Positive Blood Alcohol Concentration Research Articles

Alcohol testing and alcohol involvement among violent deaths by state, 2014–2016

Blood alcohol concentration (BAC) testing rates vary across states, potentially biasing estimates of alcohol involvement in violent deaths. The National Violent Death Reporting System (NVDRS) collects information on violent deaths, including decedents' BACs. This study assessed characteristics of violent deaths by BAC testing status, and the proportion of decedents with a positive BAC or BAC ≥ 0.08 g/dL. NVDRS data from 2014 to 2016 (2014: 18 states; 2015: 27 states; 2016: 32 states) were analyzed to assess BAC testing (tested, not tested, unknown/missing) by state, decedent characteristics, and death investigation system (e.g., state medical examiner, coroners), in 2019. The proportion of violent deaths with a BAC > 0.0 or ≥ 0.08 g/dL was also assessed. Among 95,390 violent death decedents, 57.1% had a BAC test (range: 9.5% in Georgia to 95.8% in Utah), 2.3% were not tested, and 40.6% had an unknown/missing BAC testing status (range: 1.3% in Alaska to 78.0% in Georgia). Decedents who were 21–44 years, American Indian/Alaska Native or Hispanic, died by poisoning, died by undetermined intent, or were investigated by a state medical examiner were most likely to receive BAC testing. Among the violent deaths with a reported BAC, 41.1% had a positive BAC and 27.7% had a BAC ≥ 0.08 g/dL. About 2 in 5 violent deaths were missing data on alcohol testing. Increased testing and reporting of alcohol among violent deaths could inform the development and use of evidence-based prevention strategies (e.g., increasing alcohol taxes, regulating alcohol outlet density) for reducing violent deaths.

Alcohol-associated traffic injuries in Verona territory: A nine-year survey.

According to the World Health Organization, as many as 25% of traffic accidents are linked to alcohol abuse. This study describes the results of a nine-year study performed on injured drivers (N = 12,806) in the Verona area of Northern Italy. Blood samples were mandatorily collected on injured drivers who were admitted to the Emergency Health Care Unit of Verona Hospital between 2009 and 2017, after they had been involved in a traffic accident. Blood alcohol concentration (BAC) determination was then undertaken using a validated head space-gas chromatography-flame ionisation detector (HS-GC-FID) method. We found that 21% of drivers tested positive for alcohol (BAC ≥0.01 g/L), while 16.8% presented with BAC levels above the Italian legal limit (>0.5 g/L). Of those who had positive BACs, about 50% presented with very high BAC levels (>1.5 g/L). Daily time distribution analyses, involving 2031 alcohol-positive drivers, showed a surge between 18:00 hours and 06:00 hours (74.3%), with a specific rise during the weekend (58.9%). The percentage of alcohol-related road accidents was 20.6%, which is lower than results reported in other international studies performed over the last 20 years. However, evidence that around 50% of the positive subjects showed a BAC >1.5 g/L confirms the correlation between BAC and accident risk, which becomes even more significant at progressively increasing levels of BAC. The study highlights the need to implement further strategies to both prevent and deter the use of alcohol while driving.

Differential effect of ethanol intoxication on peripheral markers of cerebral injury in murine blunt traumatic brain injury.

BackgroundBlood-based biomarkers have proven to be a reliable measure of the severity and outcome of traumatic brain injury (TBI) in both murine models and patients. In particular, neuron-specific enolase (NSE), neurofilament light (NFL) and S100 beta (S100B) have been investigated in the clinical setting post-injury. Ethanol intoxication (EI) remains a significant comorbidity in TBI, with 30–40% of patients having a positive blood alcohol concentration post-TBI. The effect of ethanol on blood-based biomarkers for the prognosis and diagnosis of TBI remains unclear. In this study, we investigated the effect of EI on NSE, NFL and S100B and their correlation with blood–brain barrier integrity in a murine model of TBI.MethodsWe used ultra-sensitive single-molecule array technology and enzyme-linked immunosorbent assay methods to measure NFL, NSE, S100B and claudin-5 concentrations in plasma 3 hours post-TBI.ResultsWe showed that NFL, NSE and S100B were increased at 3 hours post-TBI. Interestingly, ethanol blood concentrations showed an inverse correlation with NSE but not with NFL or S100B. Claudin-5 levels were increased post-injury but no difference was detected compared to ethanol pretreatment. The increase in claudin-5 post-TBI was correlated with NFL but not with NSE or S100B.ConclusionsEthanol induces an effect on biomarker release in the bloodstream that is different from TBI not influenced by alcohol. This could be the basis of investigations into humans.

Walking Under the Influence : Association of Time of the Day With the Incidence and Outcomes of Intoxicated Pedestrians Struck by Vehicles.

Pedestrian fatalities commonly involve alcohol. We sought to characterize alcohol intoxication among pedestrians struck by vehicles and examine correlations between admission time and injury severity. The Los Angeles County Trauma and Emergency Medicine Information System database was reviewed for pedestrians struck by vehicles over a 16-year period starting January 2000. Subjects aged ≥18 years with available time and day of admission were selected. Patients with available blood alcohol content (BAC) were analyzed and those with positive (+) BAC (≥ 0.01%) were compared with those with negative (-) BAC. The primary outcome was mortality. 35 840 patients met criteria, with 12 122 (33.8%) tested for BAC. 71.2% were (+) BAC. The proportion of (+) BAC pedestrians peaked at 02:00 (48.9% of admitted pedestrians, 88.5% of BAC tested pedestrians). Patients with a (+) BAC were more likely hypotensive (3.5% vs 2.7%, P = .019) and admitted with a Glasgow Coma Scale ≤ 8 (9.4% vs 7.1%, P < .001). Overall mortality was 4.6%. Those admitted from 06:00 to 11:00 had the highest odds of mortality in (+) BAC patients (4.7%, adjusted odds ratio 3.16, adjusted P < .001). Pedestrians struck by vehicles during late hours are commonly intoxicated. These findings could help legislators to implement changes and strategies to decrease the risk and burden of injury in intoxicated pedestrians.

Assessment of recent alcohol consumption by detecting ethyl glucuronide and ethyl sulphate level among traffic accident patients

Objective: This study aims to explain whether EtG and EtS, which are two non-oxidative ethanol metabolites secreted by the liver and used as markers of alcohol intake related to an incident, were also present in whole blood samples of patients with traffic accident injuries.Methods: EtG and EtS concentrations in all of the whole blood samples were sent to the Forensic Medicine Department of Cukurova University for testing Blood Alcohol Concentrations (BAC) via validated liquid chromatography-tandem mass spectrometer method.Results: The scope of the study covers 200 patients that were admitted to medical services within 12 h following the incident. Of all patients 16.5% were found to be BAC positive, while 35.5 and 23.5 were positive for EtG and EtS, respectively. All samples with a positive BAC result were also positive for EtG and EtS.Conclusion: Detection of EtG and EtS, minor metabolites along with ethanol in the blood can serve as an objective tool to provide further analysis regarding alcohol-related traffic accidents at emergency services.

Alcohol Consumption and Violent Deaths in the City of Sao Paulo in 2015

Background: Excessive alcohol consumption is a serious public health issue, because drunkenness affects critical judgment and self-control, making people more vulnerable to violence and accidents, with thus a potential association between alcohol consumption and violent deaths. Objective: To assess the association between alcohol consumption and violent deaths in the city of Sao Paulo, Brazil, in 2015, and its relationship with gender, age, cause of death and blood alcohol concentration (BAC) of victims. Methods: A cross-sectional retrospective study was conducted by collection of data from 2,882 victims of violent deaths subjected to examination of BAC from the archives of the Institute of Legal Medicine of the State of Sao Paulo, Brazil. Results: Alcohol was detected in blood samples of 27.06% of the victims and mean BAC levels were 1.92 ± 1.24 g/L. The mean age of the victims was 33.49 ± 15.19 years. The majority of the victims were male (84.14%) and the prevalence of positive BAC was higher amongst men (28.74%) than women (18.16%). Homicide was the most prevalent cause of death in the sample (36.57%), but there were a higher proportion of traffic accidents victims with positive BAC (32.01%), as well as higher BAC levels in these victims (46.77% in the range of 1.6–2.5 g/L). Conclusions: The results obtained in this study support a potential association between alcohol consumption and violent deaths in the city of Sao Paulo, mainly in traffic accidents victims.

An investigation on the risk factors associated with driving errors under the influence of alcohol using structural equation modeling

Objective: Driving errors contribute to traffic crashes and thus the causal factors associated with driving errors are of great interest to the road safety researchers. The present study attempts to identify and quantify the effects of various risk factors that are likely to influence driving error with the application of structural equation modeling (SEM). These risk factors include blood alcohol concentration (BAC) levels (0%, 0.03%, 0.05%, and 0.08%), different driving environments (rural, urban), and driver attributes (such as age, gender, education).Method: Eighty-two licensed drivers participated in a driving simulator experiment. They completed driving under the influence of 4 BAC levels in the driving environments within the framework of a full-factorial within-subjects design. Driving error was modeled as an unobserved latent variable based on several driving simulator indicators. An SEM approach was utilized to examine the influence of BAC level, driving environment, and driver attributes on the latent variable pertaining to driving error.Results: The findings suggest the suitability of an SEM approach in the investigation of driving error. The results revealed that all 3 positive BACs (0.03%, 0.05%, and 0.08%) had a significant positive influence on driving error compared to 0% BAC, and the tendency toward driving error increased with increasing BAC (factor loadings for 0.03%, 0.05%, and 0.08% BAC were 0.22, 0.31, and 0.37, respectively). Moreover, driving in an urban environment led to more driving errors compared to a rural environment, including sober drivers. Among the driver attributes, gender and awareness about drink and drive laws were the only factors influencing driving error.Conclusion: This study highlights a novel approach to investigate driving error by modeling it as a latent variable instead of modeling individual performance measures. The successful execution of SEM in alcohol impairment research may serve as a significant step in the human factors field moving from piecemeal analysis to a combined analysis where interrelationships among numerous risk factors and driving error can be established. The study outcomes may serve as a reference while developing strategies to enhance road traffic safety where special emphasis can be given to the critical risk factors influencing driving error identified in the study.

Trauma in adults experiencing homelessness

BackgroundHomeless individuals suffer a greater burden of health problems than the general population. This study aimed to describe the epidemiology of physical trauma among homeless patients presenting to an urban major trauma center and to ascertain any differences in the nature, injury severity and outcomes among homeless compared to domiciled patients. MethodsA retrospective matched cohort study that included adults who met inclusion criteria for The Alfred Hospital Trauma Registry between 01 July 2010 and 31 March 2017 was conducted. Primary homelessness was identified using the International Statistical Classification of Diseases, 10th Revision Coding Z59.0 and/or ‘No fixed abode’ address data. Homeless and domiciled patients were matched at a 1:2 ratio on age, sex, month and year of injury. The primary outcome variable was the Injury Severity Score (ISS). Secondary outcomes were hospital length of stay (LOS), mortality, emergency department (ED) disposition, hospital disposition, discharge processes and trauma registry recidivism. ResultsOf 25,920 cases in the trauma registry, 147 (0.6%) were identified as homeless, comprising 131 unique homeless individuals who were matched with 262 domiciled patients. The median (Inter-Quartile Range) ISS among homeless patients was 5(2–10), compared to 9(4–17) for domiciled patients (p < 0.001). Homeless patients had significantly lower odds of sustaining an injury with ISS>12 (OR 0.5, 95% CI: 0.3–0.8, p = 0.001). Homeless patients were treated more often than domiciled patients for assault (32.1% vs 9.5%), intentional self-harm (10.7% vs 2.7%), and penetrating injury (16.0% vs 6.5%). Homeless patients had higher rates of psychiatry admissions (9.2% vs 0.8%), positive blood alcohol concentration (30.5% vs 13.7%), and higher odds of discharging against medical advice (DAMA)(OR 2.0, 95% CI: 1.1–3.6 p = 0.02). There were no differences in LOS (p = 0.51), mortality (p = 0.19), ED disposition (p = 0.64) or trauma registry recidivism (p = 0.09). ConclusionAmong injured patients who presented at an urban trauma center, homelessness was associated with higher odds of assault, intentional self-harm, penetrating injury, psychiatry admissions, DAMA but lower ISS than domiciled patients. Variable definitions of homelessness and lack of standardized documentation in the medical record should be addressed to ensure these vulnerable patients are identified and linked with peripheral services

A drink before suicide: analysis of the Queensland Suicide Register in Australia.

Previous studies analysing blood alcohol concentration (BAC) at the time of suicide have primarily focused on sociodemographic factors. Limited research has focused on psychosocial factors and co-ingestion of other substances to understand the mechanisms of how alcohol contributes to death by suicide. The aim was to examine time trends, psychosocial factors related to acute alcohol use and co-ingestion of alcohol and other substances before suicide. The Queensland Suicide Register in 2004-2015 was utilised and analysed in 2019. The cut-off point for positive BAC was set at ⩾0.05g/dl. Substances were categorised as medicines, illegal drugs and other. Medicines were coded by the Anatomical Therapeutic Chemical (ATC) classification system. Joinpoint regression, univariate odds ratios, age and sex-adjusted odds ratios and Forward Stepwise logistic regression were performed. BAC information was available for 6744 suicides, 92% of all cases in 2004-2015. The final model showed that independent factors distinguishing BAC+ from BAC- were: age group 25-44 years, Australian Indigenous background, being separated or divorced, hanging, diagnosis of substance use, lifetime suicidal ideation, relationship and interpersonal conflict, not having psychotic and other psychiatric disorder, and no nervous system drugs or any other substances in blood at the time of suicide. Our findings suggest that people who die by suicide while under the influence of alcohol are more likely to be under acute stress (e.g. separation) and not have earlier psychiatric conditions, except substance use. This highlights the importance of more strict alcohol policies, but also the need to improve substance use treatment.

Geographic gender differences in traumatic unintentional injury hospitalization and youth drinking

IntroductionFew studies have used both spatial and non-spatial techniques to the study of alcohol outcomes. The objectives of this study were to identify clusters of traumatic unintentional injury hospitalizations by gender and blood alcohol concentration (BAC), and to determine trends and correlates by BAC levels. MethodsState Trauma Registry data capturing unintentional injuries for those aged 10 to 24 hospitalized with negative and positive BAC levels (n = 6233) were analyzed from 2006 to 2015 for all Chicago block groups. Spatial clustering techniques were applied to detect spatial clusters and Generalized Estimating Equations to determine correlates and trends while controlling for correlation within block groups. ResultsRegardless of BAC level, hospitalization rates decreased for all age groups between 2006 to 2010 and 2011 to 2015 from 94.41 to 67.69 per 100,000 population. The decline for males hospitalized with positive BAC was 1.4 times greater than the decline for their female counterparts. Risk factors included being male, black or of a minority race, having no private insurance and living in a disadvantaged neighborhood. Male hospitalization rates clustered among 33 census block groups located in three Chicago Community Areas. No clustering was detected for female patients. Motor vehicle accidents were the leading cause of hospitalization. ConclusionsHospitalizations are decreasing in Chicago, yet the risk is concentrated, with greater decreasing rates among males than females. Spatial approaches can be valuable tools in analyzing substance abuse outcomes, to identify high-risk areas and shifts in risk within a large geographic area.

Patient-level factors are more salient than a legislation prohibiting minors in bars in predicting unintentional injury hospitalizations

BackgroundAlcohol related homicide, suicide and aggravated assault represent the largest costs for the state of Illinois. Previous research has examined the impact of some alcohol-related policies on youth alcohol use and alcohol-related harm in the United States but findings have been mixed. To our knowledge, no study has provided a detailed epidemiology of the relationship between the impacts of alcohol policies on unintentional injury in Illinois. Therefore, the purpose of this study is to determine whether a legislation that prohibit minors under 21 years old in establishments that serve alcohol is more salient than individual level factors in predicting hospitalization for traumatic unintentional injuries.MethodsA retrospective observational study of data abstracted from 6,139 patients aged 10 to 19 hospitalized in Illinois Level I and Level II trauma centers. Patient data from 2006 to 2015 was linked with the city-level alcohol-related legislation (n = 514 cities). The response variable was whether a patient tested positive or negative for blood alcohol concentration (BAC) at the time of admission. Mixed-effects logistic regression analyses were conducted to model the patient and city level legislation effect of having a positive BAC test result on hospitalizations after adjusting for the legislation and patient factors.ResultsAfter adjustment, patients aged 15 to 19 and white patients who tested positive for BAC at the time of admission had the greater odds of hospitalization for traumatic alcohol-related unintentional injuries compared to patients who had a negative BAC test result. However, odds of hospitalization decreased for female patients and for those with private insurance, and over time, but a significant decrease in such hospitalizations occurred during 2010, 2014 and 2015. The alcohol-related legislation of interest was not a significant predictor of traumatic alcohol-related unintentional injury hospitalization.ConclusionsPatient-level covariates were significant predictors of traumatic alcohol-related unintentional injury hospitalization; an alcohol-related legislation may not reduce hospitalizations for young patients aged 10 to 19. Therefore, to prevent underage drinking and consequences, interventions should target sex/gender, race/ethnicity and focus on both individual and environmental strategies.

Alcohol Policies and Alcohol Involvement in Intimate Partner Homicide in the U.S.

Intimate partner violence (IPV) results in deaths of both primary and corollary (i.e., nonintimate partner) victims. Alcohol use is a known risk factor for IPV, yet the relationship between alcohol policies and IPV homicides is unclear. This repeated cross-sectional study characterizes alcohol involvement, and the relationship between alcohol policies and alcohol involvement, among victims of IPV homicides in the U.S. Homicide victim data from 17 states in the National Violent Death Reporting System from 2003 to 2012 were analyzed in 2017-2018. Alcohol Policy Scale scores characterized alcohol policies by state year and were used in generalized estimating equation logistic regression models to predict the odds of alcohol involvement among victims of IPV homicide. Among victims of IPV homicide, 36.5% of primary and 41.1% of corollary victims had a blood alcohol concentration (BAC) >0.00%. Of the victims with a positive BAC, 67.6% had a BAC ≥0.08%. In adjusted models, a 10-percentage point increase in Alcohol Policy Scale score was associated with reduced odds of having a positive BAC (AOR=0.77, 95% CI=0.64, 0.93) and having a BAC ≥0.08% (AOR=0.82, 95% CI=0.68, 0.99) among all victims, primary victims (AOR=0.78, 95% CI=0.63, 0.98; AOR=0.82, 95% CI=0.65, 1.04), and corollary victims (AOR=0.61, 95% CI=0.42, 0.89; AOR=0.68, 95% CI=0.48, 0.97). Alcohol use was prevalent among victims of IPV homicide, and more-restrictive alcohol policies were associated with reduced odds of alcohol involvement. Strengthening alcohol policies is a promising strategy to reduce alcohol-involved IPV homicide victimization.

The relationship between impaired control, impulsivity, and alcohol self-administration in nondependent drinkers.

Impaired control over drinking is a significant marker of alcohol use disorder (AUD), and a potential target of intervention (Heather, Tebbutt, Mattick, & Zamir, 1993; Leeman, Toll, Taylor, & Volpicelli, 2009). Impaired control may be related to, but conceptually distinct from, impulsivity (Leeman, Patock-Peckham, & Potenza, 2012; Leeman, Ralevski, et al., 2014). However, the relationship between impaired control, impulsivity, and alcohol consumption, particularly in nondependent drinkers is less clear. This study aimed to characterize these relationships using a free-access intravenous alcohol self-administration (IV-ASA) paradigm in nondependent drinkers (N = 48). Results showed individuals with higher self-reported impaired control achieved higher blood alcohol concentrations (BAC) during the IV-ASA session and reported greater hedonic subjective responses to alcohol. Higher impaired control was also associated with greater positive urgency and reward sensitivity. Moderated-mediation analysis showed that the relationship between positive urgency and peak BAC was mediated by impaired control, and partially moderated by subjective alcohol response. These findings highlight the critical role of impaired control over drinking on alcohol consumption and subjective responses in nondependent drinkers. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Falls from a balcony while intoxicated: a new injury trend among young adults?

BackgroundUnintentional falls from heights, including balconies, result in life threatening traumatic injury. Alcohol, when combined with environmental factors and poor judgement, can potentially lead to fatal outcomes. One trauma center’s registry identified a group of young adults falling from balconies and we investigated the role of alcohol.MethodsHospital trauma service admissions from 2010 through 2017 were reviewed for unintentional falls from heights. Suicide attempts and unintentional falls off ladders or roofs were excluded. Data were obtained from trauma registry and medical record review, as well as social work service interviews.ResultsFalls from heights comprised 4.8% of injuries treated at our trauma center during the eight-year study period with 98.5% admitted. Of patients admitted because of falls, 10.3% (55/532) were from a balcony. The majority of this group of patients was male and 19–29 years old (67%). Of patients with a blood alcohol concentration (BAC) determination, 62% had a positive BAC upon hospital admission with an average of 0.20 g/dL among those 34 patients. No gender differences were evident for alcohol use. Seven of the eight patients under the legal drinking age of 21 years were a subgroup with high alcohol use as compared with patients 21 years and older (p = 0.099). Ninety-four percent of falls occurred at residential locations such as dormitories or apartment complexes, often during a social event. Backward falls off railings and attempts to jump to adjoining balconies were common. Head, thorax/abdomen, and extremity fractures were common, with an average injury severity score (ISS) of 16. Average length of hospital stay was 8 days. Most patients (67%) were discharged home after hospital stay, but 21% were transferred to inpatient rehabilitation or skilled nursing facilities. There were two deaths.ConclusionsFalls from balconies among young adults occur in our area yet the true frequency of these events remain unknown. Occurrence was most common among underage drinkers. Generalization is difficult with this small sample, yet high risk behaviors and environmental factors were evident. It is imperative that educational programs focus on this population with collaborative prevention efforts focused on the dangers of, and increased risk of injury associated with the balcony environment.

The Influence of Alcohol and Drugs on Drowning among Victims of Senior Years

Unintentional fatal drowning among older people is an issue as lifespans lengthen and older people embrace active retirement. While pre-existing medical conditions are a known risk factor for drowning among this age group, less is known about the role of alcohol and drugs. This 15-year (1 July 2002 to 30 June 2017) Australian study used coronial data to investigate the impact on older people (aged 65 years and older) of the obtundent effects of prescribed drugs which had been ingested by those with a positive blood alcohol concentration (BAC). Of the closed coronial cases with toxicological information (N = 471), one quarter (24.6%; N = 116) had consumed alcohol prior to drowning (one in seven BAC ≥ 0.05%), of which a third also had obtundent drugs present (33.6%; N = 39). Rivers/creeks/streams and swimming pools were the locations with the highest number of drowning deaths. Bathtubs (36.8%) and rivers/creeks/streams (17.9%) recorded the highest proportion of cases with victims having a BAC ≥ 0.05%. Bathtubs (13.2%), lakes (7.0%), and rivers/creeks/streams (6.8%) recorded the highest proportion of drowning cases with obtundent drug involvement. Obtundent drug involvement was significantly more likely for activities where the person who drowned was alone (i.e., unknown activity) (X2 = 6.8; p = 0.009). Common obtundent drugs included Diazepam, Tempazepam, and Codeine. Advocacy to prevent drowning in older people is a complex challenge, due to the myriad of locations where drowning occurs, the consumption of alcohol, and polypharmacy required for treating illness and maintaining good health.

High on drugs: Multi-institutional pilot study examining the effects of substance use on acute pain management

IntroductionSubstance use and abuse may have the significant, but unanticipated, consequence of lessening the efficacy of opioid analgesics for acute pain management. We hypothesized that pre-injury substance use increases opioid analgesic consumption following traumatic injury. MethodsThis retrospective multi-institutional pilot study included admitted patients to four level 1 trauma centers with vehicular trauma over four months (n = 176). We examined the effect of positive urine drug screen (UDS; 7-drug panel, examined individually and combined, yes/no) and positive blood alcohol content (BAC, ≥80 mg/dL) on pain management with opioid analgesics over the hospital stay. Average daily opioid consumption was examined using a repeated measures mixed model, by positive UDS and BAC findings, adjusting for age, injury severity score, and non-opioid analgesia. Opioid analgesics were converted to milligram morphine equivalents (MME) and analyzed with a square-root transformation due to non-normality. ResultsA positive drug or alcohol test was reported in 33.5% (59/176), including 12.5% (n = 22) with positive UDS and 26% (n = 45) with a positive BAC. There were no differences in gender, injury severity scores, Glasgow coma scores, or cause of vehicular trauma between substance users and non-users; only age was significantly different. Patients with a positive UDS consumed significantly more opioids compared to those with a negative UDS (34.7 MME vs. 24.7 MME, p = 0.04), after adjustment. Individually, detection of opiates, THC, cocaine, and amphetamines were associated with increased opioid consumption compared to their UDS negative counterparts; on the other hand, benzodiazepines and alcohol intoxication were associated with reduced opioid consumption during the course of hospitalization. However, none of the individual UDS results reached statistical significance. The largest effect of all the individual drugs was with opiates, which was associated with a borderline significant increase in opioid analgesic consumption (p = 0.06). ConclusionsOur preliminary data suggest drug use may significantly alter acute pain management following traumatic injury, corresponding to 40% increase in opioid analgesia for substance users than non-users. These results may have broad reaching implications because of the high prevalence of substance use in the trauma population.

Alcohol and marijuana use among young injured drivers in Arizona, 2008–2014

Objective: We examined alcohol and marijuana use among injured drivers aged 16–20 years evaluated at Arizona level 1 trauma centers during 2008–2014.Methods: Using data from the Arizona State Trauma Registry, we conducted a descriptive analysis of blood alcohol concentration (BAC) and qualitative test results (positive or negative) for delta-9-tetrahydrocannabinol (THC) by year of age, sex, race, ethnicity, injury severity, seat belt use, motorcycle helmet use, and type of vehicle driven. To explore compliance with Arizona’s motorcycle helmet law requiring helmet use for riders <18 years old, we examined helmet use by age.Results: Data on 5,069 injured young drivers were analyzed; the annual number of injured drivers declined by 41% during the 7-year study period. Among the 76% (n = 3,849) of drivers with BAC results, 19% tested positive, indicating that at least 15% of all drivers had positive BACs. Eighty-two percent of the BAC-positive drivers had BACs ≥0.08 g/dL, the illegal threshold for drivers aged ≥21 years. Among the 49% (n = 2,476) of drivers with THC results, 30% tested positive, indicating that at least 14% of all drivers were THC-positive. American Indians and blacks had the highest proportion of THC-tested drivers with positive THC results (38%). In addition, 28% of tested American Indians had positive results for both substances, more than twice the proportion seen in all other race or ethnic groups. Crude prevalence ratios suggested that drivers who tested positive for alcohol or THC were less likely than those who tested negative to wear a helmet or seat belt, further increasing their injury risk. Helmet use among motorcyclists was lower among 16- and 17-year-old riders compared to 18- to 20-year-olds, despite Arizona’s motorcycle helmet law requiring riders aged <18 years to wear a helmet.Conclusions: About 1 in 4 injured drivers aged 16–20 years tested positive for alcohol, THC, or both substances. Most drivers with positive BACs were legally intoxicated (BAC ≥0.08 g/dL). All substance-using young drivers in this study were candidates for substance abuse screening and possible referral to treatment. Broader enforcement of existing laws targeting underage access to alcohol and alcohol-impaired driving could further reduce injuries among young Arizona drivers. To further reduce crash-related injuries and fatalities among all road users, the state could consider implementing a primary enforcement seat belt law and a universal motorcycle helmet law.

Blood alcohol levels in road traffic accidents: Factors associated and the relationship between history of alcohol consumption and blood alcohol level detection.

Introduction:Alcohol consumption contributes to a significant number of road traffic accidents (RTAs), and data regarding the reliability of history and blood alcohol content (BAC) in RTA victims are scant.Methodology:This retrospective study was conducted in the emergency departments (EDs) over 6 weeks. All adult RTAs presenting within 12 h of the incident were included for analysis.Results:The study cohort included 369 RTA patients, with the mean interval before presentation being 3 h (standard deviation: 2.22). Two-wheeler accidents (77.2%) were the predominant mode of injury. Usage of a helmet and seat belt was documented in a meager (6.4% [17/267] and 8.8% [3/34], respectively). A positive history of alcohol consumption was reported by 19.5% of cases (72/369). However, BAC was detectable in 30.1% of cases (111/369), with an alarming 19.78% (73/369) being above the legal limit for driving. Nearly 77.5% (86/111) of those who tested positive for alcohol consumption were driving the vehicle involved. Positive BAC levels showed a significant association with young age (18–39 years), male gender, two-wheeler usage, and between 5 PM and 12 AM.Conclusion:A history of alcohol consumption leading to an RTA is not reliable in the ED. Hence, measuring BAC levels in all RTA patients provides an objective and reliable form of documentation for medico-legal purposes.

Breathalysing and surveying river users in Australia to understand alcohol consumption and attitudes toward drowning risk

BackgroundLittle is known about people’s river usage, a leading drowning location. This study examines alcohol consumption patterns of river users and their attitudes to drowning risk.MethodsA convenience sample of adult (18+ years) river users were surveyed at four river locations. The survey covered eight domains: demographics; river attendance frequency; frequency of engaging in water activities; drinking patterns; alcohol and water safety knowledge; alcohol and water safety attitudes; alcohol consumption; and Blood Alcohol Concentration (BAC). For BAC, participants were asked to record time since their last alcoholic drink and were then breathalysed to record an estimate of their BAC. BAC was examined by BAC reading (negative, positive, ≥0.050%). Hazardous lifetime drinking levels were calculated and their impact on drowning risk evaluated. Univariate and chi square analysis (95% confidence interval) was conducted.ResultsSix hundred eighty four people participated (51.6% female; 49.0% aged 18–34 years). Sixteen percent (15.9%) had a positive BAC (Mean + BAC = 0.068%; SD ± 0.08; Range = 0.001–0.334%), with 7.2% ≥0.050% (Mean BAC ≥0.050% =0.132%; SD ± 0.06). Those significantly more likely to record a BAC ≥0.050% at the river were: aged 18–34 years, resided in inner regional and low socio-economic areas, visited the river in the afternoon, with friends, on days with higher maximum air temperatures, frequent river users (11+ times in the last 30 days) and those who spend longer in the water (301+ minutes). River users who recorded a BAC ≥0.050% were more likely to self-report engaging in risky activities (i.e. diving into water of unknown depth and jumping into the river from height). River users on Australia day (a national public holiday) were significantly more likely to drink heavily (Mean BAC ≥0.05% = 0.175%; SD ± 0.09).ConclusionsDespite males accounting for 85% of alcohol-related river drowning deaths, similar numbers of males and females were consuming alcohol at the river. This study has addressed a gap in knowledge by identifying river usage and alcohol consumption patterns among those at increased drowning risk. Implications for prevention include delivering alcohol-related river drowning prevention strategies to both males and females; at peak times including during hot weather, afternoons, public holidays and to river users who swim.

Methods for investigating crash risk: Comparing case–control with responsibility analysis

Objective: There are 2 primary methods for establishing relative risk: case–control studies, in which crash and matched control data are collected separately, and responsibility analysis, which exploits a single existing crash database by using nonresponsible drivers as an “induced exposure” control group (which is less expensive and therefore more feasible for examining the large number of substances that can impact driving behavior). Though both approaches are scientifically sound and methodologically valid, each approach has its own inherent obstacles to overcome. In this article, we examine in detail how different criteria for the development of control cases influence the accuracy of crash risk estimates for drivers with positive blood alcohol concentrations (BACs).Methods: We applied responsibility analysis to crash-involved drivers in a recent crash case–control study, thereby providing 2 sets of control cases: Those from responsibility analysis and those from the case control study.Results: Case–control and responsibility analysis crash risk curves did not differ significantly, indicating that both systems generate valid estimates of the relative crash risk of drivers on the road.Conclusions: The results suggest that when researchers are faced with finance or time constraints that make case–control studies infeasible, responsibility analysis should be considered a viable alternate methodological approach.