the treatment of conditions related to alcohol misuse. Methods Patients admitted to a tertiary referral ICU between 1 November 2006 and 31 March 2007 were prospectively audited with the aim of identifying all cases in which the reason for admission could be attributed to acute or chronic alcohol misuse. Blood alcohol levels, past history from the patient/relatives or previous relevant clinical investigations and/or diagnoses were reviewed for evidence of acute or chronic alcohol misuse. Results Of 318 ICU admissions during the audit, 9.43% (30 admissions – 20 male/10 female) were judged to be due to either acute (19 of 30) or chronic (11 of 30) alcohol consumption. The mean patient age was 48.7 years (SD 14.1, range 25 to 74). Blood alcohol level on admission to hospital was available in 13 patients (43%), the median value being 170 mg% (IQR = 66 to 274). Seventeen patients (56.6%) were admitted following trauma, of whom 10 (33.3%), had brain injuries. The median length of stay (LOS) in the ICU was 10 days (IQR = 4 to 15) and the median LOS in hospital was 22 days (IQR = 10 to 38). The ICU mortality rate was 23.3% (seven out of 30) and hospital mortality was 30% (nine out of 30). During the audit period, a total of 2,567 ICU bed-days were available, of which 357 bed-days (13.9%) were used to treat this group of patients. The mean ICU occupancy during this period was 95.6%. Conclusion Alcohol misuse was implicated in almost 10% of ICU admissions – over six times the equivalent rate for total hospital admissions. These admissions required approximately 14% of total ICU capacity at a time when occupancy was almost 100%. Intensive care is a finite and expensive hospital resource. Public health bodies should be informed of the proportion of that resource required to treat alcohol-related illness and injury.