Motor vehicle collision fatalities involving alcohol and illicit drugs in Greece: the need for management protocols and a reassessment of surveillance.
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.
Papadopoulos
Iordanis N
IN
Fourth Surgery Department, University General Hospital Attikon, National and Kapodistrian University of Athens, 1 Rimini Street, Athens, Greece. ipapado@med.uoa.gr
Bonovas
Stefanos
S
Kanakaris
Nikolaos K
NK
Konstantiadou
Ioanna
I
Nikolopoulos
Georgios
G
Konstantoudakis
George
G
Leukidis
Christos
C
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