Median Blood Alcohol Concentration Research Articles

Dubowski's stages of alcohol influence and clinical signs and symptoms of drunkenness in relation to a person's blood-alcohol concentration-Historical background.

This article traces the origin of various charts and tables delineating the stages of alcohol influence in relation to the clinical signs and symptoms of drunkenness and a person's blood-alcohol concentration (BAC). In forensic science and legal medicine, the most widely used such table was created by Professor Kurt M. Dubowski (University of Oklahoma). The first version of the Dubowski alcohol table was published in 1957, and minor modifications appeared in various articles and book chapters until the final version was published in 2012. Seven stages of alcohol influence were identified including subclinical (sobriety), euphoria, excitement, confusion, stupor, alcoholic coma and death. The BAC causing death was initially reported as 0.45+ g%, although the latest version cited a mean and median BAC of 0.36 g% with a 90% range from 0.21 g% to 0.50 g%. An important feature of the Dubowski alcohol table was the overlapping ranges of BAC for each of the stages of alcohol influence. This was done to reflect variations in the physiological effects of ethanol on the nervous system between different individuals. Information gleaned from the Dubowski table is not intended to apply to any specific individual but more generally for a population of social drinkers, not regular heavy drinkers or alcoholics. Under real-world conditions, much will depend on a person's age, race, gender, pattern of drinking, habituation to alcohol and the development of central nervous tolerance. The impairment effects of ethanol also depend to some extent on whether observations are made on the rising or declining phase of the blood-alcohol curve (Mellanby effect). There will always be some individuals who do not exhibit the expected behavioral impairment effects of ethanol, such as regular heavy drinkers and those suffering from an alcohol use disorder.

Autopsy study of alcohol-associated unnatural deaths in Thailand, 2007-2019.

To date, there have been no major studies of alcohol-associated unnatural deaths in Thailand or South East Asia. Thailand leads South East Asia in per capita alcohol consumption. The objectives of this study were to determine the incidence of alcohol-associated unnatural deaths in Thailand and their relation to post-mortem blood alcohol concentration (BAC); to investigate correlations between BAC and selected demographic variables; and to evaluate the incidence of co-use of alcohol and illicit substances. We conducted a retrospective register-based study of alcohol-investigated unnatural deaths in Thailand for the period 2007-2019. The core study sample (n = 77,006) was derived from a Thai government computerized database of unnatural-death autopsies. Of the total autopsy sample 32.49% was alcohol positive (BAC ≥0.20 g/L). The rate at which male autopsy cases were alcohol positive (35.52%) was approximately twice that of female autopsy cases (16.62%), with males having significantly higher median BAC levels, 1.64 and 1.31 g/L, respectively. The incidence of female alcohol-positive cases with extremely high BACs (≥3.50 g/L) was comparable to that of male alcohol-positive autopsies. The rates at which victims of accidents, homicides, and suicides were alcohol positive were 42.44%, 38.81%, and 33.25%, respectively. Drowning fatalities had the highest rate of alcohol detection (49.12%) and the highest median BAC (2.47 g/L). The next highest rate (48.47%) was among road traffic fatalities (RTFs, BAC 1.92 g/L), which accounted for about one-half of all RTFs and one-third of all alcohol-positive autopsies. Of the total alcohol-positive population, 8.33% tested positive for illicit substances, most commonly methamphetamine/amphetamine. BAC results for the majority of male and female alcohol-positive victims exceeded the generally accepted threshold for Heavy Episodic Drinking (0.8 g/L) and provided a rare BAC-documented (≥3.50 g/L) example of gender parity in the incidence of heavy alcohol consumption. The median BAC value for alcohol-positive RTFs (1.92 g/L) was about 10% higher than in studies in most other countries and about four times greater the Thai legal limit for motor-vehicle operation (0.50 g/L).

Characteristics of Adolescents Admitted with Acute Alcohol Intoxication: A Retrospective Multicentre Study in Antwerp, Belgium, in the Period 2015-2021.

Binge drinking among adolescents is common in Belgium, posing a risk of serious health consequences. Until today, only estimations of the prevalence of acute alcohol intoxication (AAI) in adolescents have been made. Research into potential risk factors has not yet been conducted in Belgium. Therefore, this study aims to gain more insight into the prevalence, medical characteristics and potential risk factors of AAI among adolescents. A retrospective multicentre chart study was performed on adolescents aged 10-17 years with AAI in Antwerp, Belgium (2015-2021). Patient's demographics, medical characteristics and information regarding the context of the AAI were collected from medical charts. Over the study period, a total of 1016 patients were admitted with AAI in Antwerp, having a median age of 16.6 years old, a median blood alcohol concentration of 1.95 g/L and combined drug use in 10% of cases. These findings did not significantly change over the study period. Multiple linear regression analysis indicated that after correcting for covariates, higher age, no combined drug use and decreased consciousness at admission were associated with more severe AAI cases (higher blood alcohol concentration). This study shows that AAI is prevalent among Belgian adolescents, and better targeted preventive measures and policies are needed. Our findings could be taken into account when developing preventive measures. However, data addressing the demographics and context of AAI were mostly missing. Therefore, prospective research is required to further investigate potential risk factors associated with AAI.

The Burden of Alcohol-Related Emergency Department Visits in a Hospital of a Large European City

(1) Alcohol consumption contributes to the development of numerous diseases and is a big organizational burden on emergency departments (EDs). (2) We examined data on alcohol-related ED admissions in Poznan, Poland between 1 April 2019 and 31 March 2022. A total of 2290 patients' records were collected and analysed. The main goal was to determine the impact that these visits had on the functioning of the ED and the hospital. (3) The alcohol-related admission rate was significantly higher in males (78.95% vs. 21.05%), and the median blood alcohol concentration (BAC) level was 2.60 (1.78-3.38) ‱. Most of the visits took place at weekends and in the evening. Patients with higher BAC tended to stay longer in the ED, but had a lower chance of being admitted. A majority of patients required radiology and laboratory testing, 20.44% needed psychiatric examination, and 19.69% suffered trauma, mainly to the head. (4) Injuries and mental problems were the most common medical emergencies. This study presents trends in alcohol-related ED attendances, examines reasons for visits, and makes an attempt to assess overall burden on EDs.

Assessment of Alcohol Exposure From Alcohol-Based Disinfectants Among Premature Infants in Neonatal Incubators in Japan

The risk of premature infants in neonatal incubators exposed to evaporated alcohol from alcohol-based disinfectants (ABDs) is unknown. To assess alcohol concentrations in the peripheral blood of premature infants and neonatal incubators. A quality improvement study comparing 2 different populations before and after introduction of ABD practice (ABD-PRAC) was conducted in a neonatal intensive care unit of a single tertiary hospital in Japan. Participants included premature infants who were born before 34 weeks of gestational age and received medical care in neonatal incubators. The study consisted of 3 periods: (1) September 1, 2020, to August 1, 2021 (prospective observation of pre-ABD-PRAC, (2) August 2 to August 22, 2021 (introduction of ABD-PRAC to medical staff and parents in the neonatal intensive care unit), and (3) August 23, 2021, to March 31, 2022 (prospective observation of post-ABD-PRAC). No follow-up studies were initiated. An ABD-PRAC that aimed to reduce alcohol evaporation from ABDs inside neonatal incubators was instituted: (1) place alcohol preps in the incubator just before use and remove them from the incubator as soon as possible and (2) withhold placing hands into the incubators until 60 seconds after using ABDs for disinfection (applied only to family members). Blood alcohol concentration and evaporated alcohol concentrations in neonatal incubators. Disinfectant practice was assessed among 28 infants during the pre-ABD-PRAC (17 infants [10 girls]; median gestational age at birth, 29.4 [IQR, 26.3-30.3] weeks) and post-ABD-PRAC (11 infants [3 girls]; median gestational age at birth, 30.0 [IQR, 25.3-32.2] weeks) study periods. The median blood alcohol concentration was 7.0 (IQR, 5.4-9.3) mg/dL pre-ABD-PRAC and 4.2 (IQR, 2.5-7.2) mg/dL post-ABD-PRAC. The median evaporated alcohol concentration inside neonatal incubators during pre-ABD-PRAC during the day was 23.6 (IQR, 15.9-36.5) ppm and, at night, was 13.2 (IQR, 8.9-19.4) ppm; during post-ABD-PRAC, the concentration was 9.4 (IQR, 6.0-16.0) ppm during the day and 5.7 (IQR, 3.6-9.7) ppm at night. The introduction of ABD-PRAC at 22 weeks' corrected gestational age was associated with a lower blood alcohol concentration in premature infants: regression coefficient value, -8.3 (95% CI, -12.0 to -4.7). In this study, alcohol evaporated from ABDs was absorbed by premature infants in neonatal incubators. The findings suggest that introduction of ABD-PRAC was associated with lower alcohol concentrations in neonatal incubators and in the blood of premature infants.

Work-related and non-work-related fatal road accidents: Assessment of psychoactive substance use in commuting.

Commuting road traffic collisions (RTCs) are one of the main causes of occupational death worldwide, including Italy. Among the prominent yet relatively understudied personal risk factors in the subpopulation of workers, there is the use of psychoactive substances. Since the phenomenon of driving under alcohol and drugs effects in the commuter sub-population has so far been poorly studied, we carried out a study by comparing results obtained from the analysis of commuters and non-commuters. The percentage of commuting RTCs victims was 10.4% out of all the RTCs. Commuter victims were mostly men, 51-60 years-old, motorcyclists (32.1%) or car drivers (28.6%), employees, deceased during Fridays and Saturdays, in the afternoon (35.7%) and in the evening (32.1%). It was possible to perform toxicological analyses in 60.7% of commuter cases: approximately 40% tested positive, always and only for ethanol (median Blood Alcohol Concentration, BAC, of about 1.03 g/L). Values above the legal limit were observed in 23.5% of the toxicological samples analyzed from commuter accidents. Our findings contribute to bridging the gap in knowledge in the area of RTCs and commuting and emphasize the importance of carrying out toxicological investigations, with possible repercussions on both insurance issues and public health strategies, which are relevant for analyzing the phenomenon structurally.

Demographics and clinical characteristics of alcohol-related admissions in a tertiary care hospital in Qatar: Does age matter?

Background: Alcohol consumption is a major cause of acute and chronic health conditions associated with comorbidities and traumatic injuries, despite its partial prohibition in some countries. Moreover, alcohol-related hospital admissions increase the burden on the healthcare system. More than 80% of the population in Qatar comprises expatriates. This study aimed to analyze the demographics and clinical characteristics of subjects with alcohol-related emergency department (ED) visits/hospitalization with respect to different age groups in a single tertiary hospital in Qatar.Methods: It is a retrospective observational study of adult patients who visited the ED at Hamad General Hospital between January 2013 and March 2015 and were screened positive for alcohol use. Collected data included sociodemographic characteristics, blood alcohol concentration (BAC), pattern of admission, previous medical history, laboratory investigations, treatment, hospital course, and mortality. Data were compared with respect to the distribution of age groups such as < 25, 25–34, 35–44, 45–54, and >55 years.Results: In total, 1506 consecutively admitted patients screened positive for alcohol use were included in the study; the majority of them were males (95.6%), non-Qatari nationals (71.1%), and aged 35–44 years (30.9%). The age groups 35–44 years and 45–54 years showed the highest median BAC ([0.24 interquartile range (IQR: 0.14–0.33)] and [0.24 (IQR: 0.13–0.33)], respectively) as compared to the other age groups (P = 0.001). The pattern of hospital admission, sociodemographic status, presence of comorbidities, laboratory investigations, and mortality showed specific age-related distribution. Particularly, young adults were more likely to have a previous ED visit due to trauma, whereas older patients’ previous hospital admissions were mostly related to various underlying comorbidities.Conclusion: This study highlighted the patterns of age and clinico-epidemiological status of patients with alcohol-attributable hospital admissions. Our study showed that alcohol consumption was higher among the working-age group. Further studies are needed to investigate changes in the alcohol consumption patterns that may help plan for allocation of health resources and prevention of alcohol-related problems.

Everything Is Bigger in Texas: Alcohol Impaired Driving in Houston (2014-2018).

Driving while intoxicated (DWI) or driving under the influence of drugs (DUID) poses a continued public safety risk in Texas, which has one of the highest alcohol impaired traffic fatality rates. This study aimed to identify alcohol and drug use trends seen in DWI/DUID cases in the city of Houston from 2014 to 2018 to better understand the populations at risk. Blood samples submitted to the Houston Forensic Science Center (HFSC) were evaluated for blood alcohol concentration (BAC), drug concentrations and demographics. During the 5-year period, 12,682 Houston driver blood samples had a mean (median) BAC of 0.151 g/dL (0.167 g/dL) and age of 36.3 (34) years. Fifty percent of samples were white males. Seventy-five percent of samples were individuals aged 21 to 44 years. Between 2014 and 2018, the number of cases submitted nearly doubled, from approximately 2,000 cases per year to over 3,700. In 2014, 23% of cases submitted required further analysis per HFSC testing policy (drug screen and confirmation for DWI/DUID cases when BAC < 0.100 g/dL), which rose to 27% by 2018. Of those, 36% were polydrug cases, requiring two or more confirmation tests. Cannabinoids was the most common drug class detected (34% of cases analyzed for drugs), followed by benzodiazepines (25%), phencyclidine (20%), cocaine/metabolites (15%) and opioids (12%). Phencyclidine rose from the fifth-most commonly detected drug in 2014 to the second-most drug in 2018. Only 3% of all cases (n = 408) were negative for both alcohol and drugs. Communication between law enforcement and laboratory management is recommended to address growing caseload more effectively. The study limitations (e.g., limited scope of analysis) suggest the present data underestimated the full extent of impaired driving in Houston, indicating even more urgent needs for increasing resources and efforts to reduce this serious threat to public safety.

Variability in antemortem and postmortem blood alcohol concentration levels among fatally injured adults

ABSTRACT Background: Excessive alcohol use is a risk factor for injury-related deaths. Postmortem blood samples are commonly used to approximate antemortem blood alcohol concentration (BAC) levels. Objectives: To assess differences between antemortem and postmortem BACs among fatally injured adults admitted to one shock trauma center (STC). Method: Fifty-two adult decedents (45 male, 7 female) admitted to a STC in Baltimore, Maryland during 2006–2016 were included. STC records were matched with records from Maryland’s Office of the Chief Medical Examiner (OCME). The antemortem and postmortem BAC distributions were compared. After stratifying by antemortem BACs <0.10 versus ≥0.10 g/dL, differences in postmortem and antemortem BACs were plotted as a function of length of hospital stay. Results: Among the 52 decedents, 22 died from transportation-related injuries, 20 died by homicide or intentional assault, and 10 died from other injuries. The median BAC antemortem was 0.10 g/dL and postmortem was 0.06 g/dL. Thirty-one (59.6%) decedents had antemortem BACs ≥0.08 g/dL versus 22 (42.3%) decedents using postmortem BACs. Postmortem BACs were lower than the antemortem BACs for 42 decedents, by an average of 0.07 g/dL. Postmortem BACs were higher than the antemortem BACs for 10 decedents, by an average of 0.06 g/dL. Conclusion: Postmortem BACs were generally lower than antemortem BACs for the fatally injured decedents in this study, though not consistently. More routine antemortem BAC testing, when possible, would improve the surveillance of alcohol involvement in injuries. The findings emphasize the usefulness of routine testing and recording of BACs in acute care facilities.

Significant decrease in the rate of fatal alcohol poisonings in Finland validated by blood alcohol concentration statistics

BackgroundAlcohol may cause death directly by acute poisoning, as well as induce illnesses or accidents that lead to death. Our research question was whether the current decreasing trend in acute fatal alcohol poisonings in Finland is a real phenomenon or an artefact caused by possible changes in the process of determining the cause of death. MethodsAll cases in the national post-mortem toxicology database in which the underlying cause of death was acute alcohol poisoning in 1987–2018 were investigated in terms of blood alcohol concentration (BAC), age and gender. The number of acute alcohol poisonings was compared to the number of deaths from alcohol induced illness in the post-mortem toxicology database. ResultsA total of 12 126 acute alcohol poisoning cases were retrieved. Between 2004 and 2017 the number of acute alcohol poisonings decreased 60.1 %. At the same time the number of alcohol induced illnesses in the study material remained stable or decreased marginally.The median BAC in all acute alcohol poisonings was 3.2 g/kg. The annual median BAC values showed a small but significant decrease over the study period. The proportion of women in acute alcohol poisonings increased significantly over the study period, from 17.1%–22.3%. Women were on average 2.5 years older than men. ConclusionsOn grounds of the BAC statistics and supporting evidence, we conclude that the significant decrease in the number of fatal alcohol poisonings is true and likely reflects changes in the overall consumption of alcohol.

High levels of alcohol intoxication and strong support for restrictive alcohol policies among music festival visitors

BackgroundAlcohol intoxication is associated with problems such as violence, injuries, drunk driving and sexual risk-taking, and music festivals are considered a high-risk setting for high levels of alcohol consumption. This study investigates intoxication levels, drinking habits, and opinions on alcohol use and alcohol policies among visitors at one of the largest music festivals in Sweden in 2017.MethodsA cross-sectional study assessing alcohol intoxication levels was conducted at a music festival (~ 50,000 attendees). Two research teams collected data at the two festival entrances during two nights, from approximately 6:00 pm to 01:30 am. Blood alcohol concentration (BAC) levels were measured using breath analyzers. A face-to-face questionnaire was used to interview attendees about their alcohol use in the past 12 months using the Alcohol Use Disorder Identification Test-Consumption (AUDIT-C), as well as about their personal opinions on alcohol use and alcohol policies (statement). BAC levels were compared between categories of various factors using Mann-Whitney U test and Kruskal-Wallis test. The distributions of BAC, AUDIT-C and statement category across gender was analyzed using Pearson’s Chi-square tests. Associations of BAC levels with different factors were analyzed using Spearman rank correlation and multinomial logistic regression.ResultsA total of 1663 attendees were randomly selected and invited to participate, and 1410 consented (63.7% men, 34.9% women, age 16–64 years). The proportion of drinkers was 81%. Among the drinkers, the median BAC level was 0.082%. Thirty-one percent of the participants had a BAC level above 0.10%. Forty-two percent of the participants reported binge drinking monthly, and 20% said that they binge drank weekly. Sixty-three percent of participants reported risky drinking habits. A self-reported risky alcohol habit increased the risk of a high alcohol intoxication level at the festival. Respondents were supportive of restrictive alcohol policies. Men had significantly higher BAC levels, reported more often risky alcohol habits and were less supportive of restrictive alcohol policies than women.ConclusionsThe results indicate that participants at music festivals in Sweden have high levels of alcohol intoxication and largely support restrictive alcohol policies. Thus, there is both a need and support for the implementation of alcohol prevention strategies at festivals.

Traumatic brain injury in patients screened for blood alcohol concentration based on the mechanism of injury

ABSTRACTIntroduction: We aimed to investigate in-hospital outcomes of traumatic brain injury (TBI) based on blood alcohol concentration (BAC) and mechanism of injury (MOI).Methods: We conducted a retrospective study for patients admitted with TBI between 2010 and 2014. Based on BAC, patients were classified into [negative (-BAC) and positive (+BAC) group]. Data were analyzed and compared according to the MOI.Results: Out of 8141 trauma patients, 946 (11.6%) were diagnosed with TBI and 681 (72%) were subjected to BAC screening. One out of seven TBI was related to alcohol consumption with a mean age of 32 years. Gender, age, and Injury Severity Scores (ISS) were comparable in the two groups. However, the proportion of patients with polytrauma was significantly higher in -BAC than +BAC group regardless of the MOI except for the fall-related TBI. The median BAC was higher in fall-related followed by pedestrians and MVC victims [55 mmol/L (10–101), 49(9–71), and 31(1–69), respectively], p = 0.001. Overall hospital mortality was comparable between the two groups except for the pedestrian-related TBIs in which (+BAC) had significantly fewer mortality.Conclusions: Screening for BAC among patients with TBI increases substantially regardless of the MOI. The high BAC value in Fall-related TBI needs more attention to set appropriate preventive measures.

Time of Injury and Relation to Alcohol Intoxication in Moderate-to-Severe Traumatic Brain Injury: A Decade-Long Prospective Study

Knowledge about the causes and time of injury for traumatic brain injury (TBI) is important for the development of efficient prevention policies. We aimed to study time of injury and relation to alcohol intoxication for moderate-to-severe TBI in a level 1 trauma center in Norway. From October 2004 to September 2014, 493 consecutive patients (≥16 years) with moderate (Glasgow Coma Scale [GCS] score 9-13) and severe TBI (GCS score 3-8) were prospectively included in the Trondheim TBI Study (222 patients with moderate and 270 patients with severe TBI). Mean age was 47 years (standard deviation 21 years). Positive blood alcohol concentration (BAC) was found in 29%, and median BAC was 41.5 mmol/L (interquartile range 28.7-54.3), equal to 1.91‰. Admissions were more frequent on Saturdays (relative risk [RR] 2.67, 95% confidence interval [CI] 1.87-3.80) and Sundays (RR 2.10, 95% CI 1.45-3.03) compared with Mondays, and positive BAC was more common on weekends than weekdays (43% vs. 16%). Furthermore, admissions were more frequent in June (RR 2.26, 95% CI 1.44-3.55), July (RR 2.07, 95% CI 1.31-3.28), and December (RR 2.07, 95% CI 1.31-3.28) compared with January. The number of patients with positive BAC was greatest in December (RR 5.75, 95% CI 1.99-16.63), and 70% of these were caused by falls. Our findings demonstrate that moderate-to-severe TBI admissions display a clear weekly and seasonal variation and that alcohol is an important modifiable risk factor for moderate-to-severe TBI.

Alcohol-related emergency department admissions among adolescents in the Ghent and Sint-Niklaas areas

Alcohol abuse is a major health concern. The aim of this retrospective study was to analyse the alcohol-related emergency department (ED) admissions among adolescents in all hospitals of distinct areas during a 1-year period. In each hospital, all ED patients with a blood alcohol concentration (BAC) of at least 0.5 g/l were surveyed in a standardised way. Of the 3918 included patients, only 146 (3.7%) were < 18 years. The male-to-female ratio was 1.5:1. There was a strong preponderance of weekend and night time admissions. Most of the patients were transported by ambulance (77% of 138 patients with information on this item). The main reason for ED admittance was depressed level of consciousness (64%), trauma (12%), vomiting and/or abdominal pain (12%), agitation or aggression (4%), syncope (4%) and psychological problems (4%). The context of the alcohol intoxication was related to some kind of festivity in 85%, mental problems in 14% and chronic abuse in 1%. Median BAC values (and range) were 2.08 g/l (0.73–3.70 g/l) for boys and 1.51 g/l (0.73–2.90 g/l) for girls. Most patients (87%) could be discharged home within 24 hours. Our study confirms that problematic alcohol use leading to ED admissions starts in adolescence. Although the numbers of cases below 18 years are low when compared to adults, the phenomenon is alarming as it is associated with substantial health problems. Therefore, Belgium urgently needs a global national alcohol plan, with youngsters being one of the target groups.

Prevalence of alcohol and other drugs and the concentrations in blood of drivers killed in road traffic crashes in Sweden

Drunk or drug-impaired drivers represent a major public health and societal problem worldwide. Because over 95% of drivers killed on the roads in Sweden are autopsied, reliable information is available about the use of alcohol and/or other drug before the crash. This retrospective 4-year study (2008-2011) used a forensic toxicology database (TOXBASE) to evaluate the concentrations of alcohol and other drugs in blood samples from drivers killed in road-traffic crashes. The mean age of all victims (N = 895) was 48 ± 20 years, and the majority were male (86%). In 504 drivers (56%), the results of toxicological analysis were negative and these victims were older; mean age (± SD) 47 ± 20 years, than alcohol positive cases (35 ± 14 years) and illicit drug users (34 ± 15 years). In 21% of fatalities, blood-alcohol concentration (BAC) was above the statutory limit for driving (0.2 g/L), although the median BAC was appreciably higher (1.72 g/L). Illicit drugs (mainly amphetamine and cannabis) were identified in ~7% of victims, either alone (2.5%), together with alcohol (1.8%) or a prescription drug (2%). The psychoactive prescription drugs identified were mainly benzodiazepines, z-hypnotics and tramadol, which were found in the blood of 7.6% of crash victims. The high median BAC in fatally-injured drivers speaks strongly towards alcohol-induced impairment as being responsible for the crash. Compared with alcohol, the prevalence of illicit and psychoactive prescription drugs was fairly low despite a dramatic increase in the number of drug-impaired drivers arrested by the police after a zero-tolerance law was introduced in 1999.

Blood alcohol concentration and self-reported alcohol ingestion in acute poisoned patients who visited an emergency department

BackgroundMany acute poisoned patients have co-ingested alcohol in the emergency department (ED). This study aimed to estimate the blood alcohol concentration (BAC) of acute poisoned patients who visited an ED by age and gender distribution and to determine whether it is possible to obtain self-reports of alcohol ingestion among poisoned patients.MethodA retrospective medical chart review was conducted for all patients who visited the ED with acute poisoning between January 2004 and February 2008. Data regarding the patient’s age, gender, BAC, self-reported alcohol ingestion, poison ingested, time elapsed since poison exposure, presence of suicide attempts, and self-reported alcohol ingestion were collected. Patients were classified into two groups based on serum alcohol levels (≤10 mg/dl, >10 mg/dl).ResultsOf the 255 subjects, 88 subjects (34.5%) were included in the non-alcohol group and 167 subjects (65.5%) were included in the alcohol group. 227 subjects (89.0%) showed suicide intention. Using the 201 subjects who completed the self-report of alcohol ingestion, self-report resulted in 96.6% sensitivity and 86.7% specificity for the assessment of alcohol ingestion. The positive and negative predictive values for self-report were 91.2% and 94.7%, respectively. The median (interquartile range) BAC of the 97 males in the sample was 85.0 (10.0-173.5) mg/dl, and that of the 158 females was 32.0 (4.0-137.5) mg/dl (p = 0.010). The distribution of age in the groups was significantly different between the alcohol and non-alcohol groups (p = 0.035), and there was a significant difference in the mean BAC with respect to age for males (p = 0.003).ConclusionThis study showed that over two-thirds of patients presenting with acute poisoning had a BAC > 10 mg/dl. Most of patients visited by suicide attempt. Males had a higher BAC than did females. Self-reported alcohol ingestion in acute poisoned patients showed high sensitivity and specificity.

What non-alcohol drugs are used by drinking drivers in Sweden? Toxicological results from ten years of forensic blood samples

Introduction and MethodUsing a forensic toxicology database (TOXBASE), the toxicological results from 10years of forensic blood samples from people arrested for driving under the influence of alcohol and/or other drugs were reviewed. ResultsAlcohol was the only drug identified in blood in N=35,704 cases at a median blood-alcohol concentration (BAC) of 1.63mg/g. The mean age (±SD) of these offenders was 40±15years and 89% were male. The median BAC was lower (1.30mg/g) in drivers who had consumed alcohol and used a prescription drug before driving (N=1,251). The mean age of this group of traffic offenders was 38±13years and 85% were male. Both the median BAC (0.97mg/g) and the mean age were lowest (36±11years, 92% male) in N=3,153 drivers who had consumed alcohol and used illicit drugs before driving. Cannabis, amphetamine, cocaine and morphine (metabolite of heroin) were the commonest illicit drugs identified in blood samples. Sedative-hypnotics (benzodiazepines) were the major prescription drugs co-ingested with alcohol. Poly-drug use was a common finding in these traffic delinquents, although individuals who only drank alcohol had a higher median BAC and were also several years older than drinking drivers combining alcohol with other drugs before driving. Impact on IndustryZero-tolerance legislation did not deter hard-core offenders. In future there should be more focus on treatment for alcohol and substance abuse disorder rather than conventional punishments for this type of traffic crime.

Alcohol and psychoactive drugs increased the pre-hospital mortality in 655 fall-related fatalities in Greece: A call for management protocols

IntroductionThe frequency of alcohol and psychoactive drugs in fall-related fatalities and their effect on type, severity of injury and location of death constitute the subjects of this study. MethodsA retrospective analysis based on autopsy and toxicology compared demographics, location of injury; intention for the injury, height of fall, Abbreviated Injury Scale – 90 (AIS-90), post-mortem Injury Severity Score (ISS), and location of death. ResultsAmongst 655 fall-related fatalities screened for alcohol and psychoactive drugs 123 (18.8%) were classified in the positive toxicology group (PTG) and the remaining in the negative toxicology group (NTG).The median ages were 48 (16–94) years for the PTG and 62 (12–96) years for the NTG.The screened represent 31% of the national toll. The median height of fall was 7m and the median blood alcohol concentration was 53 (1.5–630)mg/dl.Males were more likely to be included in the PTG than females (21.6 versus 13.6%; p=0.014) as were the aged between 11 and 60 years.The odds of severe (AIS≥3) head, thoracic, abdominal, extremity, and spine injuries were not influenced by toxicology status.Fatalities of the PTG were as likely to have severe trauma (ISS≥16) as were fatalities of the NTG (93.5 versus 90.8%; p=0.34).There was no significant difference of ISS between PTG (median ISS 43, range: 6–75) and NTG (median ISS 35, range: 3–75).Nevertheless, 76.4% of the subjects of the PTG died during the pre-hospital stage of care compared to 60.5% of the subjects of the NTG, which was highly significant (or=2.80, p=0.001) after controlling for confounders as age, gender, intention for injury, height of fall, and ISS. ConclusionsIn fall related trauma, alcohol and psychoactive drugs increased the risk of death during the pre-hospital stage by 2.80 times. This is strong evidence that specific protocols for their early management should be instituted.

Drug poisoning deaths in Sweden show a predominance of ethanol in mono-intoxications, adverse drug–alcohol interactions and poly-drug use

Over a 10-year period (1998–2007) all deaths in Sweden classified by forensic pathologists as fatal drug poisonings ( N = 6894) were retrieved from a toxicology database (TOXBASE) belonging to the National Board of Forensic Medicine. The deaths were further classified as suicides N = 2288 (33%), undetermined N = 2260 (33%) and accidental N = 2346 (34%). The average age (±SD) of all victims was 49.1 ± 15.9 years and men 47.4 ± 15.6 years were 5-year younger than women 52.2 ± 15.8 years ( p < 0.01). Most of the deceased (78%) were poly-drug users although a single drug (mono-intoxications) was found in 22% of all poisoning deaths ( p < 0.001). The number of drugs in blood samples varied from 1 to 12 with a median of 3–4 per case. Mono-intoxication deaths were mostly ethanol-related ( N = 976) and the mean and median blood-alcohol concentration (BAC) was 3.06 g/L and 3.10 g/L, respectively. The BAC decreased as the number of additional drugs in blood increased from 2.15 g/L with one drug to 1.25 g/L with 6 or more drugs. The mean (median) concentrations of non-alcohol drugs in mono-intoxication deaths were morphine ( N = 93) 0.5 mg/L (0.2 mg/L), amphetamine ( N = 39) 2.0 mg/L (1.2 mg/L), dextropropoxyphene ( N = 33) 3.9 mg/L (2.9 mg/L), dihydro-propiomazine ( N = 32) 1.6 mg/L (1.0 mg/L) and 7-amino-flunitrazepam ( N = 28), 0.4 mg/L (0.3 mg/L). Elevated blood morphine in these poisoning deaths mostly reflected abuse of heroin as verified by finding 6-monoacetyl morphine (6-MAM) in the blood samples. When investigating drug poisoning deaths a comprehensive toxicological analysis is essential although the results do not reveal the extent of prior exposure to drugs or the development of pharmacological tolerance. The concentrations of drugs determined in post-mortem blood are one element in the case. The autopsy report, the police investigation, the findings at the scene and eye-witness statements should all be carefully considered when the cause and manner of death are determined.

Tractor driving and alcohol—A highly hazardous combination

Introduction Approximately half of all injury-related fatalities in the agricultural industry are associated with farm tractors. Skill-based psychomotor tasks, such as driving and operating such machines, are easily impaired as a consequence of the use of alcohol. We have analyzed characteristics of fatal traffic accidents involving tractors in Zagreb County, with special accent to prevalence of alcohol use among drivers. Subjects and methods The material comprised all fatal accidents involving tractor drivers in Zagreb County between the years 2001 and 2005 where a medicolegal autopsy had been performed and samples taken for subsequent forensic toxicological analysis. The total of 47 cases were included. Data were collected on characteristics of the fatally injured as well as on circumstances and dynamics of the accident itself. The results are presented with absolute and relative frequencies. Results Ninety-one percent (43 out of 47 cases) of fatally injured were males. No person was under the age of 18, 70% were between 18 and 65 years of age and 30% were above 65 years of age. Blood alcohol reading was negative in only 13 out of 47 analyzed cases (28%). Six cases (13%) had blood alcohol concentration (BAC) below 0.50 mg/mL, further 6 between 0.50 and 1.49 mg/mL, 16 (34%) between 1.50 and 2.49 mg/mL and the remaining six had BAC between 2.50 and 3.49 mg/mL. Median BAC among 34 fatalities with positive blood alcohol level was 1.80 mg/mL, while the highest concentration observed was 3.49 mg/mL. Multiple injuries were the most common cause of death (43%) followed by crush asphyxia (26%). Most of the victims (81%) died at the scene of the accident and all of them died within the first 24 h. In the majority of accidents (79%), the tractor operator was a victim of the vehicle rollover. Conclusion High percentage of farm tractor users driving under influence and high median BAC indicates that legislation alone is not sufficient in preventing accidents. Further effort should be directed toward education aimed to increase awareness of the obvious risk that alcohol use represents to driving and workplace safety. Taking into account that the overwhelming majority of fatalities occurred from rollovers, strong encouragement should be given to implementation of rollover protecting structure (ROPS) devices in order to prevent such type of fatalities.