Rationale Adolescent alcohol use/misuse has been the subject of public health concern since the latter part of the twentieth century. Costs of alcohol harm to the NHS have been estimated to £2.7 billion (2006/2007).
Aims The first audit reviewed the then existing paediatric protocol for adolescents presenting with alcohol intoxication. This recommended admission of all cases and Child and Adolescent Mental Health Services (CAMHS) assessment prior to discharge. The subsequent re-audits evaluated the use and effectiveness of an A&E proforma for integrated assessment established as a result of the first audit.
Method Retrospective analysis of notes identified by hospital coding methods was carried out. Data collection for the subsequent re-audits was carried out in the same manner, with attention paid to the same criteria examined in the original audit. We examined the records of children who had not yet achieved their 17th birthday.
Results 92 cases were identified over the 24 month period of the original audit (1998–2000). The main reason identified for alcohol intoxication was recreational use. 36% of the children presented in a non-drowsy state and 16% of children claimed to have psychological distress as a co-factor for their intoxication. 51% were determined not to need further CAMHS follow-up. 15% of patients accepted CAMHS follow-up. 5% were referred to social services. The admission rate was 60%. 2% of children re-presented during the study period with alcohol intoxication. Following these results, a new protocol was devised and mandatory referrals to CAMHS Substance Misuse Worker and Liaison Health Visitor implemented. The subsequent re-audits conducted in 2004/2005 and 2008/2009 have shown steady numbers of adolescents presenting to the Paediatric A&E Department with alcohol intoxication. The main reasons for alcohol intoxication remain recreational. Ward admissions decreased from 60% in 1999–2001 to 28% in 2008/2009. Referral rates to CAMHS increased from 25% in 2004/2005 to 90% in 2008/2009. Take-up of the service increased modestly from 5% in 1999/2001 to 16%in 2008/2009. No children covered in the re-audit re-presented owing to complications of their alcohol intoxication.
Conclusion This audit proved that by determining the factors surrounding acute alcohol intoxication in adolescents, we were able to devise an appropriate triage system that resulted in decreased admissions while still providing appropriate support.