Positive Blood Alcohol Concentration Research Articles

DUI histories in intoxicated injured bicyclists.

It has been well documented that the use of alcohol correlates with injury risk, especially in DUI (driving under the influence) and DWI (driving while intoxicated). Consumption of alcohol in patients presenting with bicycle-related injuries is associated with greater injury severity, longer hospitalization, and higher health care costs. We hypothesized that intoxicated patients operating a bicycle with traumatic injuries have previous DUI or DWI convictions and had lost their privilege to drive a motor vehicle, resorted to bicycling, and had continued alcohol consumption despite negative previous consequences. We retrospectively collected data on injured bicyclists older than 18 years with positive blood alcohol content levels treated from the period January 2009 to June 2014 at a large Level 1 urban trauma center. We then matched each patient by name and date of birth and were able to obtain public criminal records through the Superior Court of California for the local of county. A total of 149 injured bicyclists with positive blood alcohol levels were identified. Their average blood alcohol content was 236.0 mg/dL, and their average age was 41 years. Sixty-six (44.2%) of these patients had prior DUI/DWI convictions with suspension of driving privileges. Ninety-five patients in this group (63.8%) had no health insurance, and 51 patients (34.2%) tested positive for other drugs. Intoxicated bicyclists trended toward longer hospital length compared with nonintoxicated bicyclists (4.60 vs. 3.44 days; p = 0.07). Three (0.02%) of 149 patients were charged with bicycling while intoxicated. Intoxicated bicyclists involved in trauma are more likely to have a previous DUI/DWI, have other drug use, tend to have longer hospital stays, and are less likely to have insurance. Bicycle safety education and behavior modification targeting DUI/DWI offenders are warranted. In order to promote injury prevention, resources to increase awareness of this underestimated public health issue should be promoted. Epidemiologic study, level III.

Alcohol Involvement in Homicide Victimization in the United States.

Although the association between alcohol and homicide is well documented, there has been no recent study of alcohol involvement in homicide victimization in U.S. states. The objective ofthis article was to determine the prevalence of alcohol involvement in homicide victimization and toidentify socio demographic and other factors associated with alcohol involvement in homicide victimization. Data from homicide victims with a reported blood alcohol content (BAC) level were analyzed from 17 states from 2010 to 2012 using the National Violent Death Reporting System. Logistic regression was used to investigate factors associated with the odds of homicide victims having a BAC≥0.08%. Among all homicide victims, 39.9% had a positive BAC including 13.7% with a BAC between 0.01% and 0.79% and 26.2% of victims with a BAC≥0.08%. Males were twice as likely as females to have a BAC≥0.08% (29.1% vs. 15.2%; p<0.001). Characteristics that were independent predictors of homicide victims having a BAC≥0.08 included male sex, American Indian/Alaska Native race, Hispanic ethnicity, history of intimate partner violence, and nonfirearm homicides. Alcohol is present in a substantial proportion of homicide victims in the United States, with substantial variation by state, demographic, and circumstantial characteristics. Future studies should explore the relationships between state-level alcohol policies and alcohol involvement among perpetrators and victims of homicide.

Alcohol Intoxication Reduces Systemic Interleukin-6 Levels and Leukocyte Counts After Severe TBI Compared With Not Intoxicated TBI Patients.

The effect of alcohol consumption on inflammatory state and outcome in brain-injured patients remains controversial. We analyzed the influence of positive blood alcohol concentration (BAC) on inflammatory changes, inhospital complications, and mortality in traumatic brain injury (TBI) patients. Patients with an Injury Severity Score (ISS) at least 16 and Abbreviated Injury Scale of head (AIS-head) at least 3 were included upon arrival in the emergency room and grouped according to positive BAC (>0.5‰, BAC) vs. less than 0.5‰ alcohol (no BAC). Injury severity, vital signs, complications, mortality, and systemic interleukin (IL)-6 levels were prospectively determined, and BAC was quantified. According to ISS, AIS-head, age, and sex, we performed matched-pair analysis. A total of 101 TBI patients were included. Of them 74 patients were dedicated to no BAC group and 27 to BAC group. ISS was significantly higher in the no BAC group. Positive BAC group required significantly less packed red blood cells and fresh frozen plasma (P < 0.05). Shorter ICU stays were found in BAC-positive patients. Inhospital complications, including single/multiple organ failure, systemic inflammatory response syndrome, sepsis, pneumonia, and acute respiratory distress syndrome, showed no significant differences. Systemic IL-6 levels and leukocyte counts (IL-6: 65.0 ± 8.0 vs. 151.8 ± 22.3; leukocytes: 10.2 ± 0.9 vs. 13.2 ± 0.8, both P < 0.05) were significantly lower in BAC-positive patients. Matched-pair analysis was performed with 27 pairs. No significant differences in transfusions were monitored after matching. However, lowered systemic IL-6 levels and leukocyte counts in the BAC group were also detected after matching, indicating that this effect is ISS-independent. This study shows that positive BAC in TBI patients is associated with lower systemic IL-6 levels and leukocyte numbers, indicating that positive BAC may have immunosuppressive effects in this cohort of patients compared with TBI patients who were not alcohol intoxicated.

Ethanol-related death in Ga-Rankuwa road-users, South Africa: A five-year analysis

Ethanol and road traffic fatalities are a public health concern. The purpose of this study was to examine blood alcohol concentrations in different road-users in the jurisdiction of Ga-Rankuwa, South Africa according to epidemiological variables. A retrospective descriptive study involving 672 road-users over 5 years was done. Drivers presented the largest proportion of victims with positive blood alcohol concentrations, followed by pedestrians and motorcyclists with a great proportion of road-users showing levels above 0.05 g/100 ml. The majority of victims were adult males. Among the female victims, drivers and pedestrians had relatively high blood alcohol concentrations. The majority of fatalities occurred at night, during weekends, and in the spring with August being the month with the most fatalities. The most common injuries were external injuries and injury to the head and chest. Cause of death, irrespective of blood alcohol concentrations, was multiple injuries. The results showed that ethanol was associated with road traffic fatalities in Ga-Rankuwa.

The Legal Limit: Differences in Injury Severity Score for Vehicular Crashes.

In 2013, the National Transportation Safety Board advised lawmakers in the United States to reduce the legal limit of blood alcohol content (BAC) from 0.08% to 0.05%. The purpose of this research was to evaluate the rationale for reducing the legal limit of BAC to 0.05% through analysis of the relationship between BAC and injury severity. A correlational study was conducted on patients with positive BAC involved in a motor vehicular collision. Retrospective review of 446 trauma patients (aged 18-80 years) injured in a vehicular collision routinely screened for BAC was conducted. Two groups were compared: Group 1, patients with nonzero blood alcohol concentration (n = 101); and Group 2, patients with zero blood alcohol (n = 345). Standard statistical analyses were utilized. A total of 101 patients (23%) had a detectable BAC on admission. Patients with a detectable BAC were younger (33 and 44 years) and more likely to be male (27% and 16%). There was no statistically significant association between both injury severity score (ISS) and BAC or between ISS and age. There was no significant correlation between higher BAC and a higher ISS. Positive BAC alone may not affect ISS, but the potential for risk-taking behaviors by drivers under the influence may increase injury severity.

P052: The effect of blood alcohol on outcomes in patients with major traumatic brain injury in Nova Scotia

Introduction: Although alcohol use increases the risk of experiencing a traumatic brain injury (TBI), it remains unclear whether outcomes in alcohol-impaired patients are different from those of unimpaired patients. The objective of this study was to evaluate the effect of alcohol on length of stay (LOS) and mortality in patients with major TBI. Methods: Using data collected from the Nova Scotia Trauma Registry, we performed a retrospective analysis of all patients with major TBI (defined as having an abbreviated injury score (AIS) head ≥3) seen in Nova Scotia hospitals between 2002 and 2013. Patients were compared by blood alcohol concentration (BAC) at time of injury: negative (0-1.9 mmol/L), low (2-21 mmol/L), and moderate/high (≥22 mmol/L). A logistic regression model was constructed to test for outcomes and adjusted for the effects of age, gender, location, injury severity score (ISS), and BAC level. Results: In a twelve-year period, there were 4152 major TBI patients in Nova Scotia. Alcohol testing was performed in 43% of cases (80% male, mean age 44±20 years), with 48% having a positive BAC. Mean acute LOS was similar for all three BAC groups. Increasing age (odds ratio [OR]=1.01; p&lt;0.001), high ISS (OR=4.92; p&lt;0.001), injuries occurring outside of Halifax Regional Municipality (OR=1.72; p&lt;0.001), and having a lower BAC level (OR = 0.99; p&lt;0.001) independently predicted mortality. Conclusion: Our findings suggest that low BAC levels are associated with increased mortality in major TBI patients. Further study is warranted to elucidate alcohol’s mechanism in TBI outcomes.

Alcohol consumption decreases lactate clearance in acutely injured patients

IntroductionAlcohol, a common risk factor for injury, has direct toxic effects on the liver. The use of lactate clearance has been well described as an indicator of the adequacy of resuscitation in injured patients. We investigated whether acutely injured patients with positive blood alcohol content (+BAC) had less lactate clearance than sober patients. MethodsWe conducted a retrospective cohort study of acutely injured patients treated at an urban Level 1 trauma centre between January 2010 and December 2012. Blood alcohol and venous lactate levels were measured on all patients at the time of arrival. Study subjects were patients transported directly from the scene of injury, who had an elevated lactate concentration on arrival (≥3.0mmol/L) and at least one subsequent lactate measurement within 24h after admission. Lactate clearance ([Lactate1−Lactate2]/Lactate1) was calculated for all patients. Chi-squared tests were used to compare values from sober and intoxicated subjects. Lactate clearance was plotted against alcohol levels and stratified by age and Injury Severity Score (ISS). ResultsSerial lactate concentration measurements were obtained in 3910 patients; 1674 of them had +BAC. Patients with +BAC were younger (mean age: 36.6 [SD 14.7] vs 41.0 [SD 19.9] years [p=0.0001]), were more often male (83.4% vs 75.9% [p=0.0001]), had more minor injuries (ISS<9) (33.8% vs 27.1% [p=0.0001]), had a lower in-hospital mortality rate (1.4% vs 3.9% [p=0.0001]), but also had lower average lactate clearance (37.8% vs 47.6% [p=0.0001]). The lactate clearance of the sober patients (47.6 [SD 33.5]) was twice that of those with +BAC >400 (23.5 [SD 6.5]). Lactate clearance decreased with increasing BAC irrespective of age and ISS. ConclusionsIn a large group of acutely injured patients, a dose-dependent decrease in lactate clearance was seen in those with elevated BAC. This relationship will cause a falsely elevated lactate reading or prolong lactate clearance and should be taken into account when evaluating patients with +BAC.

Blood Alcohol Concentrations in Suicide and Motor Vehicle Crash Decedents Ages 18 to 54.

Using postmortem data, we examined the hypotheses that high (and very high) blood alcohol concentrations (BACs) are more common among motor vehicle crash decedents (MVCs) than among suicide decedents, whereas low alcohol levels are more common among suicides. We examined BAC in 224 suicide decedents and 166 MVCs ages 18 to 54 in the state of New Mexico in 2012. Comparisons between the groups were made based on differing BAC levels using 0.080 g/dl categories including low (0.001 to 0.079 g/dl), high (0.080 to 0.159 g/dl), and very high BAC (≥0.160 g/dl), and based on 0.100 g/dl categories including low (0.001 to 0.099 g/dl), high (0.100 to 0.199 g/dl), and very high BAC (≥0.200 g/dl), with these groups compared with a no-alcohol reference (0.000 g/dl) in separate analyses. Multivariate logistic regressions compared suicides with MVCs that adjusted for age, sex, and race/ethnicity. Support for the hypothesis that suicides are more likely to have a low BAC level was supported in the analysis using the 0.100 g/dl categorizations. Neither analysis supported the hypothesis that MVCs are more likely to have high (or very high) BACs compared with suicides. Among both injury groups with positive BACs, low BACs were least common. Low BAC levels may be more likely to be observed among suicides compared with MVCs, a possible reflection of the more varied role that alcohol plays in suicide compared with MVC. Nonetheless, high (and very high) BAC is the predominant scenario in both suicides and MVCs with positive BAC.

Prevalence of alcohol-impaired driving and riding in northern Ghana

ABSTRACTObjective: The objective of this study was to determine the roadside prevalence of alcohol-impaired driving among drivers and riders in northern Ghana. The study also verifies motorists' perceptions of their own alcohol use and knowledge of the legal blood alcohol concentration (BAC) limit in Ghana.Method: With the assistance of police, systematic random sampling was used to collect data at roadblocks using a cross-sectional study design. Breathalyzers were used to screen whether motorists had detectable alcohol in their breath and follow-up breath tests were conducted to measure the actual breath alcohol levels among positive participants.Results: In all, 9.7% of the 789 participants had detectable alcohol, among whom 6% exceeded the legal BAC limit of 0.08%. The prevalence of alcohol-impaired driving/riding was highest among cyclists (10% of all cyclists breath-tested) followed by truck drivers (9%) and motorcyclists (7% of all motorcyclists breath-tested). The occurrence of a positive BAC among cyclists was about 8 times higher (odds ratio [OR] = 7.73; P < .001) and it was 2 times higher among motorcyclists (OR = 2.30; P = .039) compared to private car drivers. The likelihood for detecting a positive BAC among male motorists/riders was higher than that among females (OR = 1.67; P = .354). The odds for detecting a positive BAC among weekend motorists/riders was significantly higher than on weekdays (OR = 2.62; P = .001).Conclusion: Alcohol-impaired driving/riding in Ghana is high by international standards. In order to attenuate the harmful effects of alcohol misuse such as alcohol-impaired driving/riding, there is the need to educate road users about how much alcohol they can consume and stay below the legal limit. The police should also initiate random breath testing to instill the deterrence of detection, certainty of apprehension and punishment, and severity and celerity of punishment among drink-driving motorists and riders.

Abstracts from The 12th Symposium of the International Neurotrauma Society February 1-4, 2016 Cape Town, South Africa.

Abstracts from The 12th Symposium of the International Neurotrauma Society February 1-4, 2016 Cape Town, South Africa.

Effects of positive blood alcohol concentration on outcome and systemic interleukin-6 in major trauma patients

BackgroundThe influence of alcohol on the outcome after major trauma remains controversial. In several recent studies, alcohol has been associated with neuroprotective effects in head injuries, while others reported negative or no effects on survival and/or the in-hospital stay in major trauma patients (TP). The purpose of this study was to examine the relationship of alcohol with injury characteristics and outcome as well as to analyze possible anti-inflammatory properties in major TP. Patients/methods184 severely injured TP with an Injury Severity Score (ISS) ≥16 were successively enrolled. All patients had measured blood alcohol concentration (BAC). Patients were grouped according to their positive BAC (>0.5‰, BAC) vs. <0.5‰ alcohol (no BAC) upon arrival at the emergency department (ED). Injury characteristics, physiologic parameters and outcome with respect to organ or multiple organ failure (MOF), SIRS, sepsis, pneumonia, ARDS or mortality were assessed. Systemic levels of interleukin (IL)-6 at ED were determined. ResultsForty-nine TP had positive BAC without chronic alcohol abuse history and 135 patients had BAC levels below 0.5‰. Overall injury severity and age were comparable in both groups. No BAC TP received significantly higher numbers of packed red blood cells and fresh frozen plasma (transfused within the initial 24h or in total) compared to BAC TP. Organ failure, MOF, SIRS, sepsis, pneumonia, ARDS and the in-hospital mortality were not different between both groups. Trauma patients with positive BAC had significantly decreased leukocyte numbers and systemic IL-6 levels compared to no BAC group. There was a significant positive correlation between leukocyte counts and IL-6 as well as BAC and leukocytes. BAC levels did not correlate with IL-6. ConclusionsPositive BAC is associated with reduced leukocyte numbers and lowered systemic IL-6 levels at admittance indicating immune-suppressive effects of alcohol in major trauma patients.

Alcohol and mortality after moderate to severe traumatic brain injury: a meta-analysis of observational studies

OBJECT Experimental studies have shown numerous neuroprotective properties of alcohol ("ethanol") after TBI, but clinical studies have provided conflicting results. The authors aimed to assess the relationship between positive blood alcohol concentration (BAC) on hospital admission and mortality after moderate to severe traumatic brain injury (TBI). METHODS The authors searched 8 databases for observational studies reported between January 1, 1990, and October 7, 2013, and investigated the effect of BAC on mortality after moderate to severe TBI. Reviews of each study were conducted, and data were extracted according to the MOOSE and PRISMA guidelines. Study quality was assessed using the Newcastle-Ottawa scale. The Mantel-Haenszel fixed effect methodology was used to generate pooled estimates. Heterogeneity was dealt with by multiple sensitivity analyses. RESULTS Eleven studies with a total of 95,941 patients (42% BAC positive and 58% BAC negative) were identified for the primary analysis (overall mortality 12%). Primary analysis showed a significantly lower risk of death for BAC-positive patients compared with BAC-negative patients (crude mortality 11.0% vs 12.3%, pooled OR 0.84 [95% CI 0.81-0.88]), although flawed by heterogeneity (I(2) = 68%). Multiple sensitivity analyses, including 55,949 and 51,772 patients, yielded similar results to the primary analysis (crude mortality 12.2% vs 14.0%, pooled OR 0.87 [95% CI 0.83-0.92] and crude mortality 8.7% vs 10.7%, pooled OR 0.78 [95% CI 0.74-0.83]) but with good study homogeneity (I(2) = 36% and 14%). CONCLUSIONS Positive BAC was significantly associated with lower mortality rates in moderate to severe TBI. Whether this observation is due to selection bias or neuroprotective effects of alcohol remains unknown. Future prospective studies adjusting for TBI heterogeneity is advocated to establish the potential favorable effects of alcohol on outcome after TBI.

A new paradigm for credibly administering placebo alcohol to underage drinkers

BackgroundThe primary goal of this study was to establish a paradigm for credibly administering placebo alcohol to underage drinkers. We also sought to create a new, valid procedure for establishing placebo alcohol believability. MethodParticipants were 138 American college students (66.7% female) predominantly (90.0%) under the legal drinking age. Groups of 2–3 participants and one same-sex confederate consumed mixed drinks, purportedly containing alcohol, ad-lib in a naturalistic bar-laboratory for 20min. All beverages, however, were non-alcoholic but we used visual, olfactory, and taste cues to maximize placebo credibility. Also, the confederate made two scripted statements designed to increase the perception of drinking real alcohol. After the drinking portion, participants responded to survey items related to alcohol consumption and intoxication. Next, they were individually debriefed, with open-ended responses used to make a determination of whether the participant was deceived with respect to placebo alcohol. ResultsAll participants estimated consuming some amount of alcohol. However, using a more conservative criteria for estimating alcohol believability based on the debrief, 89.1% of participants were classified as deceived. Deceived participants were much more likely to estimate having a positive blood alcohol content and to say that their current level of intoxication was typical given the amount of alcohol consumed than non-deceived participants. DiscussionCredibly administering placebo alcohol to underage drinkers is possible. This approach carries great potential for future laboratory work. In addition, the methodology used here to classify participants as deceived or not deceived appears valid based on self-reported BAC estimation and intoxication levels.

Bicycle-related hospitalizations at a Taiwanese level I Trauma Center.

BackgroundThis study aimed to investigate differences in injury severity and mortality between patients who met with bicycle or motorcycle accidents and were hospitalized at a Level I trauma center in Taiwan.MethodsWe performed a retrospective analysis of bicycle-related injuries that have been reported in the Trauma Registry System in order to identify and compare 699 bicyclists to 7,300 motorcyclists who were hospitalized for treatment between January 1, 2009 and December 31, 2013. Statistical analyses of the injury severity, associated complications, and length of stay in the hospital and intensive care unit (ICU) were performed to compare the risk of injury of bicyclists to that of motorcyclists with the corresponding unadjusted odds ratios and 95 % confidence intervals (CIs). Adjusted odds ratios (AORs) and 95 % CIs for mortality were calculated by controlling for confounding variables that included age, and an Injury Severity Score (ISS) was calculated.ResultsMore of the cyclists were under 19 years of age or over 70 than were the motorcyclists. In contrast, fewer bicyclists than motorcyclists wore helmets, arrived at the emergency department between 11 p.m. and 7 a.m., and had a positive blood alcohol concentration test. The bicyclists sustained significantly higher rates of injuries to the extremities, while motorcyclists sustained significantly higher rates of injuries to the head and neck, face, and thorax. Compared to motorcyclists, the bicyclists had significantly lower ISSs and New Injury Severity Scores, shorter length hospital stays, and a smaller proportion of admittance into the ICU. However, the bicyclists had higher AORs for in-hospital mortality (AOR: 1.2, 95 % CI: 1.16–1.20). In terms of critical injury severity (ISS ≥ 25), the bicyclists had 4.4 times (95 % CI: 1.95–9.82) the odds of mortality than motorcyclists with the same ISSs.ConclusionsData analysis indicated that the bicyclists had unique injury characteristics including bodily injury patterns and lower ISSs, but had higher in-hospital mortality compared to motorcycle riders. In this study, given that only 9 % of bicyclists reported wearing helmets and considering the high mortality associated with head injury, it is possible that some bicycle riders underestimated the gravity of cycling accidents.

Commentary on "The modal suicide decedent did not consume alcohol just prior to the time of death: An analysis with implications for understanding suicidal behavior".

This is a commentary on a meta-analysis in this journal by Anestis, Joiner, Hanson, and Gutierrez (2014) that analyzed 92 studies reporting data on the presence/absence of alcohol in suicide decedents based on positive blood alcohol concentrations (BACs). The authors conclude that the weighted mean percentage of suicide decedents with positive BACs is 26.9%, a result that is underestimated by 6.7% due to a coding error. The authors argue that acute use of alcohol may not be an important proximal risk factor for suicide based largely on the fact that it is not modal in decedents, a point that overlooks the fact that risk factors need not be modal to be of major public health significance. For example, most traffic fatalities do not involve a driver who had been drinking but this does not imply that alcohol use is unimportant in road deaths. Furthermore, the authors do not discuss controlled studies providing evidence that acute use of alcohol confers marked risk. The authors also predict that the percentage of suicide decedents with positive BACs who are intoxicated is low. However, published data on alcohol levels and suicide in the United States are available and show that most suicide decedents with positive blood tests have BACs at or above the U.S. legal limit of 0.08 g/dl for drinking and driving, with mean BACs well in excess of the legal limit, evidence of intoxication.

Bicycling under the influence of alcohol

ObjectiveAccording to international data estimates the proportion bicyclists with a positive Blood Alcohol Concentration (BAC) who are involved in accidents ranges from 15% to 57%. This large variance, and the fact that the reliance on accident statistics means that only the BAC of injured bicyclists is being collected, shows that we do not really know what the average and variation in BAC of bicyclists is, particularly on nights out. MethodOn a total of four nights between 5PM and 8AM BAC levels of bicyclists were collected with a Breathalyser (N=687). Samples were collected in two Dutch cities, one with a high (Groningen), and one with a modest, student population (The Hague). ResultsThe results showed that the percentage of bicyclists who had alcohol in their blood rose over the night from 7.7% at 6PM to over 89% after 1AM. Furthermore, the percentage of bicyclists with an illegal BAC above 0.5g/l rose from zero percent at 6PM to 68% at 1AM. The average BAC of bicyclists with a BAC above zero was 0.79g/l. Differences between the two cities were limited. ConclusionCycling with illegal levels of blood alcohol turns out to be very common on nights out in the Netherlands.

Alcohol intoxication may be associated with reduced truncal injuries after blunt trauma

BackgroundPrior studies suggest that positive blood alcohol concentration (BAC) is associated with lower mortality after motor vehicle collisions (MVCs). We investigated the relationship between increasing BAC and mortality after MVC. MethodsA retrospective review of the Los Angeles County trauma database from January 2003 to December 2008 was performed. MVC patients greater than or equal to 16 years of age with admission BAC were considered. Patients were stratified by BAC as follows: BAC0 (<.01), BAC1 (.01 to .08), BAC2 (.09 to .16), BAC3 (.17 to .24), BAC4 (.25 to .32), and BAC5 (>.32). Logistic regression was used to determine predictors of mortality. ResultsA total of 12,540 patients were included. Overall mortality rate was 2.2%. Mortality was lowest in BAC3 (1.6%) and BAC4 (1.3%), although the difference among all groups was not statistically significant (P = .07). Decreased rates of Injury Severity Score greater than or equal to 16 were noted with increasing BAC, which was largely because of reduced chest and abdomen/pelvis Abbreviated Injury Scale. Adjusted mortality was lower in BAC3 and BAC4 (both adjusted odds ratio .4, P < .001). ConclusionA protective effect of alcohol after MVC may be related to decreased truncal injury burden rather than protection after head injury.

Is suicide under the influence of alcohol a deliberate self-harm syndrome? An autopsy study of lethality

BackgroundAlcohol is a risk factor for suicide and is often involded in violent actions. The aim of the study was to assess the involvement of alcohol in suicides and its relationship with the lethality of suicide methods. MethodsIn a retrospective study on autopsy reports, we compared suicide and non-suicide victims, suicides with positive and negative blood alcohol concentration (BAC), and studied the lethality of suicide methods using a multivariate analysis. ResultsSuicide victims (n=88) were not different to non-suicide victims (n=270) for positive BAC and narcotics, but were more often positive for prescription medications (59.1 vs. 35.6%, p=0.003) and medications in blood (72.7 vs. 54.8%, p=0.004). Whereas non-suicidal victims died mainly of traumas (60%, p<0.001), two populations of suicides emerged with regard to BAC, self-poisoning predominating with positive BAC (38.9%, p=0.039) and asphyxiation with negative BAC (41.4%, p=0.025). Positive BAC appeared as the unique and strong independent predictive factor, increasing the risk of self-poisoning suicide by 4.36 [1.29–14.76], and decreasing the risk of suicidal asphyxiation by 84% (OR=0.16 [0.03–0.83]). Positive blood narcotics tended to behave in the similar way to alcohol. LimitationsRecruitment bias (victims declared by the Forensic authorities) and incomplete autopsy reports are the two main limitations. ConclusionsCharacteristics of suicide victims with positive BAC are suggestive of Deliberate Self-Harm Syndrome (low lethality methods, substance misuse). These being at high risk of repeated suicide attempts, previous self-harm involving alcohol may represent a warning sign and access to medication should be limited to prevent recidivism.

Alcohol consumption in adolescent homicide victims in the city of Johannesburg, South Africa.

To describe the blood alcohol concentration (BAC) of adolescent homicide victims in Johannesburg, South Africa and to identify the victim and event characteristics associated with a positive BAC at the time of death. Logistic regression of mortality data collected by the National Injury Mortality Surveillance System (NIMSS). Johannesburg, South Africa. A total of 323 adolescent (15-19 years) homicide victims for the period 2001-9 who had been tested for the presence of alcohol. Data on the victims' BAC level, demographics, weapon or method used, scene, day and time of death were drawn from NIMSS. Alcohol was present in 39.3% of the homicide victims. Of these, 88.2% had a BAC level equivalent to or in excess of the South African limit of 0.05 g/100 ml for intoxication. Multivariate logistic analysis showed that a positive BAC in homicide victims was associated significantly with the victim's sex [male: odds ratio (OR) = 2.127; 95% confidence interval (CI) = 1.012-4.471], victim's age (18-19 years: OR = 2.364; CI = 1.343-4.163); weapon used (sharp instruments: OR = 2.972; CI = 1.708-5.171); and time of death (weekend: OR = 3.149; CI = 1.842-5.383; night-time: OR = 2.175; CI = 1.243-3.804). Excessive alcohol consumption is associated with a substantial proportion of adolescent homicides in Johannesburg, South Africa, and is more prevalent among male and older adolescent victims and in victims killed with sharp instruments over the weekends and during the evenings.

Alcohol potentiates postburn remote organ damage through shifts in fluid compartments mediated by bradykinin.

Of the 450,000 burn patients each year, 50% have a positive blood alcohol content, and this predisposes them to worsened clinical outcomes. Despite high prevalence and established consequences, the mechanisms responsible for alcohol-mediated complications of postburn remote organ damage are currently unknown. To this end, mice received a single dose of alcohol (1.12 g/kg) or water by oral gavage and were subjected to a 15% total body surface area burn. Animals with a burn alone lost ∼5% of their body weight in 24 h, whereas intoxicated and burned mice lost only 1% body weight (P < 0.05) despite a 17% increase in hematocrit (P < 0.05) and a 57% increase in serum creatinine (P < 0.05) over burn injury alone. This retention of water weight despite increased dehydration suggests that intoxication at the time of a burn causes a shift in fluid compartments that may exacerbate end-organ ischemia and damage as evidenced by a 3-fold increase in intestinal bacterial translocation (P < 0.05), a 30% increase (P < 0.05) in liver weight-to-body weight ratio, and an increase in alveolar wall thickness over a burn alone. Furthermore, administration of the bradykinin antagonist HOE140 30 min after intoxication and burn restored fluid balance and alleviated end-organ damage. These findings suggest that alcohol potentiates postburn remote organ damage through shifts in fluid compartments mediated by bradykinin.