title: Motor vehicle collision fatalities involving alcohol and illicit drugs in Greece: the need for management protocols and a reassessment of surveillance.
abstract: OBJECTIVE
  The frequency and the effect of alcohol and illicit drugs on injury type, severity and location of death in motor vehicle collision (MVC) fatalities were investigated.
  
  
  METHODS
  Retrospective case-control study based on autopsy and toxicology.
  
  
  METHODS
  Single faculty accepting referrals from Greater Athens and prefectures.
  
  
  METHODS
  Consecutive pre-hospital and in hospital fatalities.
  
  
  METHODS
  Demographics, toxicology, abbreviated injury scale (AIS), injury severity score (ISS), and location of death.
  
  
  RESULTS
  Of the 1860 screened subjects, 612 (32.9%) constituted the positive toxicology group (PTG) for alcohol or illicit drugs or both and the 1248 (67.1%) the negative toxicology group (NTG). The median age was 34 (4-90) years for the PTG and 45 (3-97) years for the NTG. The PTG included significantly higher proportions of males and motorcyclists. The PTG had a 50% increased risk for a severe (AIS ≥3) cervical spine and 85% for a severe upper extremity injury, compared to the NTG. A total of 29.2% of the PTG and 22.4% of the NTG deaths were non-preventable (ISS=75). The frequency of severe trauma (ISS ≥16) was comparable between PTG and NTG (P=0.87). The PTG presented with a median ISS of 43 (6-75) versus 41 (2-75) of the NTG, hence without significant difference (P=0.11). The pre-hospital death rate was 77.8% for the PTG versus 58% of the NTG (P<0.001). The analysis confirmed that the odds of positive toxicology were considerably higher in the subjects who arrived dead at the hospital (OR 2.62, P <0.001).
  
  
  CONCLUSIONS
  In the greater Athens region, almost a third of motor vehicle collision-related fatalities involved alcohol, illicit drugs or both. Individuals screened positive for alcohol or drugs were 2.6 times more likely to die before hospital admission than those with a negative toxicology screen, despite comparable injury severity. Specific evidence-based management protocols and reassessment of surveillance are required.
authors.affiliation: Fourth Surgery Department, University General Hospital Attikon, National and Kapodistrian University of Athens, 1 Rimini Street, Athens, Greece. ipapado@med.uoa.gr
authors.forename: Iordanis N
authors.initials: IN
authors.lastname: Papadopoulos
authors.forename: Stefanos
authors.initials: S
authors.lastname: Bonovas
authors.forename: Nikolaos K
authors.initials: NK
authors.lastname: Kanakaris
authors.forename: Ioanna
authors.initials: I
authors.lastname: Konstantiadou
authors.forename: Georgios
authors.initials: G
authors.lastname: Nikolopoulos
authors.forename: George
authors.initials: G
authors.lastname: Konstantoudakis
authors.forename: Christos
authors.initials: C
authors.lastname: Leukidis
mesh_terms: D000063:Accidents, Traffic / Q000401:mortality* / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000009:adverse effects / Q000097:blood / Q000453:epidemiology; D000435:Alcoholic Intoxication / Q000150:complications / Q000453:epidemiology*; D001334:Automobile Driving; D001344:Autopsy; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D006115:Greece / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D018986:Motor Vehicles; D012189:Retrospective Studies; D015813:Substance Abuse Detection / Q000706:statistics & numerical data*; D019966:Substance-Related Disorders / Q000097:blood / Q000150:complications / Q000453:epidemiology*; D015599:Trauma Severity Indices; D014947:Wounds and Injuries / Q000097:blood / Q000145:classification / Q000401:mortality*; D055815:Young Adult