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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: March 2001 - Volume 50 - Issue 3 - pp 521-528
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.

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: psoccors@ausl.fo.it, and fabbri@libero.it.

© 2001 Lippincott Williams & Wilkins, Inc.