title: Alcohol level and injury severity: is the floppy patient myth true?
abstract: BACKGROUND
  The impact of inebriation on severity of injury is unclear. The few studies to date on this topic are limited to a particular mechanism of injury (MOI), injury pattern, or blood alcohol level (BAL). Therefore, we sought to determine the impact of BAL on injury pattern and severity across all MOI. We hypothesize that there is no relationship between BAL and injury severity when controlling for MOI.
  
  
  METHODS
  After institutional review board approval, a retrospective study was performed at an adult trauma center from January 1, 2012-December 31, 2012. All MOI were included. Injury severity was assessed using the injury severity score (ISS). Chi square and analysis of variance were used to examine the relationship between BAL, injury pattern, and ISS within each MOI. Multivariate regression analysis examined the BAL-ISS association adjusting for MOI, gender, and age.
  
  
  RESULTS
  Of 1397 patients, the mean age was 44 ± 19, ISS was 7.5 ± 6.8, BAL was 93 ± 130 mg/dL, and 70% were male. Rib fracture (P = 0.002) and hemothorax and/or pneumothorax (P = 0.0009) were negatively associated with BAL, whereas concussion and soft tissue injury had a positive association with BAL (P < 0.0001). An increasing BAL had a negative correlation with ISS after fall from standing (P < 0.001), whereas bicycle collisions had a positive association (P = 0.027). Across all MOI, there was no significant association between BAL and ISS.
  
  
  CONCLUSIONS
  BAL is associated with ISS, in specific MOI; however, across all MOI, there was no significant association between BAL and ISS. Inebriated patients should be triaged with the same clinical index of suspicion for injury as sober patients.
authors.affiliation: Center for Trauma and Critical Care, Department of Surgery, George Washington University, Washington DC.
authors.forename: Carrie
authors.initials: C
authors.lastname: Valdez
authors.affiliation: Center for Trauma and Critical Care, Department of Surgery, George Washington University, Washington DC.
authors.forename: Michal
authors.initials: M
authors.lastname: Radomski
authors.affiliation: Center for Trauma and Critical Care, Department of Surgery, George Washington University, Washington DC.
authors.forename: Christian
authors.initials: C
authors.lastname: Renne
authors.affiliation: Center for Trauma and Critical Care, Department of Surgery, George Washington University, Washington DC.
authors.forename: Richard
authors.initials: R
authors.lastname: Amdur
authors.affiliation: Center for Trauma and Critical Care, Department of Surgery, George Washington University, Washington DC.
authors.forename: James
authors.initials: J
authors.lastname: Dunne
authors.affiliation: Center for Trauma and Critical Care, Department of Surgery, George Washington University, Washington DC. Electronic address: bsarani@mfa.gwu.edu.
authors.forename: Babak
authors.initials: B
authors.lastname: Sarani
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000435:Alcoholic Intoxication / Q000097:blood* / Q000150:complications / Q000175:diagnosis; D015415:Biomarkers / Q000097:blood; D000431:Ethanol / Q000097:blood*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014218:Triage; D014947:Wounds and Injuries / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D055815:Young Adult
chemical_list: D015415:Biomarkers; D000431:Ethanol
keywords: Blood alcohol level; Injury severity score; Mechanism of injury