title: Alcohol and illicit drugs in traumatic deaths: prevalence and association with type and severity of injuries.
abstract: BACKGROUND
  My colleagues and I studied alcohol and illicit drug intoxication in trauma fatalities and their association with the nature and severity of injuries.
  
  
  METHODS
  We examined the trauma registry and autopsies of all trauma fatalities at an academic Level I trauma center. Statistical analysis was performed to evaluate the association of substance use with the Injury Severity Score, body areas with severe trauma (Abbreviated Injury Score >/= 3), and spinal injuries.
  
  
  RESULTS
  From January 2000 to May 2003, 931 trauma deaths occurred; 600 victims were tested for alcohol and illicit drugs and 256 of these (42.7%) tested positive. Male victims were significantly more likely to have a positive screen than female patients (46.1% versus 26.7%, p = 0.0003). Penetrating trauma was significantly more likely to be associated with a positive screen than blunt trauma (53.0% versus 31.0%, p < 0.001). Hispanic and African-American victims were more likely to have a positive screen than Caucasians or Asians. Half the patients in the age group 15 to 50 years had a positive screen. Victims with penetrating trauma and positive screen were significantly more likely to be dead at hospital arrival than victims with negative toxicology (68.8% versus 48.8%, p = 0.05). Pedestrians killed by automobiles who had positive screens were more likely to have severe abdominal trauma (Abbreviated Injury Score >/= 3) than victims with negative toxicology (54.2% versus 25.0%, p = 0.02).
  
  
  CONCLUSIONS
  There is a high rate of alcohol and illicit drug use in patients who die from trauma, especially penetrating trauma in men aged 15 to 50 years, who are Hispanic or African American. Victims with penetrating trauma and positive toxicology are considerably more likely to have no vital signs on admission than victims with negative toxicology. Pedestrians killed by automobiles who had positive screens have a higher incidence of severe abdominal injuries than victims with negative screens.
authors.affiliation: Department of Surgery, Division of Trauma and Surgical Intensive Care Unit, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
authors.forename: Demetrios
authors.initials: D
authors.lastname: Demetriades
authors.forename: George
authors.initials: G
authors.lastname: Gkiokas
authors.forename: George C
authors.initials: GC
authors.lastname: Velmahos
authors.forename: Carlos
authors.initials: C
authors.lastname: Brown
authors.forename: James
authors.initials: J
authors.lastname: Murray
authors.forename: Thomas
authors.initials: T
authors.lastname: Noguchi
mesh_terms: D000428:Alcohol Drinking / Q000009:adverse effects; D002140:California / Q000453:epidemiology; D005260:Female; D006801:Humans; D013287:Illicit Drugs / Q000009:adverse effects; D008297:Male; D011041:Poisoning / Q000209:etiology / Q000401:mortality; D015995:Prevalence; D012042:Registries; D019966:Substance-Related Disorders / Q000150:complications / Q000401:mortality*; D015599:Trauma Severity Indices; D014947:Wounds and Injuries / Q000145:classification / Q000150:complications / Q000401:mortality*
chemical_list: D013287:Illicit Drugs