Does alcohol intoxication protect patients from severe injury and reduce hospital mortality the association of alcohol consumption with the severity of injury and survival in trauma patients

Chi-Hsun Hsieh, Li-Ting Su, Yu-Chun Wang, Chih-Yuan Fu, Hung-Chieh Lo, Chiu-Hsiu Lin

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Alcohol-related motor vehicle collisions are a major cause of mortality in trauma patients. This prospective observational study investigated the influence of antecedent alcohol use on outcomes in trauma patients who survived to reach the hospital. From 2005 to 2011, all patients who were older than 18 years and were admitted as a result of motor vehicle crashes were included. Blood alcohol concentration (BAC) was routinely measured for each patient on admission. Patients were divided into four groups based on their BAC level, which included nondrinking, BAC less than 100, BAC 100 to 200, and BAC 200 mg/dL or greater. Patient demographics, physical status and injury severity on admission, length of hospital stay, and outcome were compared between the groups. Odds ratios of having a severe injury, prolonged hospital stay, andmortality were estimated. Patientswith a positive BAC had an increased risk of sustaining craniofacial and thoracoabdominal injuries. Odds ratios of having severe injuries (Injury Severity Score [ISS] 16 or greater) and a prolonged hospital stay were also increased. However, for those patients whose ISS was 16 or greater and who also had a brain injury, risk of fatality was significantly reduced if they were intoxicated (BAC 200 mg/dL or greater) before injury. Alcohol consumption does not protect patients from sustaining severe injuries nor does it shorten the length of hospital stay. However, there were potential survival benefits related to alcohol consumption for patients with brain injuries but not for those without brain injuries. Additional research is required to investigate the mechanism of this association further.
Original languageEnglish
Pages (from-to)1289-1294
Number of pages6
JournalAmerican Surgeon
Volume79
Issue number12
Publication statusPublished - 2013
Externally publishedYes

Fingerprint

Alcoholic Intoxication
Hospital Mortality
Alcohol Drinking
Length of Stay
Survival
Wounds and Injuries
Brain Injuries
Injury Severity Score
Motor Vehicles
Odds Ratio
Alcohols
Blood Alcohol Content
Patient Admission
Observational Studies
Demography
Prospective Studies
Mortality

Keywords

  • alcohol
  • abdominal injury
  • adult
  • age distribution
  • alcohol blood level
  • alcohol consumption
  • alcohol intoxication
  • Article
  • brain injury
  • chronic disease
  • consciousness disorder
  • controlled study
  • craniofacial malformation
  • demography
  • disease association
  • disease severity
  • drinking
  • face injury
  • female
  • head injury
  • hospital admission
  • hospitalization
  • human
  • hypotension
  • incidence
  • injury scale
  • intensive care unit
  • major clinical study
  • male
  • mortality
  • motor vehicle
  • multivariate logistic regression analysis
  • neck injury
  • observational study
  • outcome assessment
  • physical capacity
  • prospective study
  • rating scale
  • risk factor
  • scoring system
  • severe injury
  • sex ratio
  • survival rate
  • thoraco abdominal injury
  • thorax injury
  • traffic accident
  • article
  • blood
  • cohort analysis
  • drinking behavior
  • injury
  • middle aged
  • young adult
  • Alcoholic Intoxication
  • complication
  • Wounds and Injuries
  • Accidents, Traffic
  • Adult
  • Alcohol Drinking
  • Cohort Studies
  • Ethanol
  • Female
  • Hospital Mortality
  • Hospitalization
  • Humans
  • Male
  • Middle Aged
  • Survival Rate
  • Trauma Severity Indices
  • Young Adult

Cite this

Does alcohol intoxication protect patients from severe injury and reduce hospital mortality the association of alcohol consumption with the severity of injury and survival in trauma patients. / Hsieh, Chi-Hsun; Su, Li-Ting; Wang, Yu-Chun; Fu, Chih-Yuan; Lo, Hung-Chieh; Lin, Chiu-Hsiu.

In: American Surgeon, Vol. 79, No. 12, 2013, p. 1289-1294.

Research output: Contribution to journalArticle

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title = "Does alcohol intoxication protect patients from severe injury and reduce hospital mortality the association of alcohol consumption with the severity of injury and survival in trauma patients",
abstract = "Alcohol-related motor vehicle collisions are a major cause of mortality in trauma patients. This prospective observational study investigated the influence of antecedent alcohol use on outcomes in trauma patients who survived to reach the hospital. From 2005 to 2011, all patients who were older than 18 years and were admitted as a result of motor vehicle crashes were included. Blood alcohol concentration (BAC) was routinely measured for each patient on admission. Patients were divided into four groups based on their BAC level, which included nondrinking, BAC less than 100, BAC 100 to 200, and BAC 200 mg/dL or greater. Patient demographics, physical status and injury severity on admission, length of hospital stay, and outcome were compared between the groups. Odds ratios of having a severe injury, prolonged hospital stay, andmortality were estimated. Patientswith a positive BAC had an increased risk of sustaining craniofacial and thoracoabdominal injuries. Odds ratios of having severe injuries (Injury Severity Score [ISS] 16 or greater) and a prolonged hospital stay were also increased. However, for those patients whose ISS was 16 or greater and who also had a brain injury, risk of fatality was significantly reduced if they were intoxicated (BAC 200 mg/dL or greater) before injury. Alcohol consumption does not protect patients from sustaining severe injuries nor does it shorten the length of hospital stay. However, there were potential survival benefits related to alcohol consumption for patients with brain injuries but not for those without brain injuries. Additional research is required to investigate the mechanism of this association further.",
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author = "Chi-Hsun Hsieh and Li-Ting Su and Yu-Chun Wang and Chih-Yuan Fu and Hung-Chieh Lo and Chiu-Hsiu Lin",
note = "被引用次數:4 Export Date: 24 March 2016 CODEN: AMSUA 通訊地址: Hsieh, C.-H.; Department of Trauma and Emergency Surgery, China Medical University Hospital, China Medical University, 2 Yuh-Der Road, Taiwan 化學物質/CAS: alcohol, 64-17-5; Ethanol, 3K9958V90M; Ethanol 參考文獻: Li, G., Keyl, P.M., Smith, G.S., Alcohol and injury severity: Reappraisal of the continuing controversy (1997) J Trauma, 42, pp. 562-569; Chen, S.C., Lin, F.Y., Chang, K.J., Body region prevalence of injury in alcohol-And non-Alcohol-related traffic injuries (1999) J Trauma, 47, pp. 881-884; Cornwell, E.E., Belzberg, H., Velmahos, G., The prevalence and effect of alcohol and drug abuse on cohort-matched critically injured patients (1998) Am Surg, 64, pp. 461-465; Fabbri, A., Marchesini, G., Morselli-Labate, A.M., Positive blood alcohol concentration and road accidents A prospective study in an Italian emergency department (2002) Emerg Med J, 19, pp. 210-214; Pories, S.E., Gamelli, R.L., Vacek, P., Intoxication and injury (1992) J Trauma, 32, pp. 60-64; Tulloh, B.R., Collopy, B.T., Positive correlation between blood alcohol level and ISS in road trauma (1994) Injury, 25, pp. 539-543; Brackett, D.J., Gauvin, D.V., Lerner, M.R., Dose-And timedependent cardiovascular responses induced by ethanol (1994) J Pharmacol Exp Ther, 268, pp. 78-84; Horton, J.W., Cardiac contractile effects of ethanolism and hemorrhagic shock (1992) Am J Physiol, 262, pp. H1096-H1103; McDonough, K.H., Giaimo, M.E., Miller, H.I., Low-dose ethanol alters the cardiovascular, metabolic, and respiratory compensation for severe blood loss (2002) J Trauma, 53, pp. 541-548; Phelan, H., Stahls, P., Hunt, J., Impact of alcohol intoxication on hemodynamic, metabolic, and cytokine responses to hemorrhagic shock (2002) J Trauma, 52, pp. 675-682; Madan, A.K., Yu, K., Beech, D.J., Alcohol and drug use in victims of life-threatening trauma (1999) J Trauma, 47, pp. 568-571; Moore, E.E., Alcohol and trauma: The perfect storm (2005) J Trauma, 59, pp. S53-S56; Salim, A., Ley, E.J., Cryer, H.G., Positive serum ethanol level and mortality in moderate to severe traumatic brain injury (2009) Arch Surg, 144, pp. 865-871; Talving, P., Plurad, D., Barmparas, G., Isolated severe traumatic brain injuries: Association of blood alcohol levels with the severity of injuries and outcomes (2010) J Trauma, 68, pp. 357-362; Demetriades, D., Gkiokas, G., Velmahos, G.C., Alcohol and illicit drugs in traumatic deaths: Prevalence and association with type and severity of injuries (2004) J Am Coll Surg, 199, pp. 687-692; Centers for Disease Control and PreventionVital signs: Alcohol-impaired driving among adults-United States, 2010 (2011) MMWR Morb Mortal Wkly Rep, 60, pp. 1351-1356; Modig, F., Fransson, P.A., Magnusson, M., Blood alcohol concentration at 0.06 and 0.10{\%} causes a complex multifaceted deterioration of body movement control (2012) Alcohol, 46, pp. 75-88; Smith, G.S., Branas, C.C., Miller, T.R., Fatal nontraffic injuries involving alcohol: A metaanalysis (1999) Ann Emerg Med, 33, pp. 659-668; Plurad, D., Demetriades, D., Gruzinski, G., Motor vehicle crashes: The association of alcohol consumption with the type and severity of injuries and outcomes (2010) J Emerg Med, 38, pp. 12-17; Gramenzi, A., Caputo, F., Biselli, M., Review article: Alcoholic liver disease-pathophysiological aspects and risk factors (2006) Aliment Pharmacol Ther, 24, pp. 1151-1161; Blomqvist, S., Thorne, J., Elmer, O., Early post-traumatic changes in hemodynamics and pulmonary ventilation in alcoholpretreated pigs (1987) J Trauma, 27, pp. 40-44; Johnston, J.J., McGovern, S.J., Alcohol related falls: An interesting pattern of injuries (2004) Emerg Med J, 21, pp. 185-188; Sperry, J.L., Gentilello, L.M., Minei, J.P., Waiting for the patient to sober up: Effect of alcohol intoxication on Glasgow Coma Scale score of brain injured patients (2006) J Trauma, 61, pp. 1305-1311; Stuke, L., Diaz-Arrastia, R., Gentilello, L.M., Effect of alcohol on Glasgow Coma Scale in head-injured patients (2007) Ann Surg, 245, pp. 651-655; Luna, G.K., Maier, R.V., Sowder, L., The influence of ethanol intoxication on outcome of injured motorcyclists (1984) J Trauma, 24, pp. 695-700; Tureci, E., Dashti, R., Tanriverdi, T., Acute ethanol intoxication in a model of traumatic brain injury: The protective role of moderate doses demonstrated by immunoreactivity of synaptophysin in hippocampal neurons (2004) Neurol Res, 26, pp. 108-112; Salim, A., Teixeira, P., Ley, E.J., Serum ethanol levels: Predictor of survival after severe traumatic brain injury (2009) J Trauma, 67, pp. 697-703; Plurad, D., Demetriades, D., Gruzinski, G., Pedestrian injuries: The association of alcohol consumption with the type and severity of injuries and outcomes (2006) J Am Coll Surg, 202, pp. 919-927; Hayes, R.L., Jenkins, L.W., Lyeth, B.G., Neurotransmittermediated mechanisms of traumatic brain injury: Acetylcholine and excitatory amino acids (1992) J Neurotrauma, 9, pp. S173-S187; Janis, L.S., Hoane, M.R., Conde, D., Acute ethanol administration reduces the cognitive deficits associated with traumatic brain injury in rats (1998) J Neurotrauma, 15, pp. 105-115",
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TY - JOUR

T1 - Does alcohol intoxication protect patients from severe injury and reduce hospital mortality the association of alcohol consumption with the severity of injury and survival in trauma patients

AU - Hsieh, Chi-Hsun

AU - Su, Li-Ting

AU - Wang, Yu-Chun

AU - Fu, Chih-Yuan

AU - Lo, Hung-Chieh

AU - Lin, Chiu-Hsiu

N1 - 被引用次數:4 Export Date: 24 March 2016 CODEN: AMSUA 通訊地址: Hsieh, C.-H.; Department of Trauma and Emergency Surgery, China Medical University Hospital, China Medical University, 2 Yuh-Der Road, Taiwan 化學物質/CAS: alcohol, 64-17-5; Ethanol, 3K9958V90M; Ethanol 參考文獻: Li, G., Keyl, P.M., Smith, G.S., Alcohol and injury severity: Reappraisal of the continuing controversy (1997) J Trauma, 42, pp. 562-569; Chen, S.C., Lin, F.Y., Chang, K.J., Body region prevalence of injury in alcohol-And non-Alcohol-related traffic injuries (1999) J Trauma, 47, pp. 881-884; Cornwell, E.E., Belzberg, H., Velmahos, G., The prevalence and effect of alcohol and drug abuse on cohort-matched critically injured patients (1998) Am Surg, 64, pp. 461-465; Fabbri, A., Marchesini, G., Morselli-Labate, A.M., Positive blood alcohol concentration and road accidents A prospective study in an Italian emergency department (2002) Emerg Med J, 19, pp. 210-214; Pories, S.E., Gamelli, R.L., Vacek, P., Intoxication and injury (1992) J Trauma, 32, pp. 60-64; Tulloh, B.R., Collopy, B.T., Positive correlation between blood alcohol level and ISS in road trauma (1994) Injury, 25, pp. 539-543; Brackett, D.J., Gauvin, D.V., Lerner, M.R., Dose-And timedependent cardiovascular responses induced by ethanol (1994) J Pharmacol Exp Ther, 268, pp. 78-84; Horton, J.W., Cardiac contractile effects of ethanolism and hemorrhagic shock (1992) Am J Physiol, 262, pp. H1096-H1103; McDonough, K.H., Giaimo, M.E., Miller, H.I., Low-dose ethanol alters the cardiovascular, metabolic, and respiratory compensation for severe blood loss (2002) J Trauma, 53, pp. 541-548; Phelan, H., Stahls, P., Hunt, J., Impact of alcohol intoxication on hemodynamic, metabolic, and cytokine responses to hemorrhagic shock (2002) J Trauma, 52, pp. 675-682; Madan, A.K., Yu, K., Beech, D.J., Alcohol and drug use in victims of life-threatening trauma (1999) J Trauma, 47, pp. 568-571; Moore, E.E., Alcohol and trauma: The perfect storm (2005) J Trauma, 59, pp. S53-S56; Salim, A., Ley, E.J., Cryer, H.G., Positive serum ethanol level and mortality in moderate to severe traumatic brain injury (2009) Arch Surg, 144, pp. 865-871; Talving, P., Plurad, D., Barmparas, G., Isolated severe traumatic brain injuries: Association of blood alcohol levels with the severity of injuries and outcomes (2010) J Trauma, 68, pp. 357-362; Demetriades, D., Gkiokas, G., Velmahos, G.C., Alcohol and illicit drugs in traumatic deaths: Prevalence and association with type and severity of injuries (2004) J Am Coll Surg, 199, pp. 687-692; Centers for Disease Control and PreventionVital signs: Alcohol-impaired driving among adults-United States, 2010 (2011) MMWR Morb Mortal Wkly Rep, 60, pp. 1351-1356; Modig, F., Fransson, P.A., Magnusson, M., Blood alcohol concentration at 0.06 and 0.10% causes a complex multifaceted deterioration of body movement control (2012) Alcohol, 46, pp. 75-88; Smith, G.S., Branas, C.C., Miller, T.R., Fatal nontraffic injuries involving alcohol: A metaanalysis (1999) Ann Emerg Med, 33, pp. 659-668; Plurad, D., Demetriades, D., Gruzinski, G., Motor vehicle crashes: The association of alcohol consumption with the type and severity of injuries and outcomes (2010) J Emerg Med, 38, pp. 12-17; Gramenzi, A., Caputo, F., Biselli, M., Review article: Alcoholic liver disease-pathophysiological aspects and risk factors (2006) Aliment Pharmacol Ther, 24, pp. 1151-1161; Blomqvist, S., Thorne, J., Elmer, O., Early post-traumatic changes in hemodynamics and pulmonary ventilation in alcoholpretreated pigs (1987) J Trauma, 27, pp. 40-44; Johnston, J.J., McGovern, S.J., Alcohol related falls: An interesting pattern of injuries (2004) Emerg Med J, 21, pp. 185-188; Sperry, J.L., Gentilello, L.M., Minei, J.P., Waiting for the patient to sober up: Effect of alcohol intoxication on Glasgow Coma Scale score of brain injured patients (2006) J Trauma, 61, pp. 1305-1311; Stuke, L., Diaz-Arrastia, R., Gentilello, L.M., Effect of alcohol on Glasgow Coma Scale in head-injured patients (2007) Ann Surg, 245, pp. 651-655; Luna, G.K., Maier, R.V., Sowder, L., The influence of ethanol intoxication on outcome of injured motorcyclists (1984) J Trauma, 24, pp. 695-700; Tureci, E., Dashti, R., Tanriverdi, T., Acute ethanol intoxication in a model of traumatic brain injury: The protective role of moderate doses demonstrated by immunoreactivity of synaptophysin in hippocampal neurons (2004) Neurol Res, 26, pp. 108-112; Salim, A., Teixeira, P., Ley, E.J., Serum ethanol levels: Predictor of survival after severe traumatic brain injury (2009) J Trauma, 67, pp. 697-703; Plurad, D., Demetriades, D., Gruzinski, G., Pedestrian injuries: The association of alcohol consumption with the type and severity of injuries and outcomes (2006) J Am Coll Surg, 202, pp. 919-927; Hayes, R.L., Jenkins, L.W., Lyeth, B.G., Neurotransmittermediated mechanisms of traumatic brain injury: Acetylcholine and excitatory amino acids (1992) J Neurotrauma, 9, pp. S173-S187; Janis, L.S., Hoane, M.R., Conde, D., Acute ethanol administration reduces the cognitive deficits associated with traumatic brain injury in rats (1998) J Neurotrauma, 15, pp. 105-115

PY - 2013

Y1 - 2013

N2 - Alcohol-related motor vehicle collisions are a major cause of mortality in trauma patients. This prospective observational study investigated the influence of antecedent alcohol use on outcomes in trauma patients who survived to reach the hospital. From 2005 to 2011, all patients who were older than 18 years and were admitted as a result of motor vehicle crashes were included. Blood alcohol concentration (BAC) was routinely measured for each patient on admission. Patients were divided into four groups based on their BAC level, which included nondrinking, BAC less than 100, BAC 100 to 200, and BAC 200 mg/dL or greater. Patient demographics, physical status and injury severity on admission, length of hospital stay, and outcome were compared between the groups. Odds ratios of having a severe injury, prolonged hospital stay, andmortality were estimated. Patientswith a positive BAC had an increased risk of sustaining craniofacial and thoracoabdominal injuries. Odds ratios of having severe injuries (Injury Severity Score [ISS] 16 or greater) and a prolonged hospital stay were also increased. However, for those patients whose ISS was 16 or greater and who also had a brain injury, risk of fatality was significantly reduced if they were intoxicated (BAC 200 mg/dL or greater) before injury. Alcohol consumption does not protect patients from sustaining severe injuries nor does it shorten the length of hospital stay. However, there were potential survival benefits related to alcohol consumption for patients with brain injuries but not for those without brain injuries. Additional research is required to investigate the mechanism of this association further.

AB - Alcohol-related motor vehicle collisions are a major cause of mortality in trauma patients. This prospective observational study investigated the influence of antecedent alcohol use on outcomes in trauma patients who survived to reach the hospital. From 2005 to 2011, all patients who were older than 18 years and were admitted as a result of motor vehicle crashes were included. Blood alcohol concentration (BAC) was routinely measured for each patient on admission. Patients were divided into four groups based on their BAC level, which included nondrinking, BAC less than 100, BAC 100 to 200, and BAC 200 mg/dL or greater. Patient demographics, physical status and injury severity on admission, length of hospital stay, and outcome were compared between the groups. Odds ratios of having a severe injury, prolonged hospital stay, andmortality were estimated. Patientswith a positive BAC had an increased risk of sustaining craniofacial and thoracoabdominal injuries. Odds ratios of having severe injuries (Injury Severity Score [ISS] 16 or greater) and a prolonged hospital stay were also increased. However, for those patients whose ISS was 16 or greater and who also had a brain injury, risk of fatality was significantly reduced if they were intoxicated (BAC 200 mg/dL or greater) before injury. Alcohol consumption does not protect patients from sustaining severe injuries nor does it shorten the length of hospital stay. However, there were potential survival benefits related to alcohol consumption for patients with brain injuries but not for those without brain injuries. Additional research is required to investigate the mechanism of this association further.

KW - alcohol

KW - abdominal injury

KW - adult

KW - age distribution

KW - alcohol blood level

KW - alcohol consumption

KW - alcohol intoxication

KW - Article

KW - brain injury

KW - chronic disease

KW - consciousness disorder

KW - controlled study

KW - craniofacial malformation

KW - demography

KW - disease association

KW - disease severity

KW - drinking

KW - face injury

KW - female

KW - head injury

KW - hospital admission

KW - hospitalization

KW - human

KW - hypotension

KW - incidence

KW - injury scale

KW - intensive care unit

KW - major clinical study

KW - male

KW - mortality

KW - motor vehicle

KW - multivariate logistic regression analysis

KW - neck injury

KW - observational study

KW - outcome assessment

KW - physical capacity

KW - prospective study

KW - rating scale

KW - risk factor

KW - scoring system

KW - severe injury

KW - sex ratio

KW - survival rate

KW - thoraco abdominal injury

KW - thorax injury

KW - traffic accident

KW - article

KW - blood

KW - cohort analysis

KW - drinking behavior

KW - injury

KW - middle aged

KW - young adult

KW - Alcoholic Intoxication

KW - complication

KW - Wounds and Injuries

KW - Accidents, Traffic

KW - Adult

KW - Alcohol Drinking

KW - Cohort Studies

KW - Ethanol

KW - Female

KW - Hospital Mortality

KW - Hospitalization

KW - Humans

KW - Male

KW - Middle Aged

KW - Survival Rate

KW - Trauma Severity Indices

KW - Young Adult

M3 - Article

VL - 79

SP - 1289

EP - 1294

JO - American Surgeon

JF - American Surgeon

SN - 0003-1348

IS - 12

ER -