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CORRELATING INJURIES AND BLOOD ALCOHOL CONCENTRATION WITH INJURY SEVERITY SCORE AND INJURY PATTERNS IN TRAUMA PATIENTS

Imayanagita, Bryan; Pham, Jacqueline; Kong, Allen; Dolich, Matthew; Bernal, Nicole; Lekawa, Michael; Barrios, Cristobal

doi: 10.1097/01.ccm.0000425237.44389.e6
Poster: ABSTRACT Only
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Introduction: The Computerized Alcohol Screening Intervention tool (CASI) has been used effectively to diagnose patients who are dependent on alcohol or at risk of becoming dependent. In the absence of unreliable exams secondary to altered level of consciousness, areas of concern should be prioritized for further observation. Our goal is to determine if there is a significant link between alcohol consumption, injury severity or injury pattern in trauma patients between intoxicated and non-intoxicated patients.

Hypothesis: Higher CASI scores will correlate with higher blood alcohol concentrations (BAC) in admitted patients. Injuries that are sustained by intoxicated patients will show similar injury patterns.

Methods: A total of 1691 trauma inpatients (at an urban level-1 trauma center) completed a survey of their alcohol consumption using the CASI tool from 2009 to 2012. Patients were given a score of 1 to 4 based on their risk for alcohol dependency. The patient’s BAC, injury severity scores (ISS), and ICD-9 codes were included in the analysis. Groups were analyzed by single variable ANOVA and 2 proportion Z tests.

Results: All 4 CASI categories were compared along with the BAC, ISS, and ICD-9 scores of each patient. BAC was a significant indicator between all CASI group categories (P<.001). Comparing ISS and risk of dependency, patients who had a CASI score of 1 or 2 showed a small but significant correlation (p<0.01) Patient ICD-9 codes were analyzed between patients who had a BAC greater than or less than 80 mg/dL. Patients with a BAC>80 showed significantly more injuries to the head and facial area (p<.001) compared with patients with a BAC<80 as seen in table 1. Abdominal injuries were also more significant with BAC>80 patients (p<.001). Comparisons of the chest/spinal region and of the extremities showed no significant difference.

Conclusions: The ability of CASI to classify patient alcohol risk based on the presence of alcohol consumption is validated. Injury pattern data demonstrate that head and intra-abdominal injuries are associated with excessive alcohol consumption. Targeting rapid identification of these injuries in altered patients by avoiding delayed or missed diagnosis could improve outcomes.

University of California Irvine Medical Center

University of California, Irvine

UCIMC Dept Of Surgery

University of California Irvine Medical Center

© 2012 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins