Thomas Brockamp1,2, Andreas Böhmer3, Rolf Lefering4, Bertil Bouillon5, Arasch Wafaisade5, Manuel Mutschler5, Paola Kappel5, Matthias Fröhlich5. 1. Department of Trauma and Orthopaedic Surgery, University of Witten/Herdecke, Cologne-Merheim-Medical-Center, Ostmerheimer Street 200, 51109, Cologne, Germany. tbrockamp@gmail.com. 2. Working Group of Injury Prevention of the German Trauma Society, The German Trauma Society (DGU), Straße des 17. Juni 106-108, 10623, Berlin, Germany. tbrockamp@gmail.com. 3. Department of Anaesthesiology and Surgical Intensive Care Medicine, University of Witten/Herdecke, Cologne-Merheim-Medical-Center, Ostmerheimer Street 200, 51109, Cologne, Germany. 4. Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Ostmerheimer Street 200, 51109, Cologne, Germany. 5. Department of Trauma and Orthopaedic Surgery, University of Witten/Herdecke, Cologne-Merheim-Medical-Center, Ostmerheimer Street 200, 51109, Cologne, Germany.
Abstract
BACKGROUND: Blood alcohol level (BAL) has previously been considered as a factor influencing the outcome of injured patients. Despite the well-known positive correlation between alcohol-influenced traffic participation and the risk of accidents, there is still no clear evidence of a positive correlation between blood alcohol levels and severity of injury. The aim of the study was to analyze data of the TraumaRegister DGU® (TR-DGU), to find out whether the blood alcohol level has an influence on the type and severity of injuries as well as on the outcome of multiple-trauma patients. METHODS: Datasets from 11,842 trauma patients of the TR-DGU from the years 2015 and 2016 were analyzed retrospectively and 6268 patients with a full dataset and an AIS ≥ 3 could be used for evaluation. Two groups were formed for data analysis. A control group with a BAL = 0 ‰ (BAL negative) was compared to an alcohol group with a BAL of ≥0.3‰ to < 4.0‰ (BAL positive). Patients with a BAL > 0‰ and < 0.3‰ were excluded. They were compared with regard to various preclinical, clinical and physiological parameters. Additionally, a subgroup analysis with a focus on patients with a traumatic brain injury (TBI) was performed. A total of 5271 cases were assigned to the control group and 832 cases to the BAL positive group. 70.3% (3704) of the patients in the control group were male. The collective of the control group was on average 5.7 years older than the patients in the BAL positive group (p < .001). The control group showed a mean ISS of 20.3 and the alcohol group of 18.9 (p = .007). In terms of the injury severity of head, the BAL positive group was significantly higher on average than the control group (p < 0.001), whereas the control group showed a higher AIS to thorax and extremities (p < 0.001). The mean Glasgow Coma Scale (GCS) was 10.8 in the BAL positive group and 12.0 in the control group (p < 0.001). Physiological parameters such as base excess (BE) and International Normalized Ratio (INR) showed reduced values for the BAL positive group. However, neither the 24-h mortality nor the overall mortality showed a significant difference in either group (p = 0.19, p = 0.14). In a subgroup analysis, we found that patients with a relevant head injury (AIS: Abbreviated Injury Scale head ≥3) and positive BAL displayed a higher survival rate compared to patients in the control group with isolated TBI (p < 0.001). CONCLUSIONS: This retrospective study analyzed the influence of the blood alcohol level in severely injured patients in a large national dataset. BAL positive patients showed worse results with regard to head injuries, the GCS and to some other physiological parameters. Finally, neither the 24-h mortality nor the overall mortality showed a significant difference in either group. Only in a subgroup analysis the mortality rate in BAL negative patients with TBI was significantly higher than the mortality rate of BAL positive patients with TBI. This mechanism is not yet fully understood and is discussed controversially in the literature.
BACKGROUND: Blood alcohol level (BAL) has previously been considered as a factor influencing the outcome of injured patients. Despite the well-known positive correlation between alcohol-influenced traffic participation and the risk of accidents, there is still no clear evidence of a positive correlation between blood alcohol levels and severity of injury. The aim of the study was to analyze data of the TraumaRegister DGU® (TR-DGU), to find out whether the blood alcohol level has an influence on the type and severity of injuries as well as on the outcome of multiple-traumapatients. METHODS: Datasets from 11,842 traumapatients of the TR-DGU from the years 2015 and 2016 were analyzed retrospectively and 6268 patients with a full dataset and an AIS ≥ 3 could be used for evaluation. Two groups were formed for data analysis. A control group with a BAL = 0 ‰ (BAL negative) was compared to an alcohol group with a BAL of ≥0.3‰ to < 4.0‰ (BAL positive). Patients with a BAL > 0‰ and < 0.3‰ were excluded. They were compared with regard to various preclinical, clinical and physiological parameters. Additionally, a subgroup analysis with a focus on patients with a traumatic brain injury (TBI) was performed. A total of 5271 cases were assigned to the control group and 832 cases to the BAL positive group. 70.3% (3704) of the patients in the control group were male. The collective of the control group was on average 5.7 years older than the patients in the BAL positive group (p < .001). The control group showed a mean ISS of 20.3 and the alcohol group of 18.9 (p = .007). In terms of the injury severity of head, the BAL positive group was significantly higher on average than the control group (p < 0.001), whereas the control group showed a higher AIS to thorax and extremities (p < 0.001). The mean Glasgow Coma Scale (GCS) was 10.8 in the BAL positive group and 12.0 in the control group (p < 0.001). Physiological parameters such as base excess (BE) and International Normalized Ratio (INR) showed reduced values for the BAL positive group. However, neither the 24-h mortality nor the overall mortality showed a significant difference in either group (p = 0.19, p = 0.14). In a subgroup analysis, we found that patients with a relevant head injury (AIS: Abbreviated Injury Scale head ≥3) and positive BAL displayed a higher survival rate compared to patients in the control group with isolated TBI (p < 0.001). CONCLUSIONS: This retrospective study analyzed the influence of the blood alcohol level in severely injured patients in a large national dataset. BAL positive patients showed worse results with regard to head injuries, the GCS and to some other physiological parameters. Finally, neither the 24-h mortality nor the overall mortality showed a significant difference in either group. Only in a subgroup analysis the mortality rate in BAL negative patients with TBI was significantly higher than the mortality rate of BAL positive patients with TBI. This mechanism is not yet fully understood and is discussed controversially in the literature.
Authors: G de Gaetano; S Costanzo; A Di Castelnuovo; L Badimon; D Bejko; A Alkerwi; G Chiva-Blanch; R Estruch; C La Vecchia; S Panico; G Pounis; F Sofi; S Stranges; M Trevisan; F Ursini; C Cerletti; M B Donati; L Iacoviello Journal: Nutr Metab Cardiovasc Dis Date: 2016-03-31 Impact factor: 4.222
Authors: P Hadjizacharia; T O'Keeffe; D S Plurad; D J Green; C V R Brown; L S Chan; D Demetriades; P Rhee Journal: Eur J Trauma Emerg Surg Date: 2010-07-22 Impact factor: 3.693