title: Diagnosis-based emergency department alcohol harm surveillance: What can it tell us about acute alcohol harms at the population level?
abstract: Acute harm from heavy drinking episodes is an increasing focus of public health policy, but capturing timely data on acute harms in the population is challenging. This study aimed to evaluate the precision of readily available administrative emergency department (ED) data in public health surveillance of acute alcohol harms.
  
  
  
  We selected a random sample of 1000 ED presentations assigned an ED diagnosis code for alcohol harms (the 'alcohol syndrome') in the New South Wales, Australia, automatic syndromic surveillance system. The sample was selected from 68 public hospitals during 2014. Nursing triage free-text fields were independently reviewed to confirm alcohol consumption and classify each presentation into either an 'acute' or 'chronic' harm. Positive predictive value (PPV) for acute harm was calculated, and predictors of acute harm presentations were estimated using logistic regression.
  
  
  
  The PPV of the alcohol syndrome for acute alcohol harm was 53.5%. Independent predictors of acute harm were ambulance arrival [adjusted odds ratio (aOR) = 3.4, 95% confidence interval (CI) 2.4-4.7], younger age (12-24 vs. 25-39 years: aOR = 3.4, 95% CI 2.2-5.3), not being admitted (aOR 2.2, 95% CI 1.5-3.2) and arriving between 10 pm and 5.59 am (aOR 2.1, 95% CI 1.5-2.8). PPV among 12 to 24-year-olds was 82%.
  
  
  
  The alcohol syndrome provides moderate precision as an indicator of acute alcohol harms presenting to the ED. Precision for monitoring acute harm in the population is improved by filtering the syndrome by the strongest independent predictors of acute alcohol harm presentations. [Whitlam G, Dinh M, Rodgers C, Muscatello DJ, McGuire R, Ryan T, Thackway S. Diagnosis-based emergency department alcohol harm surveillance: What can it tell us about acute alcohol harms at the population level? Drug Alcohol Rev 2016;35:693-701].
authors: Centre for Epidemiology and Evidence, NSW Ministry of Health, Sydney, Australia.
authors: Genevieve
authors: G
authors: Whitlam
authors: Emergency Department, Royal Prince Alfred Hospital, Sydney, Australia.
authors: Michael
authors: M
authors: Dinh
authors: Alcohol and Drug Service, St Vincent's Hospital, Sydney, Australia.
authors: Craig
authors: C
authors: Rodgers
authors: School of Public Health and Community Medicine, University of NSW, Sydney, Australia.
authors: David J
authors: DJ
authors: Muscatello
authors: Centre for Epidemiology and Evidence, NSW Ministry of Health, Sydney, Australia.
authors: Rhydwyn
authors: R
authors: McGuire
authors: Centre for Epidemiology and Evidence, NSW Ministry of Health, Sydney, Australia.
authors: Therese
authors: T
authors: Ryan
authors: Centre for Epidemiology and Evidence, NSW Ministry of Health, Sydney, Australia.
authors: Sarah
authors: S
authors: Thackway
mesh_terms: D000293:Adolescent; D000328:Adult; D019973:Alcohol-Related Disorders / Q000175:diagnosis* / Q000453:epidemiology*; D000435:Alcoholic Intoxication / Q000175:diagnosis*; D001315:Australia / Q000453:epidemiology; D002648:Child; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D012720:Severity of Illness Index; D014218:Triage; D055815:Young Adult
keywords: alcohol-related disorder; emergency department; intoxication; public health surveillance; triage