Predictors of loss to follow-up in young patients with minor trauma after screening and written intervention for alcohol in an urban emergency department.
OBJECTIVE
In health promotion studies, young age, male gender, low education, and substance use have been found to be relevant predictors of loss to follow-up. The purpose of this study was to assess factors of loss to follow-up after screening and tailored brief advice for alcohol problems in an emergency department setting.


METHODS
A randomized controlled intervention study was conducted and followed up at 12 months. At baseline (T0), 2,562 consecutive trauma patients (62.1% male) were screened for substance use (smoking, alcohol consumption, and illicit drug use) and for socioeconomic factors (income, relationship status, and education). Patients with five points or more in the Alcohol Use Disorders Identification Test randomly received tailored brief advice on alcohol and were followed up at 3 (T3), 6 (T6), 9 (T9), and 12 months (T12).


RESULTS
At baseline, median age was 32 years (range: 18-89). There was a loss of 950 participants (37.1%) from T0 to T12. Loss to follow-up was strongly dependent on social factors. In participants with a high school diploma, only smoking was predictive of loss to follow-up (odds ratio [OR] = 1.81, 95% confidence interval [CI] = 1.43-2.29). In participants with no high school diploma, alcohol problems alone predicted loss to follow-up (medium level of alcohol problems, OR = 1.57, 95% CI = 1.09-2.27; high level of alcohol problems, OR = 1.62, 95% CI = 0.96-2.76; p = .017). Smoking (OR = 1.35, 95% CI = 0.97-1.89) and, for smokers, age 18-31 years (OR = 1.65, 95% CI = 0.98-2.78) showed a tendency toward an increased risk of loss to follow-up.


CONCLUSIONS
After screening and a brief intervention in an emergency department, substance use and differences in education level predicted loss to follow-up. Patients with alcohol problems and no high school diploma are at increased risk of becoming lost to follow-up.
Neuner
Bruno
B
Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum and Campus Charité-Mitte, Department of Anesthesiology and Intensive Care Medicine, Charitéplatz 1, 10117 Berlin, Germany. bruno.neuner@charite.de
Fleming
Michael
M
Born
Rike
R
Weiss-Gerlach
Edith
E
Neumann
Tim
T
Rettig
Jordan
J
Lau
Alexandra
A
Schoenfeld
Helge
H
Kallischnigg
Gerd
G
Spies
Claudia
C
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019973:Alcohol-Related Disorders / Q000453:epidemiology* / Q000534:rehabilitation*; D003142:Communication; D004522:Educational Status; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D010352:Patient Dropouts / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012959:Socioeconomic Factors; D014505:Urban Population / Q000706:statistics & numerical data*; D014705:Verbal Behavior; D014947:Wounds and Injuries / Q000453:epidemiology*