# Assessing the utility of night‐time presentations as a proxy for alcohol‐related harm among young emergency department trauma patients

## TL;DR

This study found that while many alcohol-related injuries in young people happen at night, using time of day alone isn't enough to accurately identify these cases in emergency departments.

## Contribution

The study demonstrates the limitations of using night-time ED presentations as a proxy for alcohol-related harm in youth trauma patients.

## Key findings

- 2644 (17.8%) of young trauma patients presented at night, closely matching 3064 (20.6%) identified through coding methods as alcohol-related harm cases.
- Nighttime (00:00-04:59) had 4.4–5.1 times higher ARH risk compared to midday presentations.
- Night-time presentations had low sensitivity (0.39) and positive predictive value (0.46) for identifying ARH in individuals.

## Abstract

To assess the usefulness of night‐time presentations to measure alcohol‐related harm (ARH) in young trauma patients, aged 12–24 years, attending Western Australian EDs.

A retrospective longitudinal study examined alcohol‐related ED presentations in Western Australia (WA; 2002–2016) among 12‐ to 24‐year‐olds. Data from the Emergency Department Data Collection, WA State Trauma Registry Database and Hospital Morbidity Data Collection were used to identify ARH through specific codes and text searches. These were compared to ARH estimates based on presentation time. Statistical analysis involved sensitivity and specificity calculations and Cox proportional hazards modelling.

We identified 2644 (17.8%) night‐time presentations as a proxy measure of ARH among the 14 887 presentations of patients aged 12–24 years. This closely matched the 3064 (20.6%) identified as ARH through coding methods. The highest risk for an ARH presentation occurred during the night hours between 00.00 and 04.59 hours. During these hours, the risk was 4.4–5.1 times higher compared to presentations at midday (between 12.00 and 12.59 hours). However, when looking at individual patients, we observed that night‐time presentations were not a strong predictor of ARH (sensitivity: 0.39; positive predictive value: 0.46).

Implementing targeted interventions during night hours could be beneficial in addressing ARH presentations. However, relying solely on the time of presentation as a proxy for ARH is unlikely to effectively identify ARH in young individuals. Instead, the present study emphasises the importance of implementing mandatory data collection strategies in EDs to ensure accurate measurement of ARH cases.

A retrospective study assessed the usefulness of night‐time presentations as a proxy for measuring alcohol‐related harm (ARH) in young trauma patients in Western Australian EDs. Our analysis revealed that whereas a substantial proportion of ARH cases occurred during night hours, relying solely on presentation time was insufficient to accurately identify ARH in individual patients. Our findings emphasise the importance of implementing mandatory data collection strategies in EDs to ensure accurate measurement and targeted interventions for ARH cases.