Introduction Patients with alcohol related brain injury (ARBI) including Korsakoff’s syndrome frequently present to hospital with cognitive impairment, physical illness and consequences of greater risk-taking behaviour. We studied the impact of ARBI admissions on an acute hepatology unit and compared this with trends in hospitalisation for alcohol related liver disease over a 5 year period.
Method We studied a large acute hospital serving a population of over 650,000 in the highest national quintile for both alcohol related admissions and cirrhosis deaths. We analysed hospital episode statistics and departmental databases for 5 consecutive financial years from 2009–2014, focusing on Korsakoff’s syndrome, specific liver disorders including complications of cirrhosis and alcohol related admissions in general. A cohort of frequently attending patients with ARBI were selected for detailed analysis of admission patterns and clinical outcomes.
Results During the 5 years from 2009/10 to 2013/14, admissions with ARBI increased by over 120% (p < 0.05) while annual bed days rose from 103 to a peak of 484, accounting for 1,351 bed days in total. Mean length of stay for ARBI increased by 56% overall. Some 64% of stays were for more than 14 days, 38% were over 28 days and 28% were over 42 days. However, admissions with alcohol related liver disease did not change substantially (p=NS) and, similarly, hospital-wide alcohol related admissions increased only marginally from 1,993 to 2,031 per 100,000 across the study period. Detailed case analysis found that 13 individuals (mean age 50 years, range 42–59) with Korsakoff’s syndrome accounted for over 90% of the ARBI bed days along with 297 ED attendances during the study, requiring a mean of 19.6 inpatient days per person per year.
Conclusion Patients with Korsakoff’s syndrome pose significant clinical challenges with recurrent, prolonged admissions to hospital. Both the numbers of admissions and bed occupancy due to ARBI have substantially increased over the last 5 years, out of proportion to other markers of alcohol-related harm including acute and chronic liver disease. Further work may be needed to improve community and hospital care for these vulnerable individuals.
Disclosure of interest None Declared.
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