Citation

Afshar M, Netzer G, Salisbury-Afshar E, Murthi S, Smith GCS. Injury 2015; 47(1): 83-88.

Affiliation

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.

Copyright

(Copyright © 2015, Elsevier Publishing)

DOI

10.1016/j.injury.2015.10.063

PMID

26556488

Abstract

OBJECTIVE: Most data regarding high blood alcohol concentrations (BAC) ≥400mg/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 100mg/dL intervals. Alcohol questionnaire data on frequency and quantity was captured in the BAC ≥400mg/dL group. The primary analysis was for BAC ≥400mg/dL.

RESULTS: BAC was recorded in 44,502 (96.3%) patients. Those with a BAC ≥400mg/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 199mg/dL and was not different or decreased for groups above 200mg/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 ≥400mg/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.

Language: en