Initial Assessment Of Trauma Patients Research Articles

Delayed diagnosed injuries in trauma patients after initial trauma assessment with a total-body computed tomography scan

IntroductionEven when using the Advanced Trauma Life Support (ATLS) guidelines and other diagnostic protocols for the initial assessment of trauma patients, not all injuries will be diagnosed in this early stage of care. The aim of this study was to quantify how many, and assess which type of injuries were diagnosed with delay during the initial assessment of trauma patients including a total-body computed tomography (TBCT) scan in a Level 1 Trauma Center in the Netherlands. MethodsWe conducted a retrospective cohort study of 697 trauma patients who were assessed in the trauma bay of the Amsterdam University Medical Center (AUMC), using a TBCT. A delayed diagnosed injury was defined as an injury sustained during the initial trauma and not discovered nor suspected upon admission to the Intensive Care Unit (ICU) or surgical ward following the initial assessment, diagnostic studies, or during immediate surgery. A clinically significant delayed diagnosis of injury was defined as an injury requiring follow-up or further medical treatment. We aimed to identify variables associated with delayed diagnosed injuries. ResultsIn total, 697 trauma patients with a median age of 46 years (IQR 30–61) and a median Injury Severity Score (ISS) of 16 (IQR 9–25) were included. Delayed diagnosed injuries were found in 97 patients (13.9 %), of whom 79 injuries were clinically significant (81.4 %). Forty-eight of the delayed diagnosed injuries (49.5 %) were within the TBCT field. Ten delayed diagnosed injuries had an Abbreviated Injury Scale (AIS) of ≥3. Most injuries were diagnosed before or during the tertiary survey (60.8 %). The median time of delay was 34.5 h (IQR 17.5–157.3). Variables associated with delayed diagnosed injuries were primary ICU admission (OR 1.8, p = 0.014), an ISS ≥ 16 (OR 1.6, p = 0.042), and prolonged hospitalization (40+ days) (OR 8.5, p < 0.001). ConclusionWith the inclusion of the TBCT during the primary assessment of trauma patients, delayed diagnosed injuries still occurs in a significant number of patients (13.9 %). Factors associated with delayed diagnosed injuries were direct admission to ICU and an ISS ≥ 16.

Initial Assessment of Trauma Patients

Introduction: The initial assessment of trauma patients is a critical and time-sensitive phase in the realm of emergency medicine. This presentation outlines the fundamental components and principles of conducting an effective initial assessment, which is essential for promptly identifying life-threatening injuries and ensuring timely interventions for patient stabilization.&#x0D; The primary objective of the initial assessment is to swiftly detect and address imminent life-threatening conditions. This process adheres to a structured approach, often following established protocols such as Advanced Trauma Life Support (ATLS).&#x0D; Commencing with the evaluation of the patient's airway, breathing, and circulation (ABCs), healthcare providers prioritize the maintenance of a patent airway, adequate respiration, and a stable circulatory system. Any life-threatening issues identified during this phase demand immediate intervention.&#x0D; Simultaneously, healthcare providers perform a concise yet comprehensive patient history and physical examination, gathering information about the injury's mechanism, the patient's medical background, and any pertinent details. This collected data serves as the foundation for subsequent assessments and treatment plans.&#x0D; The secondary survey, a more detailed and systematic examination, follows the initial assessment. This phase involves a thorough head-to-toe evaluation aimed at detecting injuries that may have been initially overlooked. Diagnostic procedures, including imaging studies and laboratory tests, may be initiated during this phase to further assess and diagnose injuries.&#x0D; The initial assessment places specific emphasis on identifying and managing conditions with rapid and potentially lethal deterioration, such as tension pneumothorax, cardiac tamponade, and massive hemorrhage.&#x0D; Throughout the assessment process, effective communication among the trauma team members is paramount to ensure a coordinated and efficient response. This includes making triage decisions and facilitating swift patient transport to the most appropriate care facility, all of which contribute to optimal trauma patient management.&#x0D; In conclusion, the initial assessment in trauma patients is a dynamic and systematic process designed to swiftly identify and address life-threatening injuries. By recognizing these injuries promptly, initiating timely interventions, and gathering critical patient information, healthcare providers and emergency responders play a vital role in ensuring the best possible outcomes for trauma patients. Training in these procedures is essential to equip healthcare teams with the skills and knowledge needed for successful trauma patient management.

Implanted Penile Prosthetic Visualized During Focused Assessment with Sonography for Trauma Examination: A Case Report.

This is a case report of an implanted penile prosthetic visualized during focused assessment with sonography for trauma (FAST) examination. The case represents a unique finding near the lateral bladder that may confound assessment of intraperitoneal fluid collections during initial assessment of trauma patients. A 61-year-old Black male was brought to the emergency department from a nursing facility for evaluation after sustaining a ground-level fall. A FAST exam demonstrated an abnormal fluid collection anterior and lateral to the bladder, later identified as an implanted penile prosthetic. Focused assessment with sonography for trauma examinations are often performed on unidentified patients in a time-sensitive manner. Understanding of potential false-positive results is crucial to appropriate use of the tool. This report demonstrates a novel false-positive result that may be difficult to differentiate from a true intraperitoneal bleed.

Severe thoracic or abdominal injury in major trauma patients can safely be ruled out by "Valutazione Integrata Bed Side" evaluation without total body CT scan.

During the initial assessment of trauma patients, the severity of injury is very often not immediately recognizable. In trauma centers, a total body CT (TBCT) scan is routinely used to evaluate this kind of patients, even if it is burdened with health risk, economical costs, and logistical difficulties. We investigated the use of a clinical guide to establish a safe alternative to this routine practice. We enrolled retrospectively 438 patients referring to the Emergency Department of Careggi University Hospital in Florence (Italy) over a 1-year period from 2014 to 2015, with the evidence of trauma and high-priority triage codes and then subjected to TBCT. We created a tool called VIBS ("Valutazione Integrata Bed Side") (from the Italian translation of "Bed Side Integrated Evaluation") which included all clinical, laboratory, and diagnostic data acquired bedside during the primary survey. Every VIBS profile was dichotomized in negative or positive if there was at least one altered item. We performed an analysis of correlation between VIBS and TBCT to determine sensibility, specificity, positive, and negative predictive value and likelihood ratio of VIBS. Sensibility of VIBS in the prediction of positive CT scan was 100% and specificity was 31.7%. Positive and negative predictive value (95% C.I.) was 44.3 (38.8-49.5) and 100 (94.0-99.9). Positive and negative likelihood ratios were 1.464 and 0. Failure rate resulted in 0% and efficiency was 20.54%. VIBS can safely rule out severe thoracic or abdominal injuries. This approach could limit the use of TBCT in one-fifth of suspected major trauma patients.

Decreasing Accuracy of the eFAST Examination—Another Challenge Due to Morbid Obesity

The extended focused assessment with sonography for trauma (eFAST) ultrasound examination is an essential step in the initial assessment of trauma patients. Its accuracy depends on the ability to acquire high-quality ultrasound images, and we hypothesized that increasing BMI was associated with increased odds for incorrect eFAST. All adult blunt trauma activations at a high-volume urban trauma center in 2016 that underwent eFAST and CT chest, abdomen, and pelvis were included (n = 446). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the eFAST were calculated with CT results as reference. The association of BMI and eFAST accuracy was determined using univariate analyses. Sensitivity and specificity of the eFAST examination were 27.1 per cent and 91.7 per cent, respectively, with an overall 76.2 per cent accuracy. At BMI 36 kg/m², the odds of having incorrect eFAST results increased to odds ratio (OR) = 1.85 (95% confidence interval, 1.03-3.32; P = 0.05). For those with BMI > 40 kg/m², the OR increased to OR = 3.12 (95% confidence interval, 1.45-6.69; P = 0.01). One-third of patients in this study were obese or morbidly obese. The latter was associated with increased odds for incorrect eFAST results, particularly the abdominal examination component.

Diagnostic accuracy of eFAST in the trauma patient: a systematic review and meta-analysis.

Performing an extended Focused Assessment with Sonography in Trauma (eFAST) exam is common practice in the initial assessment of trauma patients. The objective of this study was to systematically review the published literature on diagnostic accuracy of all components of the eFAST exam. We searched Medline and Embase from inception through October 2018, for diagnostic studies examining the sensitivity and specificity of the eFAST exam. After removal of duplicates, 767 records remained for screening, of which 119 underwent full text review. Meta-DiSc™ software was used to create pooled sensitivities and specificities for included studies. Study quality was assessed using the Quality in Prognostic Studies (QUADAS-2) tool. Seventy-five studies representing 24,350 patients satisfied our selection criteria. Studies were published between 1989 and 2017. Pooled sensitivities and specificities were calculated for the detection of pneumothorax (69% and 99% respectively), pericardial effusion (91% and 94% respectively), and intra-abdominal free fluid (74% and 98% respectively). Sub-group analysis was completed for detection of intra-abdominal free fluid in hypotensive (sensitivity 74% and specificity 95%), adult normotensive (sensitivity 76% and specificity 98%) and pediatric patients (sensitivity 71% and specificity 95%). Our systematic review and meta-analysis suggests that e-FAST is a useful bedside tool for ruling in pneumothorax, pericardial effusion, and intra-abdominal free fluid in the trauma setting. Its usefulness as a rule-out tool is not supported by these results.

The use of simulation training module to train surgical residents in the focused assessment with sonography for trauma (FAST)

Introduction: The focused assessment with sonography for trauma (FAST) is a commonly used and life-saving tool in the initial assessment of trauma patients. Surgical residents being trained through lectures and hands-on learning of ultrasound can be challenging; inclusion of novel educational strategies, such as simulation can be utilized. Thus this study ought to evaluate whether ultrasound simulator is a suitable alternative method for ultrasound education than the traditional methods. Method: Observational analytical study. Sixteen surgical residents were taken for the study, by lottery chit system they were segregated into to arm of eight each. One arm was with traditional hands on training and another arm was taught in Simulation skill lab on interpretation of FAST. The duration of study was 6 weeks, 2 hours per week. Knowledge content of FAST evaluated trough Pre-test and Post MCQ test (Identical) and OSCE assessment was done for their skill and interpretation of FAST. Evaluator was blinded to both groups. Chi square and student t test was used for statistical analysis. Result: All students showed significant improvement from pre- to post-test scores and significant improvement in comfort level using ultrasound in general and on FAST (p Conclusion: These findings suggest that an ultrasound simulator is a suitable alternative method for ultrasound education.

Acute Traumatic Cervical Facet Fractures

Acute cervical facet fractures are increasingly being detected due to the use of cervical spine CT imaging in the initial assessment of trauma patients. For displaced cervical facet fractures with dislocations and subluxations, early surgery can decompress the spinal cord and stabilize the spine. For patients with non-displaced cervical facet fractures, the challenge in managing these patients is the determination of spinal stability. Although many of the patients with non-displaced cervical facet fractures can be managed with a cervical collar, the imaging needs to be analyzed carefully since certain fracture patterns may be better managed with early surgical stabilization.

Radiological findings and radiation exposure during trauma workup in a cohort of 1124 level 1 trauma patients.

During the initial assessment of patients with potential severe injuries, radiological examinations are performed in order to rapidly diagnose clinically relevant injuries. Previous studies have shown that performing these examinations routinely is not always necessary and that trauma patients are exposed to substantial radiation doses. The aim of this study was to assess the amount and findings of radiological examinations during the initial assessment of trauma patients and to determine the radiation doses to which these patients are exposed to. We analyzed the 1124 patients included in a randomized trial. All radiological examinations during the initial assessment (i.e., primary and secondary survey) were assessed. The examination results were categorized as positive findings (i.e., (suspicion for) traumatic injury) and normal findings. The effective radiation doses for the examinations were calculated separately for each patient. Eight hundred and three patients were male (71%), median age was 38years, and 1079 patients sustained blunt trauma (96%). During initial assessment, almost 3900 X-rays were performed, of which 25.4% showed positive findings. FAST of the abdomen was performed in 989 patients (88%), with positive findings in 10.6%. Additional CT scanning of specific body regions was performed 1890 times in 813 patients (72.1%), of which approximately 43.4% revealed positive findings. Hemodynamically stable patients showed more normal findings on the radiographic studies than unstable patients. The mean radiation doses for the total population was 8.46mSv (±7.7) and for polytraumatized patients (ISS ≥ 16) 14.3mSv (±9.5). Radiological diagnostics during initial assessment of trauma patients show a high rate of normal findings in our trauma system. The radiation doses to which trauma patients are exposed are considerable. Considering that the majority of the injured patients are hemodynamically stable, we suggest more selective use of X-ray and CT scanning.

Management of Post-Traumatic Complications by Interventional Ultrasound: a Review

We reviewed the current literature to assess the feasibility of ultrasound-assisted and ultrasound-guided procedures for the treatment of post-traumatic complications and to address the indications and techniques of procedures. Non-operative strategies have been introduced in the treatment of severe trauma, and consequently, the incidence of some post-traumatic complications has increased. US can be useful both for the initial assessment of trauma patients and for the treatment of complications. Ultrasound-guided and ultrasound-assisted procedures as a therapeutic tool in the management of post-trauma settings are probably underused, in comparison with their successful use in other acute settings. Some new possible fields of clinical researches are suggested.

Muscle Oxygen Saturation Improves Diagnostic Association Between Initial Vital Signs and Major Hemorrhage: A Prospective Observational Study

ObjectivesDuring initial assessment of trauma patients, vital signs do not identify all patients with life‐threatening hemorrhage. We hypothesized that a novel vital sign, muscle oxygen saturation (SmO2), could provide independent diagnostic information beyond routine vital signs for identification of hemorrhaging patients who require packed red blood cell (RBC) transfusion.MethodsThis was an observational study of adult trauma patients treated at a Level I trauma center. Study staff placed the CareGuide 1100 tissue oximeter (Reflectance Medical Inc., Westborough, MA), and we analyzed average values of SmO2, systolic blood pressure (sBP), pulse pressure (PP), and heart rate (HR) during 10 minutes of early emergency department evaluation. We excluded subjects without a full set of vital signs during the observation interval. The study outcome was hemorrhagic injury and RBC transfusion ≥ 3 units in 24 hours (24‐hr RBC ≥ 3). To test the hypothesis that SmO2 added independent information beyond routine vital signs, we developed one logistic regression model with HR, sBP, and PP and one with SmO2 in addition to HR, sBP, and PP and compared their areas under receiver operating characteristic curves (ROC AUCs) using DeLong's test.ResultsWe enrolled 487 subjects; 23 received 24‐hr RBC ≥ 3. Compared to the model without SmO2, the regression model with SmO2 had a significantly increased ROC AUC for the prediction of ≥ 3 units of 24‐hr RBC volume, 0.85 (95% confidence interval [CI], 0.75–0.91) versus 0.77 (95% CI, 0.66–0.86; p < 0.05 per DeLong's test). Results were similar for ROC AUCs predicting patients (n = 11) receiving 24‐hr RBC ≥ 9.ConclusionsSmO2 significantly improved the diagnostic association between initial vital signs and hemorrhagic injury with blood transfusion. This parameter may enhance the early identification of patients who require blood products for life‐threatening hemorrhage.

Is heart rate variability better than routine vital signs for prehospital identification of major hemorrhage?

ObjectiveDuring initial assessment of trauma patients, metrics of heart rate variability (HRV) have been associated with high-risk clinical conditions. Yet, despite numerous studies, the potential of HRV to improve clinical outcomes remains unclear. Our objective was to evaluate whether HRV metrics provide additional diagnostic information, beyond routine vital signs, for making a specific clinical assessment: identification of hemorrhaging patients who receive packed red blood cell (PRBC) transfusion. MethodsAdult prehospital trauma patients were analyzed retrospectively, excluding those who lacked a complete set of reliable vital signs and a clean electrocardiogram for computation of HRV metrics. We also excluded patients who did not survive to admission. The primary outcome was hemorrhagic injury plus different PRBC transfusion volumes. We performed multivariate regression analysis using HRV metrics and routine vital signs to test the hypothesis that HRV metrics could improve the diagnosis of hemorrhagic injury plus PRBC transfusion vs routine vital signs alone. ResultsAs univariate predictors, HRV metrics in a data set of 402 subjects had comparable areas under receiver operating characteristic curves compared with routine vital signs. In multivariate regression models containing routine vital signs, HRV parameters were significant (P < .05) but yielded areas under receiver operating characteristic curves with minimal, nonsignificant improvements (+0.00 to +0.05). ConclusionsA novel diagnostic test should improve diagnostic thinking and allow for better decision making in a significant fraction of cases. Our findings do not support that HRV metrics add value over routine vital signs in terms of prehospital identification of hemorrhaging patients who receive PRBC transfusion.

Whole‐body computed tomography in the initial assessment of trauma patients: Is there optimal criteria for patient selection?

To describe the use of whole-body computed tomography (WBCT) at this Major Trauma Centre; to determine independent predictors of multi-region injury; and to evaluate the accuracy of the decision to perform WBCT in detecting multi-region injury. A prospective cohort study was performed at a single Major Trauma Centre in New South Wales, Australia. All adult patients who triggered trauma team activation and required an initial CT scan were studied. Primary outcome was the presence of multi-region injury. Logistic regression with stepwise selection was used to derive a prediction model for the need for WBCT based on our primary outcome. Receiver operator characteristic (ROC) analysis was used to compare the accuracy of the derived model and the clinical decision to perform WBCT. Six hundred and sixty patients were studied. WBCT scanning rate was 9.3% of all trauma activations. Of the patients who underwent WBCT, 31/98 (32.0%) had multi-region injury compared with 31/562 (5.5%) who underwent selective CT scanning (P < 0.001). Predictors of multi-region injuries were GCS <9 (OR 3.0, 95% CI 1.3-7.0, P = 0.01), full trauma activation (OR 2.9, 95% CI 1.5-5.3, P = 0.001), fall >5 m (OR 4.8, 95% CI 1.8-13.4, P = 0.003) and pedal cyclist (OR 3.0, 95% CI 1.2-7.5, P = 0.02). Area under ROC curve for the clinical decision to perform WBCT was 0.70 (95% CI 0.63-0.76) compared with 0.74 (95% CI 0.67-0.80) for the prediction model. The decision to perform WBCT scans in trauma should be at the discretion of the treating clinician. Applying a prediction rule would increase the number of WBCT scans performed without improving overall accuracy.

Renaissance of base deficit for the initial assessment of trauma patients: a base deficit-based classification for hypovolemic shock developed on data from 16,305 patients derived from the TraumaRegister DGU®

IntroductionThe recognition and management of hypovolemic shock still remain an important task during initial trauma assessment. Recently, we have questioned the validity of the Advanced Trauma Life Support (ATLS) classification of hypovolemic shock by demonstrating that the suggested combination of heart rate, systolic blood pressure and Glasgow Coma Scale displays substantial deficits in reflecting clinical reality. The aim of this study was to introduce and validate a new classification of hypovolemic shock based upon base deficit (BD) at emergency department (ED) arrival.MethodsBetween 2002 and 2010, 16,305 patients were retrieved from the TraumaRegister DGU® database, classified into four strata of worsening BD [class I (BD ≤ 2 mmol/l), class II (BD > 2.0 to 6.0 mmol/l), class III (BD > 6.0 to 10 mmol/l) and class IV (BD > 10 mmol/l)] and assessed for demographics, injury characteristics, transfusion requirements and fluid resuscitation. This new BD-based classification was validated to the current ATLS classification of hypovolemic shock.ResultsWith worsening of BD, injury severity score (ISS) increased in a step-wise pattern from 19.1 (± 11.9) in class I to 36.7 (± 17.6) in class IV, while mortality increased in parallel from 7.4% to 51.5%. Decreasing hemoglobin and prothrombin ratios as well as the amount of transfusions and fluid resuscitation paralleled the increasing frequency of hypovolemic shock within the four classes. The number of blood units transfused increased from 1.5 (± 5.9) in class I patients to 20.3 (± 27.3) in class IV patients. Massive transfusion rates increased from 5% in class I to 52% in class IV. The new introduced BD-based classification of hypovolemic shock discriminated transfusion requirements, massive transfusion and mortality rates significantly better compared to the conventional ATLS classification of hypovolemic shock (p < 0.001).ConclusionsBD may be superior to the current ATLS classification of hypovolemic shock in identifying the presence of hypovolemic shock and in risk stratifying patients in need of early blood product transfusion.

An evaluation of the use of whole-body computed tomography in trauma patients at a United Kingdom trauma centre

We sought to identify the impact of whole-body computed tomography (WBCT) on working and suspected diagnoses in Emergency Department (ED) trauma patients and to determine the rate of WBCT scans with no detectable traumatic injuries. We performed a retrospective database analysis of all trauma patients who underwent WBCT in 2009, comparing pretest suspicion of specific injury to WBCT findings, looking for the rates of unexpected findings and the absence of traumatic injury in WBCT studies. Our results showed that of the 179 patients who underwent WBCT, no traumatic injury reported in 17 patients while 162 patients demonstrated pathology (47 confirming previously suspected or diagnosed injury and 115 with previously unexpected injury). Overall, WBCT results differed from clinical findings in 130 (72.6%) patients, a statistically significant difference (P<0.0001). In conclusion, WBCT identifies previously unexpected injuries in almost 66% of ED trauma patients, supporting its continued use in the initial assessment of trauma patients.

Incidental Findings in Trauma Patients during Focused Assessment with Sonography for Trauma

During the initial assessment of trauma patients they usually undergo a Focused Assessment with Sonography for Trauma (FAST) in which there are occasionally incidental findings of other surgical conditions. In this audit we discuss the incidence, demographics, and implications of these findings and we propose a management algorithm. Within 2 years we managed 6041 trauma patients in the emergency department based on the Advanced Trauma Life Support protocols, 95 per cent of which underwent a FAST ultrasound. Incidental findings were reported in 468 patients (7.8%), whereas in a further 11.2 per cent of these patients there was a second finding. The mean age of these patients was 57.55 years (15-105), and most of them were men (51.1%). The vast majority of the findings were related to the liver and biliary tree (52.1%) followed by the urinary track (27.1% + 8%). In multivariate analysis only the age was a significant factor associated with incidental findings (P < 0.001) whereas in univariate analysis both the gender [men (54.1%) vs women (45.9), P = 0.013] and the mechanism of trauma (P < 0.001) were as important as the age (P < 0.001). The patients who had incidental findings were 15 years older than the rest. The detection of unknown surgical conditions in FAST may lead to managerial and possible medico-legal issues rendering the development of a proper algorithm mandatory.

Major trauma CT scanning: the experience of a regional trauma centre in the UK

IntroductionTrauma remains a major cause of mortality and morbidity, particularly among young adults. A major trauma (whole-body) CT protocol based upon mechanism of injury was investigated in a busy emergency...

International Anesthesiology Clinics. Critical Care: Current Challenges and Future Directions.

International Anesthesiology Clinics. Critical Care: Current Challenges and Future Directions.

National Survey of Canadian General Surgery Program Directors Regarding Focused Assessment With Sonography for Trauma

Focused assessment with sonography for trauma (FAST) is an important modality in the initial assessment of trauma patients. Information regarding the current status, availability, as well as educational and training processes in the use of FAST is limited. The purpose of this study was to survey Canadian general surgery residency program directors regarding FAST. A Web-based survey was developed to assess the availability and use of FAST, education and training, as well as the role of FAST in general surgery residency training programs across Canada. Two experts reviewed the survey for validity and reliability. The survey was then pilot tested by 2 general surgeons. The survey response rate was 75.0% (12/16). FAST was available at all the institutions that responded. FAST was used 100% of the time in the initial assessment of the trauma patient. In all, 75.0% (9/12) respondents have no formal residency training in FAST, 91.7% (11/12) of respondents agreed or strongly agreed that training in FAST should be included in the residency curriculum, and 66.7% (8/12) of respondents perceive that general surgery residents are not competent in the use of FAST. Overall, Canadian general surgery program directors do not feel that surgical residents are competent in the use of FAST. Current training is limited, and program directors believe that training and education in FAST should be included in the postgraduate education curriculum.

The Implications of Alcohol Intoxication and the Uniform Policy Provision Law on Trauma Centers; A National Trauma Data Bank Analysis of Minimally Injured Patients

Alcohol intoxication may confound the initial assessment of trauma patients, resulting in increased use of diagnostic and therapeutic procedures, thereby increasing hospital costs. The Uniform Policy Provision Law (UPPL) exists in many states and allows insurance companies to deny payment for medical treatment for alcohol-related injuries. If intoxication increases resource utilization, these denials compound the financial burden of alcohol use on trauma centers. We hypothesized that patients injured while under the influence of alcohol require more diagnostic tests, procedures, and hospital admissions, leading to higher hospital charges. The National Trauma Databank (2000-2004) was analyzed to identify adult trauma patients (age > or = 16 years) who were discharged alive, had a length of stay < or = 1 day and minor injuries (Injury Severity Score < 9), and were tested for blood alcohol. The study was confined to minimally injured patients to facilitate identification of unexpected resource use most likely attributable to alcohol use. Resource utilization was compared among patients who tested positive or negative for alcohol use. Results are presented as odds ratio (OR) with 95% confidence intervals (CI). Sixty-eight thousand eight patients met study criteria, of which 31,020 were positive for alcohol. Despite similar baseline characteristics, alcohol-positive patients required significantly more invasive procedures, including intubation (OR 4.16, 95% CI = 3.56-4.85) and Foley catheter insertion (OR 1.52, 95% CI = 1.39-1.67) as well as diagnostic tests (CT scan OR 1.16, 95% CI = 1.12-1.20). They were also less likely to be discharged from the emergency department (OR 0.61, 95% CI = 0.58-0.64), and more frequently required hospital (OR 1.64, 95% CI = 1.57-1.73) or intensive care unit admission (OR 1.82, 95% CI = 1.71-1.94). Mean hospital charges were $1,833 greater ($10,405 +/- 225 vs. 8,572 +/- 68). A significant amount of trauma center costs are primarily attributable to alcohol use rather than injury severity or outcome. The financial costs associated with alcohol use and UPPL-related cost-shifting to trauma centers is a significant burden to trauma centers. UPPL laws that penalize trauma centers for identifying intoxicated patients should be repealed in states where they exist.