Alcohol-related Trauma Research Articles

A Ten year review of alcohol use and major trauma in a Canadian province: still a major problem

BackgroundAlcohol plays a significant role in major traumatic injuries. While the role of alcohol in motor vehicle trauma (MVT) is well described, its role and approaches to prevention in other injury mechanisms is less defined.MethodsA 10 year retrospective examination of Alberta Trauma Registry (ATR) data was conducted on all major trauma patients (age ≥ 9 and ISS ≥ 12) from 2001–2010. The role and prevalence of alcohol is examined.ResultsOf 22,457 patients included in our study, only 60 %(n = 13,552) were screened for alcohol use. Of those screened, 38 %(n = 5,170) tested positive for alcohol with a mean blood alcohol concentration (BAC) of 39.4 ± 21.1 mmol/L. Of the positive screening tests, 82.3 % had BAC levels greater than the common legal driving limit of 17.4 mmol/L (0.08 %). Testing positive was associated with male gender (p < 0.001) and younger age (p < 0.001). The rate of positive alcohol use in major trauma increased from 20.3 % in 2001 to 24.3 % in 2010, corresponding with a screening rate increase from 51.3 % to 61.2 % over the same period. Railway incidents have the highest rate of alcohol involvement (65 %), followed by undetermined-if-accidental/self-inflicted (53.5 %) and assault (49 %); motor vehicle traffic (MVT) incidents had a frequency of 25.4 %.ConclusionsThe prevalence of alcohol use in major trauma appears to be increasing in Alberta but the true extent is still underappreciated. Furthermore, the role of alcohol in non-MVT injuries is significant and deserves further attention. The vast majority of patients involved in alcohol-related trauma are legally intoxicated. Alcohol use continues to be a substantial contributor to major trauma in Alberta, and represents an important opportunity to reduce preventable injuries.

Prevention of Alcohol-Related Crime and Trauma (PACT): brief interventions in routine care pathway – a study protocol

BackgroundGlobally, alcohol-related injuries cause millions of deaths and huge economic loss each year . The incidence of facial (jawbone) fractures in the Northern Territory of Australia is second only to Greenland, due to a strong involvement of alcohol in its aetiology, and high levels of alcohol consumption. The highest incidences of alcohol-related trauma in the Territory are observed amongst patients in the Maxillofacial Surgery Unit of the Royal Darwin Hospital. Accordingly, this project aims to introduce screening and brief interventions into this unit, with the aims of changing health service provider practice, improving access to care, and improving patient outcomes.MethodsEstablishment of Project Governance: The project governance team includes a project manager, project leader, an Indigenous Reference Group (IRG) and an Expert Reference Group (ERG).Development of a best practice pathway: PACT project researchers collaborate with clinical staff to develop a best practice pathway suited to the setting of the surgical unit. The pathway provides clear guidelines for screening, assessment, intervention and referral.Implementation: The developed pathway is introduced to the unit through staff training workshops and associate resources and adapted in response to staff feedback.Evaluation: File audits, post workshop questionnaires and semi-structured interviews are administered.DiscussionThis project allows direct transfer of research findings into clinical practice and can inform future hospital-based injury prevention strategies.

Study Protocol: Screening and Treatment of Alcohol-Related Trauma (START) – a randomised controlled trial

BackgroundThe incidence of mandibular fractures in the Northern Territory of Australia is very high, especially among Indigenous people. Alcohol intoxication is implicated in the majority of facial injuries, and substance use is therefore an important target for secondary prevention. The current study tests the efficacy of a brief therapy, Motivational Care Planning, in improving wellbeing and substance misuse in youth and adults hospitalised with alcohol-related facial trauma.Methods and designThe study is a randomised controlled trial with 6 months of follow-up, to examine the effectiveness of a brief and culturally adapted intervention in improving outcomes for trauma patients with at-risk drinking admitted to the Royal Darwin Hospital maxillofacial surgery unit. Potential participants are identified using AUDIT-C questionnaire. Eligible participants are randomised to either Motivational Care Planning (MCP) or Treatment as Usual (TAU). The outcome measures will include quantity and frequency of alcohol and other substance use by Timeline Followback. The recruitment target is 154 participants, which with 20% dropout, is hoped to provide 124 people receiving treatment and follow-up.DiscussionThis project introduces screening and brief interventions for high-risk drinkers admitted to the hospital with facial trauma. It introduces a practical approach to integrating brief interventions in the hospital setting, and has potential to demonstrate significant benefits for at-risk drinkers with facial trauma.Trial RegistrationThe trial has been registered in Australian New Zealand Clinical Trials Registry (ANZCTR) and Trial Registration: ACTRN12611000135910.

A randomized trial of brief intervention strategies in patients with alcohol-related facial trauma as a result of interpersonal violence

Facial trauma is associated with male gender, low socioeconomic status, alcohol misuse, and violence. Brief intervention (BI) for alcohol is effective at reducing consumption in patients presenting with facial trauma. Single-session control of violence for angry impulsive drinkers (SS-COVAID) is a new intervention that attempts to address alcohol-related violence. This study assessed the effect of SS-COVAID and BI on drinking and aggression in facial trauma patients. Male facial trauma patients who sustained their injuries as a result of interpersonal violence while drinking and who had Alcohol Use Disorders Identification Test (AUDIT) scores of ≥8 were randomized to either BI or SS-COVAID. Patients were followed up at six and 12 months, and drinking and aggression outcomes were analyzed. One hundred ninety-nine patients entered the trial, and 187 were included in the analysis. Of these, 165 (89%) considered themselves to be victims, 92 (51%) had sustained a previous alcohol-related injury, and 28 (15%) had previous convictions for violence. Both interventions resulted in a significant decrease in negative drinking outcomes over 12 months of follow-up (p < 0.001). Neither intervention had a significant effect on aggression scores, nor was there a significant difference between interventions in terms of either outcome. Both SS-COVAID and BI had a significant effect on drinking variables in this patient cohort. No effect on aggression was seen despite the fact that SS-COVAID specifically addresses the relationship between alcohol and violence. One reason for this may be that the facial trauma patients in this study considered themselves to be victims rather than aggressors. Another possibility is that, while BI may successfully address lifestyle factors such as hazardous or harmful drinking, it may not be effective in modifying personality traits such as aggression.

High risk alcohol-related trauma among the Aboriginal and Torres Strait Islanders in the Northern Territory.

High risk drinking is linked with high rates of physical harm. The reported incidence of alcohol - related trauma among Aboriginal and Torres Strait Islander people in the Northern Territory is the highest in the world. Facial fractures are common among young Aboriginal and Torres Strait Islanders. They are often linked with misuse of alcohol in the Northern Territory and are frequently secondary to assault. This review focuses on alcohol-related trauma in the Territory and draws attention to an urgent need for preventative health approach to address this critical issue.

Are Alcohol Prices and Taxes an Evidence-Based Approach to Reducing Alcohol-Related Harm and Promoting Public Health and Safety? A Literature Review

This literature review examines alcohol prices and taxes as potential prevention strategies—examining the links with high-risk drinking and drinking patterns and alcohol-related harm. A literature search of the studies on alcohol price and taxation was conducted using multiple electronic bibliographic databases. Examined outcomes were a) drinking patterns and high risk drinking; and b) harm from alcohol. Fifty-four relevant studies were evaluated, and the majority found that a change in price or taxes on alcohol had an impact on one or more of the two main outcome variables. Significant variations exist across studies in terms of designs, settings, effects across groups, and types of harm. In order to reduce alcohol-related trauma, chronic disease, and other consequences of high-risk drinking, an increase in pricing/taxation is a central component of an overall alcohol strategy.

The role of alcohol in maxillofacial trauma—a comparative retrospective audit between the two centers

Alcohol abuse and maxillofacial trauma, particularly that due to interpersonal violence, have a well-established relationship in the literature. We present a retrospective audit comparing the role of alcohol in maxillofacial trauma between Selly Oak Hospital in Birmingham, United Kingdom and Westmead Hospital in Sydney, Australia, and the association between alcohol involvement and patient demographics, including age, sex, marital status, and employment status. Also presented are the differences between the two centers in terms of mechanisms and types of injuries and the locations where these injuries were sustained. Alcohol was involved in 34.78 and 30.77% of patients at Westmead and Birmingham, respectively. A multiple logistic regression analysis revealed a reduced likelihood of alcohol involvement in episodes of maxillofacial trauma where patients were unemployed ( P = .04), and where injuries were sustained secondary to mechanisms other than assault ( P < .001) and in locations other than pubs and nightclubs ( P = .024). There appeared to be no statistically significant contribution to the likelihood of alcohol involvement by treating center, marital status, patient sex, or age. Alcohol continues to be a strong driving factor in cases of maxillofacial trauma, particularly those due to alleged assault, with a typical patient demographic of the gainfully employed frequenting drinking establishments being most at risk for alcohol-related trauma, most commonly sustaining their injuries secondary to assault. Identifying patient groups most at risk is a key step in developing public health strategies aimed at prevention, and our findings would appear to suggest this group of patients as being the most worthwhile to target with measures aimed at reducing alcohol-fueled maxillofacial trauma.

Characteristics of Problem Drinking in an Urban South American Indigenous Population

This 2002 Medcen Foundation-funded study explored characteristics of problem drinking among 211 urban Venezuelan Native Americans of Arawak origin. Prevalence of problem drinking using Alcohol Use Disorders Identification Tests was 88.5% among men and 17.3% among women. Periodic binge drinking was marked by loss of control, failure to meet obligations, and alcohol-related trauma. Focus group participants noted that previous occasional binge drinking by men has been replaced by frequent male and female heavy weekend drinking, violence, and death. Limitations and implications are discussed. Awareness of high levels of problem drinking and desire for assistance present compelling mandates for community intervention efforts.

Deadly Partners: Interdependence of Alcohol and Trauma in the Clinical Setting

Trauma is the leading cause of death for Americans aged 1 to 45. Over a third of all fatal motor vehicle collisions and nearly eighty percent of completed suicides involve alcohol. Alcohol can be both a cause of traumatic injury as well as a confounding factor in the diagnosis and treatment of the injured patient. Fortunately, brief interventions after alcohol-related traumatic events have been shown to decrease both trauma recidivism and long-term alcohol use. This review will address the epidemiology of alcohol-related trauma, the influence of alcohol on mortality and other outcomes, and the role of prevention in alcohol-related trauma, within the confines of the clinical setting.

Characteristics of trauma patients visiting Jeju Island

Jeju Island is the most famous sightseeing place in South Korea. Jeju has high death rate of injury in the country. We investigated the characteristics of trauma patients visiting ED by comparing visitors with residents in Jeju. New Injury Severity Score (NISS)，alcohol-related trauma. intentional trauma, mechanisms of trama and motor vehicle accidents, places trauma occurred, and results after treatment were investigated. A total of 5, 114 trauma patients visited ED from March 2008 to February 2009. There were no differences in NlSS.alcohol-related trauma，intentional trauma, mechanism of trauma, and results after treatment between residents and visitors. On the other hand, more visitors got injured in the commercial area and outdoor area , and they had more motorcycle accidents and passenger accidents. lesser driver accidents (p&lt;0.001). We should take adequate measuresfor safely of residents and visitors using these results to decrease trauma mortality in Jeju.

Alcohol and High-Risk Behavior Among Young First-Time Offenders

Underage drinking carries a high risk of injury. An important approach for reducing underage drinking is limiting youth access to alcohol. Underage drinkers obtain alcohol from multiple sources and patterns of access may vary by region. We examined patterns of access to alcohol and alcohol use among youth in a local court-ordered diversion program for first-time adolescent alcohol offenders as a basis for designing and evaluating community prevention efforts. Youth in the program completed a survey of demographic data, type of offense, source, setting, and quantity of alcohol consumed at time of offense, and 1-year alcohol-related high-risk behaviors. Significance was attributed to p < or = 0.05. Completed surveys were obtained from 1,158 (84.8%) of 1,366 eligible participants during the 23-month study period. There were 71% males and 29% females with a mean age of 17.2 years (range, 12-24 years). Respondents were Caucasian (64.5%), Hispanic/Latino (19.9%), Asian (3.5%), African American (2.5%), and others (9.6%). Offenses included minor in possession (55.8%), driving under the influence (21.2%), and drunk in public (20.4%). Consumption at time of offense was one or less drinks in 36.3%, two to five drinks in 31.7%, and 32.0% reported six or more drinks. Social sources of alcohol (got it from someone else) were reported by 72.9% and commercial sources (bought it or took it from a store) were reported in 11.9%. The two most common places of consumption were someone else's home (30.7%) and the beach (14.6%). Multiple 1-year high-risk behaviors were reported and 41.0% drove after drinking or rode with someone else who had been drinking. Binge drinking (5 or more drinks for males; 4 or more drinks for females) was reported by 43.1% of males and 36.7% of females. All high-risk behaviors were more common in binge drinkers (p < 0.001). Drinking and driving or riding with a drinking driver was reported in 54.2% of those who binged. Females who binged reported a higher rate than males in 8 of 10 high-risk behaviors. This study revealed the predominance of social sources of alcohol among young first-time alcohol offenders. Drinking and driving or riding with a drinking driver was reported at an alarmingly high rate. Other alcohol-related high-risk behaviors were also common. Efforts to prevent alcohol-related trauma should target social access to alcohol, the resulting high-risk behaviors, and include a special focus on young females.

Treatment options of pelvic and acetabular fractures in patients with osteoporotic bone

The incidence of pelvic ring and acetabular fractures in the elderly is climbing relentlessly. This increase is attributed to a greater longevity and a decrease in the incidence of alcohol-related trauma in younger adults. Often, the elderly trauma patient has compromised physiological reserve and healing capacity due to concomitant morbidities, resulting in a less favourable clinical outcome. The presence of osteopenic or osteoporotic bone and other treatments for existing comorbidities hamper some treatment alternatives, especially those designed for younger patients. Diverse clinical presentations include minor trauma, major polytrauma and insufficiency fractures. An assessment of the general health and functional status of the patient is of utmost importance to determine the optimal treatment. The different treatment options of pelvic and acetabular fractures in the presence of osteoporosis vary mainly according to the clinical presentation and include: conservative methods, percutaneous or minimally invasive procedures, open reduction and fixation, and primary total hip arthroplasty. Whichever treatment is chosen, even for elderly people, the aim is a rapid mobilisation of the patient in order to reduce complications to some extent inherent to this age group.

Conversation with Richard Fuller.

Conversation with Richard Fuller.

Attribution of injury to alcohol involvement in young adults seriously injured in alcohol-related motor vehicle crashes

Approximately 40% of all traffic fatalities are associated with the use of alcohol. Hospitalization for serious injury after a motor vehicle crash related to use of alcohol may be an opportunity to change drinking behaviors in non-alcohol-dependent drinkers, thereby reducing the risk for future disability and death. To determine the degree to which non-alcohol-dependent adults aged 18 to 45 years with alcohol-related vehicular trauma attributed their injury to use of alcohol. During hospitalization, 132 subjects involved in alcohol-related motor vehicle crashes were interviewed. The interviews included the question, "To what extent do you believe your alcohol consumption was responsible for this injury?" Responses were measured on a 7-point scale ranging from 1 (not at all) to 7 (totally). In response to the question about attribution of injury to alcohol, 37.8% of subjects responded "not at all," 24.3 responded "somewhat," and 37.9% responded "mostly" or "totally." Spearman rank correlation between attribution of injury to alcohol involvement and blood alcohol content at admission was r = 0.440 (P < .001). More than 60% of patients injured in alcohol-related motor vehicle crashes attributed their injury partly or totally to use of alcohol. When alcohol-free, hospitalized patients with higher blood levels of alcohol on admission were more likely than those with lower levels to attribute their injury to alcohol. Hospitalization for a motor vehicle crash related to use of alcohol provides an opportunity for interventions to decrease drinking.

Surgical treatment of acetabular fractures in elderly patients with osteoporotic bone.

The incidence of acetabular fractures in the elderly has recently shown a marked increase due to the combination of greater longevity for the population as a whole and a relative decrease in the incidence of alcohol-related trauma in younger adults. The compromised physiologic reserve and the diminished healing capacity of the typical elderly patient have an adverse effect on the potential for a favorable clinical outcome. The presence of osteopenic bone or degenerative arthritis and the effects of previous radiation therapy to the hip and pelvis hamper diagnostic imaging and the utility of some treatment alternatives that were designed primarily for younger patients. The diverse clinical presentations include major polytrauma, minor trauma, and insufficiency fractures. An assessment of the prior health and functional status of the patient is crucial in determining the optimal therapeutic protocol. Treatment options vary according to the clinical presentation and include conservative methods, percutaneous fixation in situ, open reduction, and acute total hip arthroplasty. The feasibility of acute total hip arthroplasty rests on the use of newly developed techniques for minimally invasive stabilization of the acetabular fracture with cables and the application of morselized or structural autograft harvested from the femoral head. Whichever surgical method is chosen, the objective is rapid mobilization of the patient on a walker or crutches. Late complications that may occur after nonoperative or operative treatment include posttraumatic arthritis, nonunion, wound infection, and heterotopic bone formation.

Brief interventions for patients with alcohol-related trauma

Patients who have sustained alcohol-related injuries are frequently treated in departments of oral and maxillofacial surgery. Often, an alcohol intervention will not be possible in accident and emergency departments due to intoxication but, when attending out-patient clinics for follow-up, patients are usually sober. This presents a unique opportunity for encouraging patients to review their alcohol consumption at a time when their facial injury may make them more receptive to advice. This article reviews the convincing evidence of the effectiveness of advice and brief interventions designed to be incorporated into standard out-patient consultations and describes practical screening of patients for harmful drinking, the Stages of Change Model of behaviour change and motivational interviewing for facilitating behavioural change.

Linking injury prevention and alcohol policy: seeking a common agenda

A recent Canadian report on the economic costs of substance abuse (Single et al., 1996) indicated that among alcoholrelated health problems, the most costly is injuries, particularly falls. This finding might be counter-intuitive to the lay perception that liver disease and other chronic or longer-term complications of drinking result in the largest economic burden to society. In this collection we explore the nature of drinking-related injuries and its implications for preventionoriented policy development. The links between alcohol policy and injury prevention Alcohol availability has been shown to be an important contributor to rates of drinking-related problems. Policies that dramatically increase access to alcoholic beverages are likely to result in higher rates of chronic as well as acute problems related to drinking, including liver cirrhosis, cancer, injuries, suicide, homicide and assault. Conversely, where access to alcohol is curtailed-for example, through higher taxes or prices, higher legal drinking age, lower number or density of outlets where alcohol is available-one might expect to find lower rates of damage related to drinking (e.g., Bruun et al., 1975; Edwards et al., 1994; Holder & Edwards, 1995). These macrolevel policies are complemented by policies that influence the microlevel of the drinking context. One example is found among the increasing number of drinking establishments and community groups that are encouraging more responsible service and consumption practices in the hope of reducing drunkenness-related incidents, preventing tragedy, and reducing the risk of legal action. Macropolicies at the level of the state, province, city or town, as well as formal or informal policies in the drinking venue-be it a restaurant, bar, community facility or private home-have a clear potential for effective injury prevention. As this collection shows, alcohol is implicated in many injuries, particularly among youths and young adults. Effective targeted and broad-based policies can reduce the frequency of high-risk drinking events, curtail the number of persons who drink to intoxication, or separate heavy drinking from risk-taking behavior. Such policies can reduce the incidence of alcohol-related harm among high-risk groups and the general population. Toward a common research agenda Alcohol-related-injury prevention has an ambiguous status in research arenas. On the one hand, research of some time ago (e.g., Giesbrecht et al., 1989), as well as accounts in this collection (Robson et al.; Pickett et al.) and the reports to the U.S. Congress on Alcohol and Health (e.g., U.S. Dept. of Health and Human Services, 1997), clearly signal that a significant share of alcohol-related incidents results in trauma. Nevertheless, cost-effective systems to detect alcohol injuries in hospital or primary care situations are not widespread (Degutis, this collection). Their absence poses special challenges for alcohol and injury prevention researchers and practitioners, chief among them the difficulty in marshaling resources and political support to deal with a problem that is largely invisible and poorly understood by the public, the media, and policy-makers. By its nature, trauma, in contrast to other alcohol-related harms, offers some unique opportunities for research: The numbers of trauma cases are quite high for some types of incidents, many of those affected tend to be young, the gestation period is short relative to chronic drinking-related problems, and the social, environmental and situational contexts are essential considerations. Whereas reducing frequency of drinking and amount of alcohol consumed are likely to be important in managing alcohol-related chronic conditions, it is drinking practices and environments that demand special attention in the prevention of alcohol-related trauma. Practices such as drinking to intoxication, binge drinking, combining alcohol and other drugs, or drinking prior to or while engaging in an activity that requires skill, coordination or concentration may result in a high number of injuries and deaths, including among inexperienced or occasionally immoderate drinkers. …

Cofactors of alcohol-related trauma at a rural trauma center

To analyze the cofactors of alcohol-related trauma at a rural, Level II trauma center, 127 admitted trauma patients were interviewed about psychological problems, social factors, and medical histories. Patients were divided into two groups, blood alcohol content (BAC) positive and BAC negative, for analysis. Seventy-one patients (56%) were BAC negative; 56 (44%) were BAC positive. Forty-three of the 82 males (52%) had positive BAC tests, compared with 13 of the 45 females (29%) ( P = .01). Fifty-one of the 56 BAC-positive patients (91%) were aged 21 to 50 years, compared with 29 of the 71 BAC-negative patients (41%) ( P = .0001). Ten of the 12 patients (83%) who were recently unemployed were BAC positive, compared with 46 of the 115 patients (40%) who were not recently unemployed ( P = .004). Eleven of the 12 patients (92%) with positive drug screens were BAC positive, compared with 45 of the 115 patients (39%) with negative drug screens ( P = .0005). These results show that there are important cofactors of alcohol-related trauma in rural areas.

Economic costs of alcohol abuse and alcoholism.

The economic cost to society from alcohol abuse and alcoholism in the United States was an estimated $148 billion in 1992. When adjusted for inflation and population, the estimates are generally comparable with cost estimates produced over the past 20 years. The current estimates are significantly greater than the most recent detailed estimates developed for 1985--about 42% above increases due to population growth and inflation. Between 1985 and 1992, inflation accounted for about 37.5% and population growth for 7.1% increases. Changes in prevalence have been associated with a modest reduction in alcohol costs. Though crime rates did not materially change over this period, criminal justice expenditures more than doubled overall, even after adjustment for price increases. The balance of changes are due to new findings and/or methodology indicating larger impacts than previously estimated. It is estimated that 45.1% of costs are borne by alcohol abusers and/or members of their households, 38.6% are borne by government, 10.2% by private insurance, and 6.0% by victims of alcohol-related trauma (motor vehicle crashes plus crime). The costs staying in the household of the abusers may be materially incident on persons other than the abuser, e.g., spouses, children.

Drinking and driving prevention in the community: program planning and implementation

This paper describes the rationale, development and implementation of the Drinking and Driving Component, which is one of five components of the Community Trials Project conducted by the Prevention Research Center, Berkeley, California (USA). It traces the background of drunk driving enforcement technology and practice against which the programs at the three sites were implemented. A conceptual model for the enforcement component of a comprehensive community alcohol-related trauma project is presented and its implementation at the three sites is described. Limitations in the available police department resources delayed the implementation of local programs. Media advocacy tied to specific operations proved to be successful in publicizing sensors and sobriety checkpoints were only partially accepted. Overall, the community trials sites increased or held steady their arrest rates in contrast to the comparison sites where DUI arrests declined.