title: The implications of alcohol intoxication and the Uniform Policy Provision Law on trauma centers; a national trauma data bank analysis of minimally injured patients.
abstract: BACKGROUND
  Alcohol intoxication may confound the initial assessment of trauma patients, resulting in increased use of diagnostic and therapeutic procedures, thereby increasing hospital costs. The Uniform Policy Provision Law (UPPL) exists in many states and allows insurance companies to deny payment for medical treatment for alcohol-related injuries. If intoxication increases resource utilization, these denials compound the financial burden of alcohol use on trauma centers. We hypothesized that patients injured while under the influence of alcohol require more diagnostic tests, procedures, and hospital admissions, leading to higher hospital charges.
  
  
  METHODS
  The National Trauma Databank (2000-2004) was analyzed to identify adult trauma patients (age > or = 16 years) who were discharged alive, had a length of stay < or = 1 day and minor injuries (Injury Severity Score < 9), and were tested for blood alcohol. The study was confined to minimally injured patients to facilitate identification of unexpected resource use most likely attributable to alcohol use. Resource utilization was compared among patients who tested positive or negative for alcohol use. Results are presented as odds ratio (OR) with 95% confidence intervals (CI).
  
  
  RESULTS
  Sixty-eight thousand eight patients met study criteria, of which 31,020 were positive for alcohol. Despite similar baseline characteristics, alcohol-positive patients required significantly more invasive procedures, including intubation (OR 4.16, 95% CI = 3.56-4.85) and Foley catheter insertion (OR 1.52, 95% CI = 1.39-1.67) as well as diagnostic tests (CT scan OR 1.16, 95% CI = 1.12-1.20). They were also less likely to be discharged from the emergency department (OR 0.61, 95% CI = 0.58-0.64), and more frequently required hospital (OR 1.64, 95% CI = 1.57-1.73) or intensive care unit admission (OR 1.82, 95% CI = 1.71-1.94). Mean hospital charges were $1,833 greater ($10,405 +/- 225 vs. 8,572 +/- 68).
  
  
  CONCLUSIONS
  A significant amount of trauma center costs are primarily attributable to alcohol use rather than injury severity or outcome. The financial costs associated with alcohol use and UPPL-related cost-shifting to trauma centers is a significant burden to trauma centers. UPPL laws that penalize trauma centers for identifying intoxicated patients should be repealed in states where they exist.
authors.affiliation: Division of Trauma, Critical Care, and Emergency Surgery, Department of Surgery, University of Arizona, Tucson, Arizona 85724, USA. tokeeffe@surgery.arizona.edu
authors.forename: Terence
authors.initials: T
authors.lastname: O'Keeffe
authors.forename: Shahid
authors.initials: S
authors.lastname: Shafi
authors.forename: Jason L
authors.initials: JL
authors.lastname: Sperry
authors.forename: Larry M
authors.initials: LM
authors.lastname: Gentilello
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000435:Alcoholic Intoxication / Q000191:economics*; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D019458:Insurance Coverage / Q000331:legislation & jurisprudence*; D007349:Insurance, Health, Reimbursement / Q000331:legislation & jurisprudence*; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015813:Substance Abuse Detection / Q000191:economics / Q000331:legislation & jurisprudence*; D014193:Trauma Centers / Q000191:economics* / Q000331:legislation & jurisprudence*; D014481:United States; D014947:Wounds and Injuries / Q000191:economics*