You could be reading the full-text of this article now if you...

If you have access to this article through your institution,
you can view this article in

Blood Alcohol Concentration and Management of Road Trauma Patients in the Emergency Department

Fabbri, Andrea MD; Marchesini, Giulio MD; Morselli-Labate, Antonio Maria PhD; Rossi, Fiorenzo MD; Cicognani, Andrea MD; Dente, Massimo MD; Iervese, Tiziana MD; Ruggeri, Saverio PhD; Mengozzi, Ubaldo MD, and; Vandelli, Alberto MD

Journal of Trauma-Injury Infection & Critical Care:
Article Titles

Background: The effects of blood alcohol on injury after crash are controversial, and safe limits are not settled. We examined if a positive blood alcohol concentration, even in a nontoxic range, affects management and outcome of injured patients after road crashes.

Methods: In this prospective cohort study, we recruited all adult subjects admitted to an emergency department within 4 hours after a road crash. Outcomes were mortality or expected permanent disability, and data related to patients’ management.

Results: Alcohol-positive trauma patients were more frequently critical at admission (odds ratio [OR], 1.89; 95% confidence interval [CI], 1.18–3.02), and had an increased risk of combined mortality or expected permanent disability (OR, 1.67; 95% CI, 1.08–2.58), need for intensive care (OR, 1.87; 95% CI, 1.01–3.46), surgery (OR, 1.91; 95% CI, 1.37–2.66) and blood transfusions (OR, 2.09; 95% CI, 1.20–3.64), and acute medical complications (OR, 1.94; 95% CI, 1.33–2.85). All these events were explained by higher trauma severity. Only the risk of unsuspected injuries, diagnosed only at final evaluation, was independently associated with a positive blood alcohol concentration (OR, 4.98; 95% CI, 3.62–6.87), in addition to trauma severity and preexisting chronic conditions. Blood alcohol measurement significantly improved the accuracy in predicting unsuspected injuries, from 81.3% to 86.2%.

Conclusion: In injured patients after a road crash, a positive blood alcohol concentration increases the chance that the final diagnosis will include more injuries than initially documented. More careful monitoring is needed in alcohol-positive trauma patients, independent of clinical status, injury severity, and overt symptoms of alcohol intoxication.

Author Information

From the Dipartimento Emergenza-Urgenza Accettazione (A.F., F.R., A.C., M.D., T.I., U.M., A.V.), Laboratorio di Patologia Clinica (S.R.), Ospedale G.B. Morgagni, Azienda Unità Sanitaria Locale di Forlì, and Dipartimento di Medicina Interna e Gastroenterologia (G.M., A.M.-L.), Università degli Studi di Bologna, Italy.

Submitted for publication May 9, 2000.

Accepted for publication November 18, 2000.

Address for reprints: Andrea Fabbri, MD, Dipartimento Emergenza-Urgenza Accettazione, Ospedale GB Morgagni, Azienda USL di Forlì, 1, P.le Solieri, I-47100 Forlì, Italy; email:, and

© 2001 Lippincott Williams & Wilkins, Inc.