title: Alcohol and psychoactive drugs increased the pre-hospital mortality in 655 fall-related fatalities in Greece: a call for management protocols.
abstract: BACKGROUND
  The frequency of alcohol and psychoactive drugs in fall-related fatalities and their effect on type, severity of injury and location of death constitute the subjects of this study.
  
  
  METHODS
  A retrospective analysis based on autopsy and toxicology compared demographics, location of injury; intention for the injury, height of fall, Abbreviated Injury Scale--90 (AIS-90), post-mortem Injury Severity Score (ISS), and location of death.
  
  
  RESULTS
  Amongst 655 fall-related fatalities screened for alcohol and psychoactive drugs 123 (18.8%) were classified in the positive toxicology group (PTG) and the remaining in the negative toxicology group (NTG). The median ages were 48 (16-94) years for the PTG and 62 (12-96) years for the NTG. The screened represent 31% of the national toll. The median height of fall was 7 m and the median blood alcohol concentration was 53 (1.5-630)mg/dl. Males were more likely to be included in the PTG than females (21.6 versus 13.6%; p = 0.014) as were the aged between 11 and 60 years. The odds of severe (AIS ≥ 3) head, thoracic, abdominal, extremity, and spine injuries were not influenced by toxicology status. Fatalities of the PTG were as likely to have severe trauma (ISS ≥ 16) as were fatalities of the NTG (93.5 versus 90.8%; p = 0.34). There was no significant difference of ISS between PTG (median ISS 43, range: 6-75) and NTG (median ISS 35, range: 3-75). Nevertheless, 76.4% of the subjects of the PTG died during the pre-hospital stage of care compared to 60.5% of the subjects of the NTG, which was highly significant (or = 2.80, p = 0.001) after controlling for confounders as age, gender, intention for injury, height of fall, and ISS.
  
  
  CONCLUSIONS
  In fall related trauma, alcohol and psychoactive drugs increased the risk of death during the pre-hospital stage by 2.80 times. This is strong evidence that specific protocols for their early management should be instituted.
authors.affiliation: Fourth Surgery Department, National & Kapodestrian University of Athens, University General Hospital Attikon, 1 Rimini Street, 12462 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: Georgios
authors.initials: G
authors.lastname: Nikolopoulos
authors.forename: Olympia
authors.initials: O
authors.lastname: Kotsilianou
authors.forename: Georgios
authors.initials: G
authors.lastname: Konstantoudakis
authors.forename: Christos
authors.initials: C
authors.lastname: Leukidis
mesh_terms: D015998:Abbreviated Injury Scale; D000058:Accidental Falls / Q000401:mortality* / Q000517:prevention & control / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000435:Alcoholic Intoxication / Q000097:blood / Q000401:mortality*; D001344:Autopsy; D002648:Child; D000431:Ethanol / Q000009:adverse effects* / Q000097:blood; D005260:Female; D006115:Greece / Q000453:epidemiology; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D011619:Psychotropic Drugs / Q000009:adverse effects* / Q000097:blood; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D013997:Time Factors; D014947:Wounds and Injuries / Q000209:etiology / Q000401:mortality* / Q000517:prevention & control; D055815:Young Adult
chemical_list: D011619:Psychotropic Drugs; D000431:Ethanol