title: 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery, University of Washington School of Medicine, The Harborview Injury Prevention and Research Center, Seattle, USA.
authors.forename: L M
authors.initials: LM
authors.lastname: Gentilello
authors.forename: F P
authors.initials: FP
authors.lastname: Rivara
authors.forename: D M
authors.initials: DM
authors.lastname: Donovan
authors.forename: G J
authors.initials: GJ
authors.lastname: Jurkovich
authors.forename: E
authors.initials: E
authors.lastname: Daranciang
authors.forename: C W
authors.initials: CW
authors.lastname: Dunn
authors.forename: A
authors.initials: A
authors.lastname: Villaveces
authors.forename: M
authors.initials: M
authors.lastname: Copass
authors.forename: R R
authors.initials: RR
authors.lastname: Ries
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000009:adverse effects* / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control*