Introduction

As emergency rooms (ERs) constitute the primary entry point for injuries in the po­pulation, they offer an ideal setting to study the associations between alcohol and injuries. However, until the late 1980s, most of the studies focused on specific types of injury like motor-vehicle collisions and on fatalities rather than on non-fatal injuries, rarely using ERs to investigate this asso­ciation. Because of the lack of large rigorous epidemiological studies on alcohol’s role across the entire range of injuries, a study focused on non-fatal injuries and alcohol use was conducted at an ER in San Francisco, US. This pivotal study then expanded globally known as the ‘Cherpitel Model’.

Material and methods

The model consisted in gathering data on blood alcohol levels and interviewing patients on reasons for ER visits, drinking prior to the event, usual drinking patterns and
alcohol-use disorder symptoms. As the research expanded, contextual factors including an Alcohol Policy Index and a measure of detrimental drinking patterns were added, allowing for the examination of how societal-level drinking context relates to alcohol-related injury. The final compilation of these studies resulted in a dataset of over 34,000 injured ER patients from 101 ER sites in 33 countries covering 6 continents.

Results

The findings from a series of international analyses highlighted relationships between risk of injuries and alcohol policies as well as drinking patterns, showing that countries with more restrictive alcohol policies have lower rates of alcohol-related injuries (with control for country-level drinking patterns) while countries having more detrimental drinking patterns are at higher risk of injury for most causes at a given level of consumption. In addition, the data produced added value contributing to the Global Burden of Diseases study as well as to the revisions of two international diagnostic systems, the ICD-11 and DSM-5.

Disscusion

Experience cumulating in more than 40 years of comparative ER studies confirm the importance of cross-cultural approaches that may identify universalities of associations while respecting the specificity of the individual country’s context. Therefore results of comparative studies
may contribute to the reservoir of universal knowledge as well as to specific alcohol policies that may reduce harm associated with alcohol use in individual countries.

Conclusions

Findings linking societal factors to alcohol-related injury highlight the value of cross-
country data for developing prevention strategies in individual countries.