title: Effect of elevated serum alcohol level on the outcome of severely injured patients.
abstract: BACKGROUND
  The influence of high blood alcohol level (BAL) on the outcome of severely injured patients and the corresponding pathophysiological changes is a controversial issue.
  
  
  OBJECTIVE
  To carry out a prognostic study to compare the physiological values and short-term outcome of severely injured patients depending on their serum alcohol level.
  
  
  METHODS
  A total of 383 severely injured patients with an Injury Severity Score (ISS) ≥17 were admitted to the trauma division between October 2008 and December 2009 and enrolled into this study. Patients were grouped according to their BAL (>0.5‰,'BAL positive' vs <0.5‰,'BAL negative'). Trauma mechanism, pattern of injury and its treatment, and a course of intensive care treatment, physiological parameters and outcome with respect to mortality were analysed.
  
  
  RESULTS
  Both groups had similar ISS. In comparison with the BAL-negative group, patients in the BAL-positive group had a significantly lower Glasgow Coma Scale score (9.64 vs 12 points; p=0.005) and, although not significant, a trend towards higher values of the Abbreviated Injury Score for the head (3.29 vs 2.81 points; p=0.146). Furthermore, significantly higher lactate (3.11 mmol/L vs 2.02 mmol/L; p<0.001) levels and lower median arterial pressure values (87.9 mm Hg vs 99.4 mm Hg; p=0.006) were seen in the BAL-positive group at day of admission. However, the overall in-hospital mortality was comparable to that in BAL-negative patients (19.6% vs 21.5%). Similarly, hospital stay (15.29 vs 17.55 days) and duration of intensive care unit treatment (8.53 vs 8.36 days) were not significantly affected by a high BAL upon admission.
  
  
  CONCLUSIONS
  Severely injured patients with a raised BAL have a higher incidence of severe traumatic brain injury and worse initial physiological parameters. However, the survival rate and in-hospital stay is not influenced. This supports the theory of a neuroprotective role of alcohol.
authors.affiliation: Department of Surgery, Division of Trauma Surgery, University Hospital, Zurich, Switzerland.
authors.forename: Max J
authors.initials: MJ
authors.lastname: Scheyerer
authors.affiliation: Department of Surgery, Division of Trauma Surgery, University Hospital, Zurich, Switzerland.
authors.forename: Joel
authors.initials: J
authors.lastname: Dütschler
authors.affiliation: Department of Surgery, Division of Trauma Surgery, University Hospital, Zurich, Switzerland.
authors.forename: Adrian
authors.initials: A
authors.lastname: Billeter
authors.affiliation: Department of Surgery, Division of Trauma Surgery, University Hospital, Zurich, Switzerland.
authors.forename: Stefan M
authors.initials: SM
authors.lastname: Zimmermann
authors.affiliation: Department of Surgery, Division of Trauma Surgery, University Hospital, Zurich, Switzerland.
authors.forename: Kai
authors.initials: K
authors.lastname: Sprengel
authors.affiliation: Department of Surgery, Division of Trauma Surgery, University Hospital, Zurich, Switzerland.
authors.forename: Clement M L
authors.initials: CM
authors.lastname: Werner
authors.affiliation: Department of Surgery, Division of Trauma Surgery, University Hospital, Zurich, Switzerland.
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Simmen
authors.affiliation: Department of Surgery, Division of Trauma Surgery, University Hospital, Zurich, Switzerland.
authors.forename: Guido A
authors.initials: GA
authors.lastname: Wanner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000032:analysis; D001794:Blood Pressure / Q000502:physiology; D001930:Brain Injuries / Q000097:blood / Q000453:epidemiology; D000431:Ethanol / Q000097:blood*; D005260:Female; D015600:Glasgow Coma Scale; D006339:Heart Rate / Q000502:physiology; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000097:blood* / Q000401:mortality / Q000503:physiopathology; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D013557:Switzerland / Q000453:epidemiology; D014193:Trauma Centers / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D015415:Biomarkers; D000431:Ethanol
keywords: Accident prevention; Drug abuse; Emergency department; Trauma; Trauma, head