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Injury. 2016 Jan;47(1):83-8. doi: 10.1016/j.injury.2015.10.063. Epub 2015 Oct 31.

Injured patients with very high blood alcohol concentrations.

Author information

1
Division of Pulmonary and Critical Care Medicine, Loyola University Health Sciences, Maywood, IL, United States; Department of Public Health Sciences, Loyola University School of Medicine, Maywood, IL, United States. Electronic address: majid_afshar@luhs.org.
2
Division of Pulmonary and Critical Care Medicine, University of Maryland, Baltimore, MD, United States; Department of Epidemiology and Public Health, University of Maryland, Baltimore, MD, United States.
3
Heartland Health Outreach, Chicago, IL, United States.
4
Program in Trauma, R. Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD, United States.
5
Department of Epidemiology and Public Health, University of Maryland, Baltimore, MD, United States; Shock Trauma and Anesthesiology Research (STAR)-Organized Research Center, University of Maryland, Baltimore, MD, United States.

Abstract

OBJECTIVE:

Most data regarding high blood alcohol concentrations (BAC) ≥400 mg/dL have been from alcohol poisoning deaths. Few studies have described this group and reported their alcohol consumption patterns or outcomes compared to other trauma patients. We hypothesised trauma patients with very high BACs arrived to the trauma centre with less severe injuries than their sober counterparts.

METHOD:

Historical cohort of 46,222 patients admitted to a major trauma centre between January 1, 2002 and October 31, 2011. BAC was categorised into ordinal groups by 100 mg/dL intervals. Alcohol questionnaire data on frequency and quantity was captured in the BAC ≥400 mg/dL group. The primary analysis was for BAC ≥400 mg/dL.

RESULTS:

BAC was recorded in 44,502 (96.3%) patients. Those with a BAC ≥400 mg/dL accounted for 1.1% (147) of BAC positive cases. These patients had the lowest proportion of severe trauma and in-hospital death in comparison with the other alcohol groups (p<0.001). In adjusted analysis, the risk for severe injury increased with the BAC groups between 1 and 199 mg/dL and was not different or decreased for groups above 200 mg/dL in reference to the BAC negative group (test for trend p=0.001). BAC ≥400 group encountered more injuries caused by blunt trauma in comparison with the other alcohol groups (p<0.001), and the group comprised mainly of falls. Admission Glasgow Coma Scale was a poor predictor for traumatic brain injury in the high BAC group. Readmission occurred in 22.4% (33) of patients the BAC ≥400 group. The majority of these patients reported drinking alcohol 4 or more days per week (81, 67.5%) and five or more drinks per day (79, 65.8%), evident of risky alcohol use.

CONCLUSIONS:

Most traumas admitted with BAC ≥400 mg/dL survived and their injuries were less severe than their less intoxicated and sober counterparts. They also had evidence for risky alcohol use and nearly one-quarter returned to the trauma centre with another injury over the study period. Recognition of this highest BAC group presents an opportunity to provide focused care for their risky alcohol use.

KEYWORDS:

Alcohol consumption; Alcohol poisoning; Alcohol use disorder; Blood alcohol level; Blunt trauma; Ethanol; Forensic toxicology; Injury; Injury prevention; Trauma recidivism

PMID:
26556488
PMCID:
PMC4852150
DOI:
10.1016/j.injury.2015.10.063
[Indexed for MEDLINE]
Free PMC Article

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