Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Oct;79(4):643-8.
doi: 10.1097/TA.0000000000000825.

Alcohol exposure, injury, and death in trauma patients

Majid Afshar  1 , Giora Netzer, Sarah Murthi, Gordon S Smith
Affiliations

Alcohol exposure, injury, and death in trauma patients

Majid Afshar et al. J Trauma Acute Care Surg. 2015 Oct.

Abstract

Background: The association of alcohol use with in-hospital trauma deaths remains unclear. This study identifies the association of blood alcohol content (BAC) with in-hospital death accounting for injury severity and mechanism.

Methods: This study involves a historical cohort of 46,222 admissions to a statewide trauma center between January 1, 2002, and October 31, 2011. Blood alcohol was evaluated as an ordinal variable: 1 mg/dL to 100 mg/dL as moderate blood alcohol, 101 mg/dL to 230 mg/dL as high blood alcohol, and greater than 230 mg/dL as very high blood alcohol.

Results: Blood alcohol was recorded in 44,502 patients (96.3%). Moderate blood alcohol was associated with an increased odds for both penetrating mechanism (odds ratio [OR], 2.22; 95% confidence interval [CI], 2.04-2.42) and severe injury (OR, 1.25; 95% CI, 1.16-1.35). Very high blood alcohol had a decreased odds for penetrating mechanism (OR, 0.75; 95% CI, 0.67-0.85) compared with the undetectable blood alcohol group. An inverse U-shaped association was shown for severe injury and penetrating mechanism by alcohol group (p < 0.001). Moderate blood alcohol had an increased odds for in-hospital death (OR, 1.50; 95% CI, 1.25-1.79), and the odds decreased for very high blood alcohol (OR, 0.69; 95% CI, 0.54-0.87). An inverse U-shaped association was also shown for in-hospital death by alcohol group (p < 0.001). Model discrimination for in-hospital death had an area under the receiver operating characteristic curve of 0.64 (95% CI, 0.63-0.65).

Conclusion: Injury severity and mechanism are strong intermediate outcomes between alcohol and death. Severe injury itself carried the greatest odds for death, and with the moderate BAC group at greatest odds for severe injury and the very high BAC group at the lowest odds for severe injury. The result was a similar inverse-U shaped curve for odds for in-hospital death. Clear associations between blood alcohol and in-hospital death cannot be analyzed without consideration for the different injuries by blood alcohol groups.

Level of evidence: Epidemiologic study, level III.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: No conflicts of interest to disclose amongst the authors.

Figures

Figure 1
Figure 1
Odds Ratios for Penetrating Injury by BAC Group Points represent adjusted odds for each alcohol group with 95% confidence interval error bars. Adjusted for age and sex. Reference group is undetectable BAC (OR=1.0). P-value for quadratic test for trend.
Figure 2
Figure 2
Odds Ratios for Severe Injury by BAC Group Points represent adjusted odds for each alcohol group with 95% confidence interval error bars. Adjusted for age and sex. Reference group is undetectable BAC (OR=1.0). P-value for quadratic test for trend.
Figure 3
Figure 3
Odds Ratios for In-Hospital Death by BAC Group Points represent adjusted risk for each alcohol group with 95% confidence interval error bars. Adjusted for age and sex. Reference group is undetectable BAC (OR=1.0). P-value for quadratic test for trend.
See this image and copyright information in PMC

References

    1. Stahre M, Roeber J, Kanny D, Brewer RD, Zhang X. Contribution of excessive alcohol consumption to deaths and years of potential life lost in the united states. Prev Chronic Dis. 2014;11:E109. - PMC - PubMed
    1. Bouchery EE, Harwood HJ, Sacks JJ, Simon CJ, Brewer RD. Economic costs of excessive alcohol consumption in the u.S., 2006. Am J Prev Med. 2011;41:516–524. - PubMed
    1. Savola O, Niemela O, Hillbom M. Blood alcohol is the best indicator of hazardous alcohol drinking in young adults and working-age patients with trauma. Alcohol and Alcoholism. 2004;39(4):340–345. - PubMed
    1. Jurkovich GJ, Rivara FP, Gurney JG, Fligner C, Ries R, Mueller BA, Copass M. The effect of acute alcohol intoxication and chronic alcohol abuse on outcome from trauma. JAMA. 1993;270(1):51–56. - PubMed
    1. Waller PF, Stewart JR, Hansen AR, Stutts JC, Popkin CL, Rodgman EA. The potentiating effects of alcohol on driver injury. JAMA. 1986;256:1461–1466. - PubMed

Publication types