Alcohol interventions in a trauma center as a means of reducing the risk of injury recurrence

Abstract

Objective: Alcoholism is the leading risk factor for injury. The authors hypothesized that providing brief alcohol interventions as a routine component of trauma care would significantly reduce alcohol consumption and would decrease the rate of trauma recidivism.

Methods: This study was a randomized, prospective controlled trial in a level 1 trauma center. Patients were screened using a blood alcohol concentration, gamma glutamyl transpeptidase level, and short Michigan Alcoholism Screening Test (SMAST). Those with positive results were randomized to a brief intervention or control group. Reinjury was detected by a computerized search of emergency department and statewide hospital discharge records, and 6- and 12-month interviews were conducted to assess alcohol use.

Results: A total of 2524 patients were screened; 1153 screened positive (46%). Three hundred sixty-six were randomized to the intervention group, and 396 to controls. At 12 months, the intervention group decreased alcohol consumption by 21.8+/-3.7 drinks per week; in the control group, the decrease was 6.7+/-5.8 (p = 0.03). The reduction was most apparent in patients with mild to moderate alcohol problems (SMAST score 3 to 8); they had 21.6+/-4.2 fewer drinks per week, compared to an increase of 2.3+/-8.3 drinks per week in controls (p < 0.01). There was a 47% reduction in injuries requiring either emergency department or trauma center admission (hazard ratio 0.53, 95% confidence interval 0.26 to 1.07, p = 0.07) and a 48% reduction in injuries requiring hospital admission (3 years follow-up).

Conclusion: Alcohol interventions are associated with a reduction in alcohol intake and a reduced risk of trauma recidivism. Given the prevalence of alcohol problems in trauma centers, screening, intervention, and counseling for alcohol problems should be routine.

Figure 1. Flow of participants in the trial.

Figure 2. Risk of repeat injury requiring treatment in the Harborview Medical Center Emergency Department or admission to the trauma center. The analysis is for King County residents at 1 year follow-up and controls for gender, SMAST score, age, injury intent, and injury severity score (hazard ratio 0.53, 95% CI 0.26-1.07).

Figure 3. Risk of injury resulting in hospital readmission in Washington State. Follow-up duration was up to three years. Analysis controls for gender, SMAST score, age, injury intent, and injury severity score (hazard ratio 0.52, 95% confidence interval 0.21 to 1.29).

Figure 4. Changes in alcohol intake in mean number of standard drinks per week during follow-up in patients with a SMAST score of 3 to 8 (p < 0.01).

Figure 5. Odds ratio and 95% confidence interval for other outcomes at 1 year of follow-up for intervention group patients compared with controls, adjusted for SMAST, age, gender, injury severity, injury intent, and number of violations or arrests in the 6 months before injury.