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Emerg Med J. 2014 Oct;31(10):813-7. doi: 10.1136/emermed-2013-202804. Epub 2013 Jul 12.

Effect of elevated serum alcohol level on the outcome of severely injured patients.

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Department of Surgery, Division of Trauma Surgery, University Hospital, Zurich, Switzerland.



The influence of high blood alcohol level (BAL) on the outcome of severely injured patients and the corresponding pathophysiological changes is a controversial issue.


To carry out a prognostic study to compare the physiological values and short-term outcome of severely injured patients depending on their serum alcohol level.


A total of 383 severely injured patients with an Injury Severity Score (ISS) ≥17 were admitted to the trauma division between October 2008 and December 2009 and enrolled into this study. Patients were grouped according to their BAL (>0.5‰,'BAL positive' vs <0.5‰,'BAL negative'). Trauma mechanism, pattern of injury and its treatment, and a course of intensive care treatment, physiological parameters and outcome with respect to mortality were analysed.


Both groups had similar ISS. In comparison with the BAL-negative group, patients in the BAL-positive group had a significantly lower Glasgow Coma Scale score (9.64 vs 12 points; p=0.005) and, although not significant, a trend towards higher values of the Abbreviated Injury Score for the head (3.29 vs 2.81 points; p=0.146). Furthermore, significantly higher lactate (3.11 mmol/L vs 2.02 mmol/L; p<0.001) levels and lower median arterial pressure values (87.9 mm Hg vs 99.4 mm Hg; p=0.006) were seen in the BAL-positive group at day of admission. However, the overall in-hospital mortality was comparable to that in BAL-negative patients (19.6% vs 21.5%). Similarly, hospital stay (15.29 vs 17.55 days) and duration of intensive care unit treatment (8.53 vs 8.36 days) were not significantly affected by a high BAL upon admission.


Severely injured patients with a raised BAL have a higher incidence of severe traumatic brain injury and worse initial physiological parameters. However, the survival rate and in-hospital stay is not influenced. This supports the theory of a neuroprotective role of alcohol.


Accident prevention; Drug abuse; Emergency department; Trauma; Trauma, head

[Indexed for MEDLINE]

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