title: Injured patients with very high blood alcohol concentrations.
abstract: OBJECTIVE
  Most data regarding high blood alcohol concentrations (BAC) ≥400 mg/dL have been from alcohol poisoning deaths. Few studies have described this group and reported their alcohol consumption patterns or outcomes compared to other trauma patients. We hypothesised trauma patients with very high BACs arrived to the trauma centre with less severe injuries than their sober counterparts.
  
  
  METHODS
  Historical cohort of 46,222 patients admitted to a major trauma centre between January 1, 2002 and October 31, 2011. BAC was categorised into ordinal groups by 100 mg/dL intervals. Alcohol questionnaire data on frequency and quantity was captured in the BAC ≥400 mg/dL group. The primary analysis was for BAC ≥400 mg/dL.
  
  
  RESULTS
  BAC was recorded in 44,502 (96.3%) patients. Those with a BAC ≥400 mg/dL accounted for 1.1% (147) of BAC positive cases. These patients had the lowest proportion of severe trauma and in-hospital death in comparison with the other alcohol groups (p<0.001). In adjusted analysis, the risk for severe injury increased with the BAC groups between 1 and 199 mg/dL and was not different or decreased for groups above 200 mg/dL in reference to the BAC negative group (test for trend p=0.001). BAC ≥400 group encountered more injuries caused by blunt trauma in comparison with the other alcohol groups (p<0.001), and the group comprised mainly of falls. Admission Glasgow Coma Scale was a poor predictor for traumatic brain injury in the high BAC group. Readmission occurred in 22.4% (33) of patients the BAC ≥400 group. The majority of these patients reported drinking alcohol 4 or more days per week (81, 67.5%) and five or more drinks per day (79, 65.8%), evident of risky alcohol use.
  
  
  CONCLUSIONS
  Most traumas admitted with BAC ≥400 mg/dL survived and their injuries were less severe than their less intoxicated and sober counterparts. They also had evidence for risky alcohol use and nearly one-quarter returned to the trauma centre with another injury over the study period. Recognition of this highest BAC group presents an opportunity to provide focused care for their risky alcohol use.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Loyola University Health Sciences, Maywood, IL, United States; Department of Public Health Sciences, Loyola University School of Medicine, Maywood, IL, United States. Electronic address: majid_afshar@luhs.org.
authors.forename: Majid
authors.initials: M
authors.lastname: Afshar
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of Maryland, Baltimore, MD, United States; Department of Epidemiology and Public Health, University of Maryland, Baltimore, MD, United States.
authors.forename: Giora
authors.initials: G
authors.lastname: Netzer
authors.affiliation: Heartland Health Outreach, Chicago, IL, United States.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Salisbury-Afshar
authors.affiliation: Program in Trauma, R. Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD, United States.
authors.forename: Sarah
authors.initials: S
authors.lastname: Murthi
authors.affiliation: Department of Epidemiology and Public Health, University of Maryland, Baltimore, MD, United States; Shock Trauma and Anesthesiology Research (STAR)-Organized Research Center, University of Maryland, Baltimore, MD, United States.
authors.forename: Gordon S
authors.initials: GS
authors.lastname: Smith
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000009:adverse effects* / Q000097:blood / Q000401:mortality; D000435:Alcoholic Intoxication / Q000150:complications / Q000175:diagnosis / Q000401:mortality*; D000067401:Blood Alcohol Content; D000431:Ethanol / Q000097:blood*; D005260:Female; D015600:Glasgow Coma Scale; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D014193:Trauma Centers; D015599:Trauma Severity Indices; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000097:blood / Q000209:etiology / Q000401:mortality*
chemical_list: D000067401:Blood Alcohol Content; D000431:Ethanol
keywords: Alcohol consumption; Alcohol poisoning; Alcohol use disorder; Blood alcohol level; Blunt trauma; Ethanol; Forensic toxicology; Injury; Injury prevention; Trauma recidivism