北台灣急診部酒精與外傷之關聯性研究

The Relationship between Alcohol and Injury at Emergent Department in Northern Taiwan

Objective: Growing evidence shows the relationship between alcohol drinking and injuries. We intended to do an emergency department (ED) study with a case-crossover design, to evaluate the proportion of alcohol-related injuries, the relative risk (RR) to sustain an injury during alcohol exposure, and the ability of alcohol detection by medical staffs in northern Taiwan, Methods: The injury subjects were recruited consecutively at ED over a 10-week period and divided into case (ALC) or normal control (NC) group based on whether the presence of alcohol drinking existed within six hours before injury. We collected data of breath test for blood alcohol concentration (BAC), self-report (Y90 code), and clinical assessment (Y91 code) for intoxication level. Results: Among the recruited 535 subjects, 31 subjects (5.8%) were classifi ed as ALC group. The demographic and clinical data of ALC group showed signifi cantly more male predominant (p < 0.01), signifi cantly poorer in education level (p < 0.05), and signifi cantly higher rate of intentional injuries (p < 0.01) than those of NC group. The estimated RR of alcohol-related injuries using the usual frequency analyses was 2.54 (95% confi - dence interval = 1.84 - 3.51). For 21 subjects with positive BAC, the concordance rate between BAC and Y91 code was moderate (Kendall's Tau-B 0.437 and Spearman ρ = 0.546). But self-report using Y90 code tended to be underestimated the intoxication level compared to Y91 code. Conclusion: The study showed that alcohol drinking increased risk to sustain acute injury, especially for intentional injury. The implementation of Y91 codes and breath test at ED are suitable to detect the alcohol-related injuries in northern Taiwan. 目的：目前已有大量研究證明酒精和外傷是密切相關的，為了評估在北台灣飲酒造成外傷的相對風險、酒精與外傷的關係及檢測酒精中毒的能力，本研究採用案例交叉設計方式用結構性的問卷，針對上列各項變數在急診部調查。方法：本研究在 10 個星期的期間於不同的時間點在急診室連續收案外傷病人。基於病人是否在受傷前 6 小時有飲酒故分為飲酒組及對照組。經病人同意後給予吹氣測量血液酒精濃度及問卷調查，並使用 ICD-10 Y90 及 ICD10 Y91 碼來評估病人自己及醫療人員對病人酒精中毒嚴重度的差異。結果：本研究共收案 535 人，其中 31 人（5.8%）是飲酒組。飲酒組相較於對照組有顯著比較多的男性（p < 0.01）、教育程度顯著的較差（p < 0.05）及顯著較高的比率有蓄意傷害的情形（p < 0.01）。分析後酒精造成外傷的風險為 2.54 倍（95% 信度差距 = 1.84 - 3.51）。再者有 21 個病人其血液酒精濃度大於 0，血液酒精濃度及 Y91 有中等的一致率。然而，病人自評的 Y90 碼跟 Y91 碼相比傾向於低估飲酒嚴重度。結論：本研究顯示飲酒會增加 2.5 倍的受傷風險，特別是蓄意的外傷。在急診室常規使用 ICD-10 Y91 碼來偵測酒精相關的外傷在北台灣是可行的。

目的：目前已有大量研究證明酒精和外傷是密切相關的，為了評估在北台灣飲酒造成外傷的相對風險、酒精與外傷的關係及檢測酒精中毒的能力，本研究採用案例交叉設計方式用結構性的問卷，針對上列各項變數在急診部調查。方法：本研究在 10 個星期的期間於不同的時間點在急診室連續收案外傷病人。基於病人是否在受傷前 6 小時有飲酒故分為飲酒組及對照組。經病人同意後給予吹氣測量血液酒精濃度及問卷調查，並使用 ICD-10 Y90 及 ICD10 Y91 碼來評估病人自己及醫療人員對病人酒精中毒嚴重度的差異。結果：本研究共收案 535 人，其中 31 人（5.8%）是飲酒組。飲酒組相較於對照組有顯著比較多的男性（p < 0.01）、教育程度顯著的較差（p < 0.05）及顯著較高的比率有蓄意傷害的情形（p < 0.01）。分析後酒精造成外傷的風險為 2.54 倍（95% 信度差距 = 1.84 - 3.51）。再者有 21 個病人其血液酒精濃度大於 0，血液酒精濃度及 Y91 有中等的一致率。然而，病人自評的 Y90 碼跟 Y91 碼相比傾向於低估飲酒嚴重度。結論：本研究顯示飲酒會增加 2.5 倍的受傷風險，特別是蓄意的外傷。在急診室常規使用 ICD-10 Y91 碼來偵測酒精相關的外傷在北台灣是可行的。