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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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1
Department of Surgery, Division of Trauma Surgery, University Hospital, Zurich, Switzerland.

Abstract

BACKGROUND:

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

OBJECTIVE:

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.

METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

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.

KEYWORDS:

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

PMID:
23850886
DOI:
10.1136/emermed-2013-202804
[Indexed for MEDLINE]

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