Blood alcohol content, injury severity, and adult respiratory distress syndrome.
BACKGROUND
Elevated blood alcohol content (BAC) is a risk factor for injury. Associations of BAC with adult respiratory distress syndrome (ARDS) have not been conclusively established.We evaluated the association of a BAC greater than 0 mg/dL with the intermediate outcomes, Injury Severity Score (ISS) and Glasgow Coma Scale (GCS) score, and their association with ARDS development.


METHODS
This is an observational retrospective cohort study of 26,305 primary trauma admissions to a statewide referral trauma center from July 11, 2003, to October 31, 2011. Logistic regression was performed to assess the relationship between admission BAC, ISS, GCS score, and ARDS development within 5 days of admission.


RESULTS
The case rate for ARDS was 5.5% (1,447). BAC greater than 0 mg/dL was associated with ARDS development in adjusted analysis (odds ratio, 1.50; 95% confidence interval [CI], 1.33-1.71; p < 0.001). High ISS (≥16) had a stronger association with ARDS development (odds ratio, 17.99; 95% CI, 15.51-20.86), as did low GCS score (≤8) (odds ratio, 8.77; 95% CI, 7.64-10.07; p < 0.001). Patients with low GCS score and high ISS had the most frequent ARDS (33.6%) and the highest case-fatality rate without ARDS (24.7%).


CONCLUSIONS
Elevated BAC is associated with ARDS development. In the analysis of alcohol exposure, ISS and GCS score occur after alcohol ingestion, making them intermediate outcomes. ISS and GCS score were strong predictors of ARDS and may be useful to identify at-risk patients. Elevated BAC may increase the frequency of the ARDS through influence on injury severity or independent molecular mechanisms, which can be discriminated only in experimental models.


METHODS
Epidemiologic study, level III.
From the Division of Pulmonary and Critical Care Medicine (M.A., M.L.T., M.B., G.N.), Department of Epidemiology and Public Health (G.S.S., M.L.T., G.N.), Shock Trauma and Anesthesiology Research (STAR)-Organized Research Center (G.S.S.), Program in Trauma (M.E.L.), R. Adams Cowley Shock Trauma Center, Department of Medicine (S.M.), and Department of Diagnostic Radiology and Nuclear Medicine (J.J.), University of Maryland, Baltimore, Maryland.
Majid
M
Afshar
Gordon S
GS
Smith
Michael L
ML
Terrin
Matthew
M
Barrett
Matthew E
ME
Lissauer
Sahar
S
Mansoor
Jean
J
Jeudy
Giora
G
Netzer
D000328:Adult; D000428:Alcohol Drinking / Q000009:adverse effects* / Q000097:blood; D016001:Confidence Intervals; D000431:Ethanol / Q000493:pharmacokinetics*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D008297:Male; D008396:Maryland / Q000453:epidemiology; D008875:Middle Aged; D016017:Odds Ratio; D012128:Respiratory Distress Syndrome / Q000097:blood / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000097:blood / Q000150:complications*; D055815:Young Adult
D000431:Ethanol