Blood alcohol concentration and management of road trauma patients in the emergency department.
BACKGROUND
The effects of blood alcohol on injury after crash are controversial, and safe limits are not settled. We examined if a positive blood alcohol concentration, even in a nontoxic range, affects management and outcome of injured patients after road crashes.


METHODS
In this prospective cohort study, we recruited all adult subjects admitted to an emergency department within 4 hours after a road crash. Outcomes were mortality or expected permanent disability, and data related to patients' management.


RESULTS
Alcohol-positive trauma patients were more frequently critical at admission (odds ratio [OR], 1.89; 95% confidence interval [CI], 1.18-3.02), and had an increased risk of combined mortality or expected permanent disability (OR, 1.67; 95% CI, 1.08-2.58), need for intensive care (OR, 1.87; 95% CI, 1.01-3.46), surgery (OR, 1.91; 95% CI, 1.37-2.66) and blood transfusions (OR, 2.09; 95% CI, 1.20-3.64), and acute medical complications (OR, 1.94; 95% CI, 1.33-2.85). All these events were explained by higher trauma severity. Only the risk of unsuspected injuries, diagnosed only at final evaluation, was independently associated with a positive blood alcohol concentration (OR, 4.98; 95% CI, 3.62-6.87), in addition to trauma severity and preexisting chronic conditions. Blood alcohol measurement significantly improved the accuracy in predicting unsuspected injuries, from 81.3% to 86.2%.


CONCLUSIONS
In injured patients after a road crash, a positive blood alcohol concentration increases the chance that the final diagnosis will include more injuries than initially documented. More careful monitoring is needed in alcohol-positive trauma patients, independent of clinical status, injury severity, and overt symptoms of alcohol intoxication.
Dipartimento Emergenza-Urgenza Accettazione, Ospedale G.B. Morgagni, Azienda Unità Sanitaria Locale di Forlì, Italy. fabbri@libero.it
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Vandelli
D000063:Accidents, Traffic / Q000401:mortality / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D000428:Alcohol Drinking / Q000009:adverse effects* / Q000097:blood*; D000704:Analysis of Variance; D001803:Blood Transfusion / Q000706:statistics & numerical data; D003422:Critical Care / Q000706:statistics & numerical data; D006233:Persons with Disabilities / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital; D004638:Emergency Treatment / Q000379:methods*; D000431:Ethanol / Q000097:blood*; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D020380:Needs Assessment; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013997:Time Factors; D015599:Trauma Severity Indices; D016896:Treatment Outcome
D000431:Ethanol