Evaluation of Injury Severity Differences in Intoxicated Blunt Trauma
BACKGROUND: Alcohol use in America is prevalent and is responsible for nearly half of all trauma deaths and nonfatal injuries. Drivers with a blood alcohol level 0.08 g/dL or higher account for 31% of all driving fatalities. There have been previous studies demonstrating a potentially ‘protective effect’ of alcohol in critically injured patients. OBJECTIVE: Assess the impact of alcohol consumption on injury severity by comparing patients with blunt trauma and positive blood alcohol levels to those without alcohol. MATERIALS AND METHODS: Following IRB approval, patients were identified by trauma registry review between 2014-2016. 1000 patients who met inclusion criteria with complete data elements were included in the study. Charts were retrospectively reviewed and stratified by the presence of alcohol intoxication and Glasgow Coma Score. Data points included age, gender, injury severity score, blood alcohol level (zero, low (0.01-0.100 mg/dl), medium (0.101-0.230 mg/dl), high (>.230 mg/dl), length of stay, mechanism of injury, discharge disposition, and mortality rates. Patient characteristics and related outcomes were summarized using descriptive statistics. RESULTS: 1000 patients were reviewed; 714 males (71.4%), 286 females (28.6%), with age range 16-92 years, mean 41.4, mortality 5.5%. Injury severity score ranged from 1-75, mean 14.16 (SD ± 10.66) with length of stay ranging from 1-75 days, geometric mean 3.37 days (SD ± 10.08). Positive blood alcohol levels were present in 346 (34.6%), ranging 0 – 0.44, mean 0.063. Patients with GCS <=8 had an average BAL of 0.082, GCS >8 0.059. The difference between these groups is significant, p < 0.05. Primary mechanism of injury was MVC (42.1%), fall (18.9%), motorcycle (13.1%), pedestrian (7%), other 18.9%. Patients were discharged to home (58.3%), in-patient rehabilitation (18.6%), other (12.9%), and long term care facility (10.2%). DISCUSSION/CONCLUSION: While other studies have shown a reported protective effect on alcohol in blunt trauma, this study does not show a correlation overall between level of ISS and EtOH level for all 1000 patients (correlation coefficient -0.07). There is a statistically significant increased ISS in the most intoxicated patients (High Group >0.230) compared to the non-intoxicated group (p < 0.05). The low and medium intoxicated groups were not statistically different in ISS compared to the non-intoxicated group.