Association between Alcohol Screening Results and Hospitalizations for Trauma in Veterans Affairs Outpatients

Abstract

Background: Alcohol consumption is a risk factor for traumatic injury, but it is unknown whether responses to alcohol screening questionnaires administered routinely in primary care are associated with subsequent hospitalization for traumatic injury. Objective: We evaluated the association between alcohol screening scores and the risk for subsequent hospitalizations for trauma among Veterans Affairs (VA) general medicine patients. Method: This study included VA outpatients (n = 32,623) at seven sites who returned mailed surveys (1997–1999). Alcohol Use Disorders Identification Test Consumption (AUDIT-C) scores grouped patients into six drinking categories representing nondrinkers, screen-negative drinkers, and drinkers who screened positive for mild, moderate, severe, and very severe alcohol misuse (scores 0, 1–3, 4–5, 6–7, 8–9, 10–12, respectively). VA administrative and Medicare data identified primary discharge diagnoses for trauma. Cox proportional hazard models were used to estimate the risk of trauma-related hospitalization for each drinking group adjusted for demographics, smoking, and comorbidity. Results: Compared with screen-negative drinkers, patients with severe and very severe alcohol misuse (AUDIT-C 8–9 and ≥10) were at significantly increased risk for trauma-related hospitalization over the follow-up period (adjusted hazard ratios AUDIT-C: 8–9 2.06, 95% confidence interval (CI) 1.31– 3.24 and AUDIT-C≥10 2.13, 95% CI 1.32–3.42). Conclusions: Patients with severe and very severe alcohol misuse had a twofold increased risk of hospital admission for trauma compared to drinkers without alcohol misuse. Scientific Significance: Alcohol screening scores could be used to provide feedback to patients regarding risk of trauma-related hospitalization. Findings could be used by providers during brief alcohol-related interventions with patients with alcohol misuse.

• alcohol screening
• trauma
• AUDIT-C
• brief alcohol counseling intervention

ACKNOWLEDGMENTS

This study was supported by VA Health Services Research and Development (HSR&D) Grants #SDR96-002, IIR99-376, and #IAC 05-206-1, as well as by Dr. Bryson’s VA Career Development Award (RCD03-177). The authors thank Rachel Thomas, MPH, for assistance with manuscript preparation and study administration.

Declaration of Interest

The views expressed here are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the University of Washington. The authors report no conflict of interest.