Between Blood Alcohol Concentration Research Articles

Alcohol and driving—How bad is the combination? A meta-analysis

Objective The objective of this study was to summarize existing knowledge on the association between driving under the influence of alcohol and road safety outcomes and to assess factors that may explain why these estimates vary. Methods Based on studies of the association between blood alcohol concentration (BAC) levels and crashes, we used multilevel metaregression to calculate summary effects of BAC level and analyze potential moderators of the association. Results Based on 60 studies and 393 effect estimates, we found that BAC level, outcome severity, use of hospital data, and geographical region contributed to heterogeneity in results. Conclusion The effect of BAC on crash and injury risk and culpability is stronger at higher BAC levels and for more serious outcomes. The relationship between BAC level and outcome is approximately exponential. The relationship is stronger in studies from Nordic countries than in studies from other countries, possibly because of the relatively low level of drunk driving in these countries. Studies based on hospital data and studies using non-crash-involved control groups find smaller effects on average.

Investigating the relationship between inaccurate blood alcohol concentration estimates, harm and other negative consequences.

Alcohol-related harms place a significant burden on the Australian economy and health-care system. The current study aims to: (i) explore the relationship between blood alcohol concentration (BAC) and self-estimated blood alcohol concentration (EBAC); and (ii) determine whether BAC underestimation is related to an increased risk of experiencing physical aggression, verbal aggression, drink driving, ejection from a venue or refusal of service. Patron street surveys were conducted in four night-time entertainment precincts (NEP) across Queensland, Australia, between June 2016 and November 2018. Participants (N=2144) reported on their EBAC and recent negative or harmful experiences in NEPs. BAC was measured via a breathalyser. Paired samples t tests were conducted to determine if patrons' BAC and EBAC were significantly different. Logistic regressions were conducted to examine whether BAC underestimation is a significant predictor of harm and negative outcomes. Analyses identified a small, significant difference between patron's BAC and EBAC. Patrons with a low BAC were more likely to overestimate their BAC, while patrons with higher BACs were more likely to underestimate their BAC. Moderately intoxicated patrons had the most precise BAC estimations. Patrons with a high BAC and who underestimated their intoxication level were more likely to have been recently ejected from licensed venues, compared to accurate estimators or over-estimators. Overall, patrons are poor evaluators of their own intoxication level, which may have implications for their experiences in NEPs. The findings highlight the need for improved BAC education for patrons.

Blood Alcohol Concentration Is Associated With Improved AIS Motor Score After Spinal Cord Injury.

To investigate the relationship between blood alcohol concentration (BAC) and neurologic recovery after traumatic spinal cord injury (TSCI) using standardized outcome measures from the International Standards for the Neurological Classification of Spinal Cord Injury (ISNCSCI) examination. This is a retrospective review of merged, prospectively collected, multicenter data from the Spinal Cord Injury Model Systems Database and institutional trauma databases from five academic medical centers across the United States. Patients with SCI and a documented BAC were analyzed for American Spinal Injury Association Impairment Scale (AIS) motor score, FIM, sensory light touch score, and sensory proprioception score upon admission and discharge from rehabilitation. Linear regression was used for the analysis. The study identified 210 patients. Mean age at injury was 47 ± 20.5 years, 73% were male, 31% had an AIS grade A injury, 56% had ≥1 comorbidity, mean BAC was 0.42 ± 0.9 g/dL, and the mean Glasgow Coma Score upon arrival was 13.27 ± 4.0. ISNCSCI motor score gain positively correlated with higher BAC (4.80; confidence interval [CI], 2.39-7.22; p < .0001). FIM motor gain showed a trend toward correlation with higher BAC, although it did not reach statistical significance (3.27; CI, -0.07 to 6.61; p = .055). ISNCSCI sensory light touch score gain and sensory proprioception score gain showed no correlation with BAC (p = .44, p = .09, respectively). The study showed a positive association between higher BAC and neurologic recovery in patients with SCI as measured by ISNCSCI motor score gain during rehabilitation. This finding has not been previously reported in the literature and warrants further study to better understand possible protective physiological mechanisms underlying the relationship between BAC and SCI.

U.S. alcohol associated traffic injuries and fatalities from 2014 to 2018.

Alcohol-impaired motor vehicle collision (MVC) fatalities comprise almost a third of total crash fatalities in the United States (U.S.). They also impose 20% of the total costs of MVCs annually. This study aims to evaluate an association between blood alcohol concentration (BAC) and number of crash injuries and fatalities from 2014 to 2018 in the U.S. Additionally, we aim to recommend solutions to reduce alcohol-impaired driving related injuries and fatalities. A retrospective analysis of National Highway Traffic Safety Administration (NHTSA) data of crash injuries, fatalities, and BAC levels (0.00g/dl, 0.01-0.07g/dl, and≥0.08g/dl) from 2014 through 2018. Descriptive statistical analysis and independent sample t-tests were conducted, with significance defined as p<.05. Compared to BAC 0.01-0.07g/dl,BAC ≥0.08g/dl resulted in significantly more injuries (6779 vs. 1357, p<.001) and fatalities (10,522 vs. 1894, p<.001). BAC level≥0.08g/dl produced significantly greater injuries and fatalities in comparison to lower BAC levels evaluated. Given the effects of alcohol-impaired driving on MVCs, the legal BAC level should be re-evaluated to protect citizens and reduce incidence of alcohol related traffic injuries and fatalities. Educational programs promoting responsible alcohol consumption need to be in place for individuals at high risk for driving under the influence.

Can blood alcohol concentration have a role in choosing high lethality method of suicide?

ABSTRACT As acute alcohol intake can trigger suicidal ideas and attempts in people already at risk, and self-aggression is more intense after alcohol consumption, the aim of this study is to assess the relationship between blood alcohol concentration (BAC) and the lethality of suicide methods. A number of different socio-demographic and clinical predictors related to selection of high lethality methods were evaluated. This retrospective autopsy study covers an 11-year period of autopsies performed in the Institute of Forensic Medicine in Belgrade. It included 308 subjects with confirmed BAC above 0‰ who committed suicide. The suicide methods were dichotomized in terms of lethality – low lethality methods (LLM – drug/chemical overdose or use of a sharp object, n = 20) and high lethality methods (HLM – hanging, firearms and explosives, drowning, jumping from a height and immolation, n = 288). Our study did not reveal a statistically significant relationship between alcohol concentration and HLM. There is an obvious trend of HLM in rising BAC categories, but without any statistical significance. Of all tested predictors, only the male gender has significant correlation with HLM (p = 0.036). Despite the absence of correlation between BAC and HLM, the rising trend in BAC in our study showed, along with opposing literature data, that we can conclude this interconnection is highly complex.

Burden of Alcohol-Related Injuries on Radiology Services at a Level I Trauma Center

The purpose of our study was to evaluate the burden of alcohol-related injuries on a radiology department at a level 1 trauma center. We linked the trauma registry (2005-2009) of Harborview Medical Center to billing department data and extracted patient demographic and injury-related characteristics and the radiology services provided. Multivariate negative binomial analysis was used to evaluate the association between blood alcohol concentration (BAC) and CT and MRI utilization rates. A total of 125,776 CT and 4681 MRI examinations were performed on 27,274 patients during the study period. Higher BAC was generally associated with higher utilization rates for all types of CT even after adjusting for potential confounding variables. Compared with patients with a BAC of 0, the greatest increases in utilization were observed in individuals with a BAC of 240 mg/dL or more for head CT (incidence rate ratio [IRR], 1.43; 95% CI, 1.32-1.54), cervical spine (IRR, 1.45; 95% CI, 1.32-1.58), and maxillofacial (IRR, 1.66; 95% CI, 1.42-1.95), with no increase observed for MRI. This association was more prominent in less severely injured patients with utilization rates for head CT (IRR, 1.83; 95% CI, 1.56-2.13), abdomen (IRR, 1.46; 95% CI, 1.32-1.63), and thorax (IRR, 1.57; 95% CI, 1.30-1.89) in individuals with a BAC of 240 mg/dL or more compared with those with a BAC of 0. Higher BAC was associated with increased CT utilization for most body region-specific CT scans and was more strongly associated in patients with less severe injuries. Any guideline that could potentially decrease unnecessary imaging for patients with alcohol-involved injuries would represent a cost-saving strategy.

Relationship Between Blood Alcohol Concentration and Hepatic Enzymes in an Emergency Department

Objective Hepatic enzymes can be used as a predictor of hepatic injury. The present study investigated the relationship between blood alcohol concentration (BAC) and hepatic enzymes in patients intoxicated with ethanol at an emergency department (ED). Materials and Methods To determine whether BAC is an independent predictor of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels, we retrospectively reviewed the medical data for patients who were intoxicated and whose BAC and hepatic enzyme levels were measured. Patients who had hepatitis caused by viruses or traumatic hepatic injury, as well as patients with a normal BAC, were excluded. Results Of the 1432 patients, 298 were female and 1134 were male. The average age of males was 41.4 ± 11.7 years and that of females was 35.6 ± 11.8 years. Mean serum AST and ALT levels were 78 ± 88 IU/L and 51 ± 67 IU/L in males, while those in females were 63 ± 110 IU/L and 40 ± 83 IU/L, respectively. Mean BACs were 199.6 ± 99.0 mg/dL for males and 175.1 ± 101.1 mg/dL for females. Log BAC had a high positive correlation with log ALT ( r = 0.208; p < 0.001) and log AST ( r = 0.086; p = 0.001) when BAC was above 50 mg/dL (0.05%). Multivariate linear regression showed that BAC was an independent predictor of AST and ALT ( r 2 = 0.057 and 0.056, respectively). Conclusion The high correlation of BAC with serum AST and ALT levels in patients intoxicated with ethanol when their BAC was above 50 mg/dL can be used to predict serum AST and ALT levels. However, a high BAC only appears to be associated with a slight elevation in hepatic enzymes. Therefore, in patients with acute alcohol intoxication at the ED, an elevation in AST and ALT levels should be considered as a result of hepatic injury rather than an effect of alcohol.

Use of Carbohydrate-Deficient Transferrin (CDT) and a Combination of GGT and CDT (GGT-CDT) to Assess Heavy Alcohol Consumption in Traffic Medicine

Carbohydrate-deficient transferrin (CDT) has become widely used in traffic medicine to detect chronic alcohol abuse among subjects applying for driving-license renewal or regranting. By defining cut-off values in a large population of abstainers and moderate drinkers, we report on CDT, GGT-CDT (a combination of gamma-glutamylaminotransferase (GGT) and CDT) and the association between blood alcohol concentration (BAC) and CDT among Italian drivers. CDT was evaluated by a high performance liquid chromatography (HPLC)-based commercial kit in 652 abstainers or moderate drinkers, 603 drivers applying for driving-license regranting after a rehabilitation programme and 105 drivers involved in car accidents with blood alcohol concentration higher than the legal limit used in Italy (BAC >0.5g/l). GGT-CDT was calculated according to Sillanaukee and Olsson and Niemelä. BAC has been assessed by gas chromatography-mass spectrometry. A common CDT cut-off (1.8%) and gender-specific GGT-CDT cut-off (4.15% for males, 3.56% for females) were calculated as 99.9th percentiles of the control population. Also, 3% and 27% of subjects were classified as CDT positive respectively among drivers applying for license regranting and drivers involved in car accidents. A significant association between BAC and both CDT values and CDT positivity was found, with a frequency up to 49% of CDT samples, suggesting chronic alcohol abuse, among drivers with BAC >2.5g/l. Concordance between CDT and GGT-CDT was only moderate (kappa = 0.44), with CDT performing better than GGT-CDT. A relevant proportion of drivers with high BAC are chronic abusers. GGT-CDT, previously validated with CDT immunoassays, should not be applied to traffic medicine in its current form and its performances re-evaluated with CDT measured by HPLC.

The relationship between blood alcohol concentration (BAC), age, and crash risk

Problem The role of age (youth and driving inexperience) and alcohol as major risk factors in traffic crash causation has been firmly established by numerous studies over the past 50 years. Less well established is how the two variables interrelate to influence crash risk. Some investigations have hypothesized an interactive or synergistic effect in which young drivers with less experience and a greater tendency to take risks are more adversely affected at lower blood alcohol concentrations (BACs) than are older drivers. The evidence for this hypothesis is mixed. Resolution of this issue has important implication for developing countermeasures directed at the young driver crash problem. Method Case control data previously collected in Long Beach and Fort Lauderdale were reanalyzed using a more sensitive method for detecting interaction effects than used in the original analysis. A conditional logistic regression analyses found a highly significant age × BAC interaction (P < .0001) involving differences between drivers under 21 and those 21 and older. Discussion The results clearly indicate that positive BACs in drivers under 21 are associated with higher relative crash risks than would be predicted from the additive effect of BAC and age. It is likely that two mechanisms are operating to cause the interaction. First, it seems likely that the crash avoidance skill of young novice drivers would be more adversely affected by alcohol due to their driving inexperience, immaturity, and less experience with alcohol. Second, drivers under 21 who choose to drink and to drive after drinking probably have pre-existing characteristics that predisposed them to risk taking and crash involvement apart from any increased vulnerability to alcohol impairment. Impact on Industry The results support increased enforcement of zero-tolerance BAC laws for minors.

Identifying drunkenness in the night‐time economy

Prohibiting the sale of alcohol to intoxicated patrons by licensees and their staff requires definitions of drunkenness. To assess the relationship between blood alcohol concentration (BAC) and indicators used in field sobriety tests putatively associated with intoxication. DESIGN, PARTICIPANTS, SETTING, MATERIAL AND METHODS: A random sample of 314 female and 579 male city centre drinkers. Surveyors scored respondents' and non-respondents' gait, eyes and speech for signs of drunkenness as well as their drunkenness on a 10-point Likert scale. Breath analysis was used to determine respondents' BAC. Combinations of slurred speech, staggering gait and glazed eyes significantly predicted levels of BAC with a staggering gait indicating highest levels of intoxication. Subjective ratings of drunkenness by trained observers corresponded with BAC. Transition BACs denoting observable behaviour change associated with intoxication have been identified. Observations of gait, combined with assessment of slurred speech should be the basis of estimates of drunkenness.

The Relationship of Blood Alcohol Concentration to Impairment Severity in Spinal Cord Injury

Objective: To investigate the relationship between blood alcohol concentration (BAC) and severity of neurological impairment.Design: Retrospective cross-sectional study.Participants: Subjects with traumatic spinal cord injury (SCI; N = 119) with dates of injury between 1991 and 2000 who received their acute treatment at a midwestern Model SCI Care System and for whominformation regarding BAC was available.Analysis: Main outcome measure: severity of neurological impairment. Data were analyzed using x2 testsand analysis of variance (ANOVA).Results: A significant association was observed between impairment severity and BAC.Conclusions: The study suggests that alcohol consumption is associated with severity of SCI. A morerigorous study controlling for trauma attributes is necessary to confirm these results and appraise whetheralcohol has a potentiating effect on impairment. If borne out, the study's findings may lead to alterations inemergency room procedures and to changes in public health and education efforts resulting froma reframing of the issue of safe consumption of alcohol.

Role of cannabis in motor vehicle crashes.

The use of is widespread throughout the world, and in many countries is increasing (1). After alcohol, the most frequently found psychoactive substance in the blood of motorists involved in traffic crashes is cannabis. The very high costs, in human and financial terms, of road traffic crashes underscores the need for a clear understanding of the contribution of use to the incidence of such crashes. If were demonstrated to be an independent risk factor for such crashes, then efforts to prevent driving after recent use could be justified. Evidence accumulated over the last half-century or more has clearly demonstrated the relation between blood alcohol concentration (BAC) and the risk of a serious road traffic crash. Significant impairment of driving skills begins at a BAC of about 50 mg/100 ml blood and increases exponentially with increasing BAC (2). This has led to various jurisdictions imposing maximum blood alcohol concentrations for legal driving. However, the relations between driving impairment and blood concentrations of other drugs, including cannabis, have not been so well established, and the legal responses have varied. The World Health Organization recently convened an Expert Working Group on Health Effects of Cannabis Use. This committee's report states: There is sufficient consistency and coherence in the evidence from experimental studies and studies of cannabinoid levels among crash victims to conclude that there is an increased risk of motor vehicle crashes among persons who drive when intoxicated with cannabis (1, p. 15). However, the references cited in support of this statement were for experimental studies and descriptive

Predicting DUI recidivism: blood alcohol concentration and driver record factors

This study examined the relationship between blood alcohol concentration (BAC) at arrest, driving history and other demographic factors, and the 1-year post-arrest probability of recidivism for drunk driving (DUI) convictees. Complex and simple prediction models were developed. All models found a statistically significant cubic relationship between BAC and recidivism, reflecting a relatively high rate of recidivism at a BAC of 0.00%, decreasing to a minimum at ca 0.09% BAC, then increasing to another relatively high rate at a BAC of ca 0.29%, followed by a decline in recidivism to BAC levels of 0.35% and beyond. High rates of recidivism at high BACs suggest alcohol dependency, while high rates at low BACs suggest the involvement of other impairing substances. The rate of DUI recidivism for offenders who refused alcohol testing was the same as for aggregated BAC-tested offenders who had prior DUIs at the time of the arrest. The probability of DUI recidivism predicted by a simple model using BAC, prior 2-year traffic convictions, and offender level (first or repeat offender) could be used along with other factors by presentence investigators, judges or in administrative settings to determine appropriate sanctions, treatment or other remedial measures. The findings support the notion that first offenders with high BAC levels and prior 2-year traffic convictions are at as high a risk of recidivating as many repeat offenders, and might therefore benefit from similar sanctions and/or remedial treatment. The findings also support viewing DUI arrestees with very low BACs as probable drug users with relatively high probabilities of recidivating.

Inhibition of platelet aggregation in whole blood after exposure of rats to alcohol by inhalation

The dose-effect relationship between blood alcohol concentration (BAC) and altered platelet function was examined in whole blood in a rat model of alcohol exposure by inhalation, using the impedance method of ex vivo whole blood platelet aggregation. With rates of alcohol addition to the chamber air inflow from 29 to 56 mg ethanol/l air/min, BAC was dependent on duration of exposure and concentration of alcohol in the air. Next, 3, 6, and 9 h exposures to the highest delivery rate were used, and platelet aggregability was tested. After 9h, BAC reached 453 ± 16 mg% and aggregation responses to three doses of collagen were significantly lower than in control blood ( p < 0.01). Less consistent inhibition was observed with arachidonic acid and ADP, and also when exposure duration was reduced. However, some significant inhibition of collagen-induced aggregation ( p < 0.05) was observed with BAC as low as 127 ± 15 mg%. These experiments demonstrate that in vivo alcohol exposure inhibits, in a concentration-dependent manner, ex vivo rat whole blood platelet aggregation, at BACs readily attained in humans by ingestion.

Positive correlation between blood alcohol level and ISS in road trauma

To assess the relationship between blood alcohol concentration (BAC) and injury severity in an unselected population of road accident victims, case notes of 820 consecutive road accident victims presenting to hospital in a 12 month period were reviewed retrospectively. Five hundred and thirty-five of these were eligible for BAC analysis and results, obtained from the Victoria Police and the Road Safety and Traffic Bureau were available in 429 cases. These were expressed as mg/100 ml (per cent). Injury severity was quantified using the Injury Severity Score (ISS). BAC was compared with injury severity in three ways. First, Spearman's correlation coefficient (ρ) of 0.27 indicated a highly significant correlation ( P < 0.01). Second, the median ISS for intoxicated patients (4) was significantly higher than that for sober patients (1) ( P < 0.05). Third, when patients were grouped according to ISS, the prevalence of intoxication in each group rose with increasing injury severity ( χ 2: P < 0.01). We conclude that there is a significant positive correlation between BAC and injury severity in road accident victims treated at a Melbourne hospital.

Drug interactions: the effects of alcohol and meprobamate applied singly and jointly in human subjects. III. The concentrations of alcohol and meprobamate in the blood and their effects on performance; application of mathematical models.

The relations between the levels of alcohol and meprobamate in the blood and performance on a visual-motor coordination tracking task were analyzed by a general system of mathematical models, using data from Experiment V by Carpenter et al. [J. Stud. Alc., Suppl. No. 7, pp. 54-139, 1975]. The derivation of the models is described. In general, the relationship between blood alcohol concentration (BAC) and performance was nonmonotonic: best performance occurred at BACS of 10 to 20 mg per 100 ml. The relationship between meprobamate concentration (BMC) and performance was monotonic: performance deteriorated with increasing BMC. The results of the reaction latency measure, howevr, showed no consistent relationship with BAC or BMC. The action of alcohol can be represented by a model which involves 2 distinct sites of action; that of meprobamate, 1 site. It could not be determined whether the site of action of meprobamate is distinct from those of alcohol because the blood levels of the drugs were not high enough. The implications of the results are discussed, with particular reference to the quantitative description of the joint action of drugs and the design of future experiments.