Positive Blood Alcohol Levels Research Articles

7 Alcohol Use Acuity and Burn Mortality: A Ten-Year Retrospective Analysis

Abstract Introduction The high incidence of alcohol consumption nationally is linked to increased susceptibility for burn injuries in both cases of acute intoxication as well as chronic misuse. While detection of elevated blood ETOH levels on admission intuitively does not always reflect a patient’s history of use, it does introduce bias and can influence clinical decision-making. Understanding these inherent biases at play, our institution through a retrospective analysis, sought to investigate the differing effects a positive blood alcohol level and true chronic alcohol use disorder had on overall mortality within our burn center. Methods We conducted a retrospective analysis utilizing data from the Institutional Burn Center Registry, which was linked to clinical and administrative records. Our study included all adult patients admitted to the Burn Center between January 1, 2012, and December 31, 2022. We collected and analyzed various parameters, including patient demographics, length of hospital stay (LOS), comorbid conditions, and mortality outcomes. Using logistic regression modeling we evaluated the association between burn mortality and ETOH. Results Over the ten-year study period, a total of 9,955 adult patients were admitted to our burn center. 6,943 tested negative and 541 patients tested positive for blood ETOH on admission. The remaining 2,471 had no test. 567 were determined to have a diagnosis of alcohol use disorder. A positive for ETOH did not have significant impact on mortality (p=0.76) while history of chronic ETOH use had a nearly three-fold increase in odds of mortality (OR 2.58, CI 1.52-4.24, p=0.000) when accounting for factors present in traditional predictive models such as burn size, age, and inhalational injury. Conclusions Chronic alcoholism has a greater association with mortality than acute alcohol intoxication at our institution. Further, clinicians should exercise caution when presuming alcohol use disorder solely based on a positive test. This highlights the necessity of accurate medical history taking when estimating and counseling patients on mortality risk. Applicability of Research to Practice This emphasizes the pressing need for research into the effects of multiple comorbidities and social determinants on mortality among burn patients. The insights gained have practical implications for refining clinical approaches and optimizing care strategies for this vulnerable patient population.

Can the use of whole-body CT be reduced in cases of kinetic-based polytrauma patients without a clinical severity criterion? A bi-center retrospective study

ObjectiveTo identify clinical and biological criteria predictive of significant traumatic injury in only kinetic-based polytrauma patients without clinical severity criteria.To propose a decisional algorithm to assist the emergency doctor in deciding whether or not to perform a WBCT in the above population. MethodsRetrospective bi-center study. 1270 patients with high velocity trauma without clinical severity criteria, for whom a WBCT was performed in 2017, were included. Patients with hemodynamic, respiratory or neurological severity criterion or those requiring pre-hospital resuscitation measures were excluded.Our primary endpoint was the identification of a significant lesion, i.e. any lesion that led to hospitalization > 24 h for monitoring or medico-surgical treatment. Data collected were age, sex, mechanism of injury, Glasgow Coma Scale score, number of symptomatic body regions, blood alcohol level, and neutrophil count. ResultsMultivariate analysis found independent predictors of significant injury: fall > 5 m (OR: 14.36; CI: 2.3–283.4; p = 0.017), Glasgow score = 13 or 14 (OR: 4.40; CI:1.30–18.52; p = 0.027), presence of 2 symptomatic body regions (OR: 10.21; CI: 4.66–23.72; p = 0.05), positive blood alcohol level (OR: 2.81; CI: 1.13–7.33; p = 0.029) and neutrophilic leukocytosis (OR: 8.76; CI: 3.94–21.27; p = 0.01).A composite clinico-biological endpoint predictive of the absence of significant lesion was identified using a Classification and Regression Tree: number of symptomatic regions < 2, absence of Neutrophilic leukocytosis and negative blood alcohol concentration. ConclusionA simple triage algorithm was created with the objective of identifying, in high velocity trauma without clinical severity criteria, those without significant traumatic injury.

Screening for alcohol and drug use in pediatric trauma.

Level 1 pediatric trauma centres should screen all trauma patients aged 12 years and older for alcohol use and provide substance use interventions as a means to minimize relapse. We aimed to approximate the rate of alcohol and drug use screening in Canadian pediatric patients admitted for trauma in our centre, determine the prevalence of intoxication on admission and compare the injury characteristics and morbidity of patients with and without concomitant substance use. We conducted a single-centre retrospective review of the Stollery Children's Hospital's medical records abstracted from the Alberta Trauma Registry database of patients aged 12-17 years who were admitted for trauma (Injury Severity Score ≥ 12) between Jan. 1, 2012, and Dec. 31, 2021. Of the 543 patients included in the analysis, 380 (70.0%) received screening for alcohol as a part of their trauma panel; meanwhile, only 5 (0.9%) patients were screened for drug use. Among the patients who were screened for alcohol, 47 (12.4%) had a positive blood alcohol level (BAC). Nine (7%) of 129 screened patients aged 12-14 years were found to have positive BACs compared with 38 (15.1%) of 251 screened patients aged 15-17 years. Patient age and mechanism of injury significantly affected rates of screening. Among patients with positive BACs on admission, the 3 most prevalent mechanisms of injury were motor vehicle accident (26 [55.3%]), assault (13 [27.7%]) and recreational vehicle accidents (4 [8.5%]). Patients with a positive BAC sustained significantly more severe injuries (p = 0.003). These results provide evidence of the importance of standardized screening to identify pediatric patients admitted for trauma who are in need of treatment for alcohol and drug use. The Screening, Brief Intervention and Referral to Treatment model is the primary approach used to fulfill substance use identification and intervention recommendations. The Alcohol Use Disorders Identification Test and the Car, Relax, Alone, Forget, Friends, Trouble questionnaire are most suitable for adolescent populations.

Traumatic brain injury in college students and the influence of alcohol consumption: A retrospective review from a rural state.

There is a strong association between alcohol consumption and traumatic brain injury (TBI). Students are known to consume alcohol at a high rate. Despite the connection between alcohol and TBI, this is one of few studies to examine the connection between students, alcohol, and TBI. The objective of this study was to explore the relationship between students, alcohol, and TBI. A retrospective chart review utilizing the institutional trauma data back was performed for patients 18-26 years of age, admitted to the emergency department with a diagnosis of a TBI and positive blood alcohol. Patient diagnosis, injury mechanism, alcohol level on admission, urine drug screen, mortality, injury severity score, and discharge disposition were recorded. The data were analyzed using Wilcoxon rank-sum tests and Chi-square tests to identify differences between students and non-student groups. Six hundred and thirty-six charts were reviewed for patients aged 18-26 with a positive blood alcohol level and TBI. The sample included 186 students, 209 non-students, and 241 uncertain of status. The student group had significantly higher levels of alcohol than the non-student group (P < 0.0001). P < 0.0001 showed that overall alcohol levels for males are significantly higher than levels of alcohol for females in the student group. Alcohol consumption contributes to significant injuries such as TBI in college students. Male students had a higher prevalence of TBI, and higher alcohol levels than female students. These results can be used to inform and better target harm reduction and alcohol awareness programs.

Homicide Victims and Alcohol Related Consumption in Brazil

Introduction: Deaths due to external causes, mainly homicides, are a serious public health problem in Brazil. There is evidence that the tendency to impulsive and / or violent behavior is exacerbated after alcohol consumption. Otherwise, the relationship between alcohol and violent deaths is described in the medical literature without much precision. Objective: Analyze the relationship between victims' blood alcohol levels and homicides, in the micro-region formed by some municipalities in Greater São Paulo. Methods: Retrospectively, we reviewed the data from the medical records of 805 necropsies performed at the Medical Legal Institute of Sao Paulo (IML-SP) in Franco da Rocha, Brazil, from 2001 to 2017. Descriptive statistics were calculated to assess BAC testing status among decedents overall. The variables studied were sex, age, manner of death and blood alcohol level (BAC). Results: Of the 230 individuals analyzed, 200 (86.9%) were male and 30 (13.04%) female. The most prevalent age range for males was between 18 and 23 years (19.5%). For the women group it was between 12 and 23 years (33.2%). The vast majority of homicides (n = 162, 70.4%) was due to firearms, followed by sharp force and blunt force trauma (13% each one). Of the 230 cases of homicide victims analyzed, 205 (89,1%) presented a positive blood alcohol level (BAC), e.g, over 0,3 mg/dl. In the group of homicide victims by firearm, 57 (24,7%) of them presented a median value of BAC of 1.3 mg/ml. Discussion and Conclusions: The results of this study indicate that alcohol intoxication was common in homicide victims in Franco da Rocha from 2001-2017. It also confirms some findings from other researchers linking blood alcohol and deaths from unnatural causes. Our study showed that majority of victims are young adults, and most of them were under alcohol effect when they were murdered. So, the fact that the victims were drunk can contribute to the fatal outcome, in cases of homicide. This approach alone cannot establish that alcohol consumption is a risk factor for become a victim of homicide and further studies are necessary to a better comprehension of the effect of alcohol in homicide victims.

Suicidal ideation and sobriety: Should acute alcohol intoxication be taken into account for psychiatric evaluation?

When evaluating an emergency department (ED) patient who presents with suicidal ideation, it is a common practice to wait until the patient's ethanol level is known or calculated to be less than 80 mg/dl to evaluate patient safety. We know of no study that establishes an association between the degree of alcohol intoxication based on a blood alcohol level (BAL) and reported suicidal ideation (SI) upon recovery. We conducted a retrospective review of patients evaluated in a Midwestern ED for the calendar year 2017. Cases were selected if they had a psychiatric social work consult and a blood alcohol level drawn while in the ED. Patients were selected on the same 2 days each week throughout the year to meet the sample size requirements of the study, resulting in 1084 cases for review. Chi-square analysis was used to evaluate the relationship between suicidal ideation and alcohol intoxication as defined by a BAL ≥80 mg/dl. Among patients presenting with suicidal ideation and a concurrent BAL ≥80 mg/dl, 69% no longer reported suicidal ideation when their BAL was <80 mg/dl, compared to 38% for patients without a positive BAL on presentation (chi-square, p= 0.000012). Our data show that patients presenting to the ED with complaints related to suicidal behavior who have a BAL ≥80 mg/dl are more likely to no longer endorse having suicidal ideation once their BAL is < 80 mg/dl than patients with similar presenting complaints and no alcohol intoxication. This finding supports the common ED practice of re-assessing suicidal ideation among individuals who are initially intoxicated once their BAL has decreased below 80 mg/dl.

Fast Maturation of Splenic Dendritic Cells Upon TBI Is Associated With FLT3/FLT3L Signaling

The consequences of systemic inflammation are a significant burden after traumatic brain injury (TBI), with almost all organs affected. This response consists of inflammation and concurrent immunosuppression after injury. One of the main immune regulatory organs, the spleen, is highly interactive with the brain. Along this brain–spleen axis, both nerve fibers as well as brain-derived circulating mediators have been shown to interact directly with splenic immune cells. One of the most significant comorbidities in TBI is acute ethanol intoxication (EI), with almost 40% of patients showing a positive blood alcohol level (BAL) upon injury. EI by itself has been shown to reduce proinflammatory mediators dose-dependently and enhance anti-inflammatory mediators in the spleen. However, how the splenic immune modulatory effect reacts to EI in TBI remains unclear. Therefore, we investigated early splenic immune responses after TBI with and without EI, using gene expression screening of cytokines and chemokines and fluorescence staining of thin spleen sections to investigate cellular mechanisms in immune cells. We found a strong FLT3/FLT3L induction 3 h after TBI, which was enhanced by EI. The FLT3L induction resulted in phosphorylation of FLT3 in CD11c+ dendritic cells, which enhanced protein synthesis, maturation process, and the immunity of dendritic cells, shown by pS6, peIF2A, MHC-II, LAMP1, and CD68 by immunostaining and TNF-α expression by in-situ hybridization. In conclusion, these data indicate that TBI induces a fast maturation and immunity of dendritic cells which is associated with FLT3/FLT3L signaling and which is enhanced by EI prior to TBI.

The impact of alcohol use and withdrawal on trauma outcomes: A case control study

IntroductionMany patients admitted to hospitals with acute trauma have positive serum blood alcohol levels. Published associations between alcohol use, injury patterns, and outcomes are inconsistent. We sought to further delineate the impact of alcohol use and alcohol withdrawal on hospital outcomes amongst acute trauma patients. MethodsWe performed a retrospective analysis of adult trauma patients hospitalized at a suburban level 1 trauma center between January 2015 and September 2019 with a blood alcohol level measurement and/or classification as alcohol withdrawal syndrome (AWS). Patients were separated into three groups: BAL ≤10 mg/dL, BAL >10 mg/dL, and alcohol withdrawal syndrome (AWS). ResultsOverall, 3896 patients met study criteria with 75.6% BAL ≤10, 23.2% BAL >10, and 1.2% AWS. The median age was significantly different (BAL ≤ 10: 59 years, BAL > 10: 44 years, AWS: 53.5 years). Alcohol withdrawal was experienced by patients with BAL ≤10 and BAL >10. While injury severity and mortality were similar across all 3 groups, AWS patients experienced significantly longer hospital and ICU lengths of stay, unplanned ICU admission, need for mechanical ventilation, and higher rates of complications. Patients with AWS had high rates of acute neuropsychiatric symptoms, complicating their management. ConclusionsExcept for mortality, AWS patients experienced worse outcomes. The complex nature of alcohol withdrawal cases, including the possibility of developing AWS despite a negative BAL on admission, emphasizes the need for early assessment for alcohol withdrawal risk factors and input from specialists.

Alcohol Consumption the Day of Liver Transplantation for Alcohol-Associated Liver Disease Does Not Affect Long-Term Survival: A Case-Control Study.

Alcohol abstinence before liver transplantation (LT) for alcohol-associated liver disease (ALD) is required for every candidate. Some listed patients might relapse, resulting in LT for patients nonabstinent during the pretransplant period. Long-term survival outcomes of these patients have never been studied. We sought to determine whether alcohol consumption on the day of the LT influenced long-term survival after LT. We conducted a retrospective case-control study among French LT centers. Cases were defined as recipients between January 1995 and December 2007 having positive blood and/or urine alcohol levels the day of LT. Each case was paired with 2 controls corresponding to patients transplanted for ALD during the same trimester. Patients were classified into 3 categories per alcohol consumption: abstainers, occasional or transitory excessive consumers, or patients with a sustained excessive consumption (daily consumption >20-30g/day). During the study period, 3052 LTs for ALD were conducted in France. We identified 42 cases paired with 84 controls. Median blood alcohol level was 0.4g/L (range 0.1-4.1g/L) and median urine alcohol level was 0.2g/L (range 0.1-2.0g/L). Median follow-up period until death or censoring was 12.9years (CI95% = [12.3; 13.6]). Long-term survival was not different between the groups. Relapse to any alcohol consumption rate was higher in the case group (59.5%) than in the control group (38.1%, odds ratio 2.44; CI95% = [1.13; 5.27]), but sustained excessive consumption was not significantly different between the groups (33.3% versus 29.8% in case and control groups respectively, χ2 =0.68). Rates of recurrent cirrhosis and cirrhosis-related deaths were more frequent in the case group. Liver transplantation for nonabstinent patients during the immediate pretransplant period does not result in impaired long-term survival despite higher relapse and recurrent cirrhosis rates.

Alcohol use in severely injured trauma patients

Alcohol is a major risk factor for several types of injuries, and it is associated with almost all types and mechanisms of injury. The focus of the study was to evaluate alcohol use in severely injured trauma patients with New Injury Severity Score (NISS) of 16 or over, and to compare mortality, injury severity scores and mechanisms and patterns of injury between patients with positive and negative blood alcohol levels (BAL). Medical histories of all severely injured trauma patients (n = 347 patients) enrolled prospectively in Trauma Register of Tampere University Hospital (TAUH) between January 2016 to December 2017 were evaluated for alcohol/substance use, injury mechanism, mortality and length of stay in Intensive Care Unit (ICU). A total of 252 of 347 patients (72.6%) were tested for alcohol with either direct blood test (50.1%, 174/347), breathalyser (11.2%, 39/347), or both (11.2%, 39/347). After untested patients were excluded, 53.5% of adult patients (18–64 years), 20.5% of elderly patients (above 65 years) and 13.3% of paediatric patients (0–17 years) tested BAL positive. The mean measured BAL for the study population was 1.9 g/L. The incidence of injuries was elevated in the early evenings and the relative proportion of BAL positive patients was highest (67.7%) during the night. Injury severity scores (ISS or NISS) and length of stay in ICU were not adversely affected by alcohol use. Mortality was higher in patients with negative BAL (18.2% vs. 7.7%, p = 0.0019). Falls from stairs, and assaults were more common in patients with positive BAL (15.4% vs. 5.4% and 8.7% vs. 2.7%, p < 0.006, respectively). There were no notable differences in injury patterns between the two groups. Alcohol use among severely injured trauma patients is common. Injury mechanisms between patients with positive and negative BAL have differences, but alcohol use will not increase mortality or prolong length of stay in ICU. This study supports the previously reported findings that BAL is not a suitable marker to assess patient mortality in trauma setting.

The influence of alcohol on the outcome of trauma patients: a matched-pair analysis of the TraumaRegister DGU®.

In the diagnosis and treatment of trauma patients, numerous individual and trauma-related factors must be considered, all of which may influence the outcome. Although alcohol exposure is a major risk factor for an accident, its influence on the outcome is unclear. This matched-pair analysis investigates the hypothesis that alcohol has no negative impact on the outcome of trauma patients. In a retrospective matched-pair analysis of the multi-centre database of the TraumaRegister DGU® patients with a maximum Abbreviated Injury Scale (MAIS) of 3 or greater from the years 2015 and 2016 with an alcohol level ≥ 0.5‰ were compared to patients with a measured alcohol level of 0.0‰. The patients were matched according to age, gender, AIS body regions (head, thorax, abdomen, pelvis/extremities) and survival presumption (Revised Injury Severity Classification Score (RISC) II the TraumaRegister ervals). After matching, a total of 834 patients were enrolled, with 417 patients in group with positive blood alcohol levels (BAL +) with a median alcohol level of 1.82‰and 417 patients in the negative-alcohol group (BAL -). As a mechanism of injury, the BAL + group showed more often penetrating injuries, pedestrian accidents and low energy falls compared to car and motorcycle accidents in the BAL - group. BAL + patients were significantly less sedated (BAL -: 66.7% vs. BAL + : 56.2%, p = 0.002), less frequently transported by rescue helicopter, were more frequently hypotensive (BAL-: 42 patients (10.3%) vs. BAL + : 61 patients (15.2%), p = 0.045, Table2) and exhibited lower base excess levels associated with an acidotic metabolic status compared to sober patients (acidosis: BAL-: 24 patients (6.1%) vs. BAL + : 61 patients (17.2%), p < 0.001). There was no difference regarding in-hospital complications, length of stay or mortality rate. Our data demonstrate that alcohol exposure in trauma patients has no impact on complication or mortality rates. On the other hand, there are initially clear differences in the mechanism of injury, sedation, mode of transport and the acid-base balance.

Sudden death due to acute hemorrhagic necrotizing pancreatitis

It is a great challenge for a forensic pathologist to solve a case of sudden and unexpected death. World Health Organization (WHO) defines sudden death as “death occurring less than 24 hours from onset of symptoms, not otherwise explained”. It is also defined as death known not to be violent or instantaneous for which no cause can be discovered and death without a sign of disease. Sudden death involving the pancreas remains a rare and unusual condition. The reason behind the sudden unexpected death due to pancreatitis is the rapid progress of the condition. A most common symptom in acute pancreatitis is abdomen pain and vomiting. Alcohol consumption affects the pancreas by direct injury to the acinar cells, ductal obstruction and also hampers the intracellular transport finally landing up in acute pancreatitis. We report a case of acute hemorrhagic necrotizing pancreatitis in a middle-aged male due to chronic alcoholism, substantiated by the histopathology findings, and positive blood alcohol levels. A thorough evaluation of history along with a meticulous autopsy is helpful in finding the etiology of sudden death, especially in the middle-aged adult population. This case highlights the forensic expert's anticipation with reference to sudden death due to inflammatory pathology.

Population-Based Autopsy Study of Traumatic Fatalities.

Injuries result in 5.8million global fatalities annually and are the leading cause of death in younger individuals. Nevertheless, population-based autopsy investigations on traumatic deaths are scarce. We set out to study all consecutive autopsies on traumatic fatalities performed in a 5-year time segment in Estonia. After the ethics review board approval, all consecutive autopsies after blunt or penetrating deaths occurring in prehospital or in-hospital settings between January 1, 2009, and December 31, 2013, were retrospectively reviewed using the National Forensic Medicine Database. Fatalities due to suffocation, intoxication, burns, or freezing were excluded. Data collection included demographics, mechanism of injuries, cause of death, and a detailed injury profile. Primary outcome was cause of death. Secondary outcomes included injury patterns. Overall, 1344 autopsies were included. 75.7% of deaths were following blunt trauma. Mean age was 50.4±18.5years, and 77.1% were male. A total of 71.8% of deaths occurred in the prehospital setting. Accidents, assaults, and suicides constituted 64.4, 20.5, and 15.2% of deaths, respectively. A total of 51.1% of injury fatalities had a positive blood alcohol level (BAL). Mean injury severity score was 39.7±23.9. Most common cause of death was due to head injuries at 50.5% followed by hemorrhage at 30.4%. Cardiac and aortic injuries were the predominant cause of hemorrhage-related fatalities. The current population-based investigation documented brain injury as the predominant cause of death followed by cardiac and aortic injuries. High incidence of positive BAL among injury fatalities requires national initiatives for alcohol harm reduction and law enforcement efforts.

Latin American Clinical Epidemiology Network Series – Paper 6: The influence of alcohol in traffic accidents and health care costs of it in Bogotá-Colombia

ObjectivesIn Colombia, some studies have estimated medical costs associated to traffic accidents. It is required to assess results by city or region and determine the influence of variables such as alcohol consumption. The main objective of this study was to identify health care costs associated to traffic accidents in Bogota and determine whether alcohol consumption can increase them. Study Design and SettingCross-sectional costs study conducted in patients over 18 years treated in the emergency rooms of six different hospitals in Bogota, Colombia. ResultsThe average total cost of medical care per patient was 628 USD, in Bogota-Colombia. The average cost per accident was estimated at 1,349 USD. On average, the total cost for health care for patients with positive blood alcohol level was 1.8 times higher than those who did not consume alcohol. The indirect costs were on average 115.3 USD per injured person. Numbers are expressed in 2011 U.S. dollars. ConclusionAlcohol consumption increases the risk of traffic accidents and direct medical health costs.

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.

Positive blood alcohol level in severe traumatic brain injury is associated with better long-term functional outcome

Objective: To investigate the association between positive blood alcohol level (BAL) and functional outcome in patients suffering severe traumatic brain injury.Study design: The brain trauma registry of an academic trauma centre was queried for patients admitted between January 2007 and December 2011. All patients (≥ 18 years) with a neurosurgical intensive care length of stay beyond 2 days were included. Patient demographics, clinical characteristics, injury profile, laboratory test and outcomes were abstracted for analysis. Primary outcome was unfavourable functional outcome defined as Glasgow Outcome Score (GOS) ≤ 3. Multivariable regression models were used for analysis.Results: Of the 352 patients, 39% were BAL (+) at admission. Patients with (+) BAL were significantly younger with less co-morbidities. The cohorts exhibited no significant difference in the severity of the intra-cranial injury and the use of intra-cranial monitoring or surgical interventions. Further, the groups presented no difference in in-hospital mortality (p = 0.1) or 1-year mortality (p = 0.5). There was a worse long-term functional outcome in (–) BAL patients compared to their BAL (+) counterparts after adjustment for confounders (GOS ≤ 3: AOR = 2.0, 95% CI = 1.1–3.5, p = 0.02).Conclusion: Positive BAL on admission is associated with a better long-term functional outcome in patients suffering severe traumatic brain injury.

Screening for at-risk drinking behavior in trauma patients.

A blood alcohol level above 0 g/dL is found in up to 50% of patients presenting with traumatic injuries. The presence of alcohol in the blood not only increases the risk of traumatic injury, but it is also associated with worse outcomes and trauma recidivism. In light of these risks, the American College of Surgeons Committee on Trauma advocates screening for at-risk drinking. Although many institutions use blood alcohol levels to determine at-risk drinking in trauma patients, the Alcohol Use Disorders Identification Test (AUDIT) offers a cheap and easy alternative. Few direct comparisons have been made between these 2 tests in trauma patients. To compare the utility of blood alcohol level and AUDIT score as indicators of at-risk drinking in trauma patients. Records for all trauma patients aged 18 years or older who were admitted to a level I trauma center from May 2013 through June 2014 were reviewed in this retrospective cohort study. Inclusion criteria required patients to have undergone both blood alcohol level testing and AUDIT on admission. A blood alcohol level greater than 0 g/dL and an AUDIT score equal to or above 8 were considered positive for at-risk drinking. Performance of both tests was indexed against the National Institute of Alcohol Abuse and Alcoholism (NIAAA) criteria for at-risk drinking. Of 750 patients admitted for trauma, 222 records (30%) contained data on both blood alcohol level and AUDIT score. The patients were predominantly male (178 [80%]) and had a mean (SD) age of 40.1 (16.7) years. Most patients (178 [80%]) had sustained blunt trauma. Ninety-seven patients (44%) had a positive blood alcohol level, 70 (35%) had a positive AUDIT score, and 54 (24%) met NIAAA criteria for at-risk drinking. The sensitivity and specificity of having a positive blood alcohol level identify at-risk drinking were 61% and 62%, respectively. The sensitivity and specificity of having a positive AUDIT score identify at-risk drinking were 83% and 81%, respectively. As a stand-alone indicator of at-risk drinking behavior in trauma patients, the AUDIT score was shown to be superior to blood alcohol level. The utility of obtaining routine blood alcohol levels in trauma patients as a screening tool for at-risk drinking should be reexamined.

Alcohol consumption as an incremental factor in health care costs for traffic accident victims: Evidence in a medium sized Colombian city

ObjectivesIdentify the possibility that alcohol consumption represents an incremental factor in healthcare costs of patients involved in traffic accidents. MethodsData of people admitted into three major health institutions from an intermediate city in Colombia was collected. Socio-demographic characteristics, health care costs and alcohol consumption levels by breath alcohol concentration (BrAC) methodology were identified. Generalized linear models were applied to investigate whether alcohol consumption acts as an incremental factor for healthcare costs. ResultsThe average cost of healthcare was 878 USD. In general, there are differences between health care costs for patients with positive blood alcohol level compared with those who had negative levels. Univariate analysis shows that the average cost of care can be 2.26 times higher (95% CI: 1.20–4.23), and after controlling for patient characteristics, alcohol consumption represents an incremental factor of almost 1.66 times (95% CI: 1.05–2.62). ConclusionsAlcohol is identified as a possible factor associated with the increased use of direct health care resources. The estimates show the need to implement and enhance prevention programs against alcohol consumption among citizens, in order to mitigate the impact that traffic accidents have on their health status. The law enforcement to help reduce driving under the influence of alcoholic beverages could help to diminish the economic and social impacts of this problem.

Prevention of delirium in trauma patients: Are we giving thiamine prophylaxis a fair chance?

Delirium is associated with increased morbidity and mortality in injured patients. Wernicke encephalopathy (WE) is delirium linked to malnutrition and chronic alcoholism. It is prevented with administration of thiamine. Our primary goal was to evaluate current blood alcohol level (BAL) testing and thiamine prophylaxis in severely injured patients. We retrospectively reviewed the cases of 1000 consecutive severely injured patients admitted to hospital between Mar. 1, 2009, and Dec. 31, 2009. We used the patients' medical records and the Alberta Trauma Registry. Among 1000 patients (mean age 48 yr, male sex 70%, mean injury severity score 23, mortality 10%), 627 underwent BAL testing at admission; 221 (35%) had a BAL greater than 0 mmol/L, and 189 (30%) had a BAL above the legal limit of 17.4 mmol/L. The mean positive BAL was 41.9 mmol/L. More than 4% had a known history of alcohol abuse. More patients were assaulted (20% v. 9%) or hit by motor vehicles (10% v. 6%) when intoxicated (both p < 0.05). Most injuries occurred after falls (37%) and motor vehicle collisions (33%). Overall, 17% of patients received thiamine prophylaxis. Of the 221 patients with elevated BAL, 44% received thiamine prophylaxis. Of those with a history of alcohol abuse, 77% received thiamine prophylaxis. Despite the strong link between alcohol abuse, trauma and WE, more than one-third of patients were not screened for alcohol use. Furthermore, a minority of intoxicated patients received adequate prophylaxis against WE. Given the low risk and cost of BAL testing and thiamine prophylaxis and the high cost of delirium, standard protocols for prophylaxis are essential.

Prognostic factors for morbidity and mortality in elderly patients undergoing acute gastrointestinal surgery: a systematic review

Elderly patients undergoing acute gastrointestinal (GI) surgery experience increased morbidity and mortality compared with younger and elective patients. Prognostic factors can be used to counsel patients of these risks and, if modifiable, to minimize them. We reviewed the literature on prognostic factors for adverse outcomes in elderly patients undergoing acute GI surgery. We searched PubMed and Embase using a strategy developed in collaboration with an expert librarian. Studies examining independent associations between prognostic factors and morbidity or mortality in patients aged 65 and older undergoing acute GI surgery were selected. We extracted data using a standardized form and assessed study quality using the QUIPS tool. Nine cohort studies representing 2958 patients satisfied our selection criteria. All studies focused on postoperative mortality. Thirty-four prognostic factors were examined, with significant variability across studies. There was limited or conflicting evidence for most prognostic factors. Meta-analysis was only possible for the American Society of Anesthesiologists (ASA) score, which was found to be associated with mortality in 4 studies (pooled odds ratio 2.77, 95% confidence interval 0.92-8.41). While acute GI surgery in elderly patients is becoming increasingly common, the literature on prognostic factors for morbidity and mortality in this patient population lags behind. Further research is needed to help guide patient care and potentially improve outcomes.