Effects of positive blood alcohol concentration on outcome and systemic interleukin-6 in major trauma patients

Background: Alcohol use is a key preventable risk factor for serious injury. To effectively prevent alcohol-related injuries, we rely on the accurate surveillance of alcohol involvement in injury events. This often involves the use of administrative data, such as International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM) coding. Objective: To evaluate the completeness and accuracy of using administrative coding for the surveillance of alcohol involvement in major trauma injury events by comparing patient blood alcohol concentration (BAC) with ICD-10-AM coding. Method: This retrospective cohort study examined 2918 injury patients aged ≥18 years who presented to a major trauma centre in Victoria, Australia, over a 2-year period, of which 78% ( n = 2286) had BAC data available. Results: While 15% of patients had a non-zero BAC, only 4% had an ICD-10-AM code suggesting acute alcohol involvement. The agreement between blood alcohol test results and ICD-10-AM coding of acute alcohol involvement was fair ( κ = 0.33, 95% confidence interval: 0.27–0.38). Of the 341 patients with a non-zero BAC, 82 (24.0%) had ICD-10-AM codes related to acute alcohol involvement. Supplementary factors Y90 Evidence of alcohol involvement determined by blood alcohol level codes, which specifically describe patient BAC, were assigned to just 29% of eligible patients with a non-zero BAC. Conclusion: ICD-10-AM coding underestimated the proportion of alcohol-related injuries compared to patient BAC. Implications: Given the current role of administrative data in the surveillance of alcohol-related injuries, these findings may have significant implications for the implementation of cost-effective strategies for preventing alcohol-related injuries.

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Effect of Lowering the Blood Alcohol Concentration Limit to 0.03 Among Hospitalized Trauma Patients in Southern Taiwan: A Cross-Sectional Analysis

Risk Management and Healthcare Policy ◽

10.2147/rmhp.s250734 ◽

2020 ◽

Vol Volume 13 ◽

pp. 571-581

Author(s):

Chun-Ying Huang ◽

Sheng-En Chou ◽

Wei-Ti Su ◽

Hang-Tsung Liu ◽

Ting-Min Hsieh ◽

...

Keyword(s):

Blood Alcohol Concentration ◽

Alcohol Concentration ◽

Concentration Limit ◽

Trauma Patients ◽

Blood Alcohol ◽

Cross Sectional ◽

Cross Sectional Analysis ◽

Southern Taiwan ◽

Sectional Analysis

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The Saliva Strip Test Is an Accurate Method to Determine Blood Alcohol Concentration in Trauma Patients

Academic Emergency Medicine ◽

10.1197/j.aem.2004.02.529 ◽

2004 ◽

Vol 11 (8) ◽

pp. 885-887 ◽

Cited By ~ 7

Author(s):

L. C. Degutis

Keyword(s):

Blood Alcohol Concentration ◽

Accurate Method ◽

Alcohol Concentration ◽

Trauma Patients ◽

Blood Alcohol ◽

Strip Test

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Prevalence of substance use among trauma patients treated in a Brazilian emergency room

Brazilian Journal of Psychiatry ◽

10.1590/s1516-44462006000300009 ◽

2006 ◽

Vol 28 (3) ◽

pp. 191-195 ◽

Cited By ~ 16

Author(s):

Alessandra Diehl Reis ◽

Neliana Buzi Figlie ◽

Ronaldo Laranjeira

Keyword(s):

Substance Use ◽

Emergency Room ◽

Blood Alcohol Concentration ◽

Cross Sectional Study ◽

Alcohol Concentration ◽

World Health ◽

Trauma Patients ◽

Blood Alcohol ◽

Emergency Rooms ◽

Cross Sectional

OBJECTIVE: Although there is a considerable amount of data in the literature regarding the association between alcohol consumption and injuries treated in emergency rooms, little is known about the relationship between such injury and the use of other substances. The objective of this study was to estimate the prevalence of substance use in patients admitted to the emergency room for non-fatal injuries. METHOD: A prospective cross-sectional study assessing all patients admitted to the emergency room within 6 hours after a non-fatal injury was conducted over a three-month period. The following were used as measures of alcohol and drug use: a standardized World Health Organization questionnaire; a self-administered questionnaire related to drug consumption within the 24 hours preceding contact; the Drug Abuse Screening Test; urine screens for cannabis, cocaine and benzodiazepines; and determination of blood alcohol concentration. Descriptive analyses were performed and the confidence interval used was 95%. RESULTS: A total of 353 patients were included. Cannabis and cocaine screens were conducted for 242 patients and benzodiazepine screens were conducted for 166. Blood alcohol concentrations reached the level of positivity in 11% (n = 39), and 10% (n = 33) presented some degree of intoxication. Among the 242 patients screened, 13.6% (n = 33) tested positive for cannabis, and 3.3% (n = 8) tested positive for cocaine, whereas 4.2% (n = 7) of the 166 patients screened tested positive for benzodiazepines. CONCLUSIONS: Substance use was highly prevalent among these individuals. In this sample, the frequency for the use of cannabis (an illicit drug) was comparable to that of alcohol. More studies are needed in order to characterize such use among Brazilians and to develop proper approaches to such cases, with the aim of reducing substance use and its consequences.

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Does Level of Blood Alcohol Content Affect Clinical Outcomes After Trauma in Older Adult Patients?

The American Surgeon ◽

10.1177/0003134820943555 ◽

2020 ◽

Vol 86 (9) ◽

pp. 1106-1112

Author(s):

Mary K. Bryant ◽

Katherine Reynolds ◽

Connor Brittain ◽

Zachery Patel ◽

Trista D.S. Reid ◽

...

Keyword(s):

Clinical Outcomes ◽

Older Patients ◽

Injury Severity ◽

Motor Vehicle ◽

Blood Alcohol Concentration ◽

Alcohol Concentration ◽

Trauma Patients ◽

Blood Alcohol ◽

Matched Cohort ◽

Poor Outcomes

Introduction Preinjury alcohol use and older age have independently been associated with poor outcomes. This study examined whether higher levels of blood alcohol concentration (BAC) correlated with an increased likelihood of poor outcomes in older trauma patients. Methods This was a retrospective cohort study of injured patients ≥65 years with BAC testing presenting to a Level 1 trauma center between 2015 and 2018. Patients were stratified by BAC at 4 thresholds of intoxication: BAC ≧10 mg/dL, BAC ≧80 mg/dL, BAC ≧150 mg/dL, and BAC ≧200 mg/dL. Propensity score matching using inverse probability of treatment weighting was used to estimate outcomes. Logistic and Poisson regression models were performed for each threshold of the BAC level with the matched cohort to assess clinical outcomes. Results Of all older patients (n = 3112), 32.5% (n = 1012) had BAC testing. In the matched cohort of 883 patients (76.7 ± 8.2 years; 48.1% female), 111 (12.5%) had BAC ≧10 mg/dL, 83 (74.8%) had BAC ≧80 mg/dL, 60 (54.1%) had BAC ≧150 mg/dL, and 37 (33.3%) had BAC ≧200 mg/dL. Falls (60.5%) and motor vehicle crashes (28.9%) were the most common mechanisms of injury. Median (IQR) of Injury Severity Score (ISS) was 5 (1-10). The risk of severe injury (ISS ≧15) was similar between alcohol-positive and alcohol-negative patients (9.9% vs 15.0%, P = .151). BAC ≧10 g/dL was not associated with length of stay, intensive care unit admission, or in-hospital complication, nor was any of the other 3 analyzed BAC thresholds. Conclusion Overall, any detectable BAC along and increasing thresholds of BAC was not associated with poor in-hospital outcomes of older patients after trauma. Alcohol screening was low in this population, and intoxication may bias injury assessment, leading to mistriage of older trauma patients.

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Decreased incidence of venous thromboembolism found in trauma patients with positive blood alcohol concentration on admission

The American Journal of Drug and Alcohol Abuse ◽

10.1080/00952990.2018.1504951 ◽

2018 ◽

Vol 45 (1) ◽

pp. 77-83 ◽

Cited By ~ 3

Author(s):

Areg Grigorian ◽

Sahil Gambhir ◽

Lutfi Al-Khouja ◽

Viktor Gabriel ◽

Sebastian D. Schubl ◽

...

Keyword(s):

Venous Thromboembolism ◽

Blood Alcohol Concentration ◽

Alcohol Concentration ◽

Trauma Patients ◽

Blood Alcohol

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Extreme Blood Alcohol Level is Associated with Increased Resource use in Trauma Patients

The American Surgeon ◽

10.1177/000313481007600105 ◽

2010 ◽

Vol 76 (1) ◽

pp. 20-24 ◽

Cited By ~ 3

Author(s):

Alissa Swearingen ◽

Vafa Ghaemmaghami ◽

Terrence Loftus ◽

Christopher J. Swearingen ◽

Helen Salisbury ◽

...

Keyword(s):

Length Of Stay ◽

Resource Utilization ◽

Injury Severity ◽

Demographic Data ◽

Blood Alcohol Concentration ◽

Alcohol Concentration ◽

Trauma Patients ◽

Blood Alcohol ◽

Icu Admission ◽

Severity Scores

This study aims to examine resource utilization and outcomes of trauma patients with extremely high blood alcohol concentrations. We hypothesized that higher blood alcohol concentration (BAC) predicts greater resource utilization and poorer outcomes. A retrospective analysis was performed on trauma patients admitted to an urban Level I trauma center over a 5-year period. Admission BAC categories were constructed using standard laboratory norms and legal definitions. Demographic data, premorbid conditions, injury severity scores (ISS), resource utilization (intensive care unit (ICU) admission rates/length of stay, total hospital days, use of consultants), and mortality were analyzed. Positive BAC on admission was associated with increased ISS ( P < 0.001), length of stay ( P < 0.003), and total ICU days ( P < 0.001). Increased BAC admission level of patients was associated with a decreased ISS score ( P = 0.0073), a higher probability of ICU admission ( P = 0.0013), and an increased percentage of ICU days ( P = 0.001). A positive BAC at admission was a significant predictor of both ICU admission and mortality (odds ratios 1.72 and 1.27, respectively). This study demonstrates that a positive BAC is associated with increased ISS, increased resource utilization, and worsened outcomes. Extreme levels of BAC are associated with increased resource utilization despite lower injury severity scores.

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Patterns of alcohol and drug utilization in trauma patients during the COVID-19 pandemic at six trauma centers

Injury Epidemiology ◽

10.1186/s40621-021-00322-0 ◽

2021 ◽

Vol 8 (1) ◽

Author(s):

Constance McGraw ◽

Kristin Salottolo ◽

Matthew Carrick ◽

Mark Lieser ◽

Robert Madayag ◽

...

Keyword(s):

Longitudinal Research ◽

Blood Alcohol Concentration ◽

Alcohol Concentration ◽

Trauma Patients ◽

Blood Alcohol ◽

Trauma Centers ◽

Chi Squared ◽

Level I ◽

The Impact ◽

At Home

Abstract Background Since the national stay-at-home order for COVID-19 was implemented, clinicians and public health authorities worldwide have expressed growing concern about the potential repercussions of drug and alcohol use due to social restrictions. We explored the impact of the national stay-at-home orders on alcohol or drug use and screenings among trauma admissions. Methods This was a retrospective cohort study at six Level I trauma centers across four states. Patients admitted during the period after the onset of the COVID-19 restrictions (defined as March 16, 2020-May 31, 2020) were compared with those admitted during the same time period in 2019. We compared 1) rate of urine drug screens and blood alcohol screens; 2) rate of positivity for drugs or alcohol (blood alcohol concentration ≥ 10 mg/dL); 3) characteristics of patients who were positive for drug or alcohol, by period using chi-squared tests or Fisher’s exact tests, as appropriate. Two-tailed tests with an alpha of p < 0.05 was used on all tests. Results There were 4762 trauma admissions across the study period; 2602 (55%) in 2019 and 2160 (45%) in 2020. From 2019 to 2020, there were statistically significant increases in alcohol screens (34% vs. 37%, p = 0.03) and drug screens (21% vs. 26%, p < 0.001). Overall, the rate of alcohol positive patients significantly increased from 2019 to 2020 (32% vs. 39%, p = 0.007), while the rate of drug positive patients was unchanged (57% vs. 52%, p = 0.13). Of the 1025 (22%) patients who were positive for alcohol or drugs, there were significant increases in a history of alcoholism (41% vs. 26%, p < 0.001), and substance abuse (11% vs. 23%, p < 0.001) in the 2020 period. No other statistically significant differences were identified among alcohol or drug positive patients during COVID-19 compared to the same period in 2019. Conclusions Our first wave of COVID-19 data suggests that trauma centers were admitting significantly more patients who were alcohol positive, as well those with substance use disorders, potentially due to the impact of social restrictions and guidelines. Further longitudinal research is warranted to assess the alcohol and drug positive rates of trauma patients over the COVID-19 pandemic.

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