Journal of Trauma and Injury

The Korean Society of Traumatology (대한외상학회)
권호 표지

Relation between Blood Alcohol Concentration and Clinical Parameters in Trauma Patients

외상 환자에서의 혈중 알코올 농도와 임상 관련 인자간의 관계

  • Hong, Tae Hwa (Department of Surgery, Yonsei University College of Medicine) ;
  • Jang, Ji Young (Department of Surgery, Yonsei University Wonju College of Medicine) ;
  • Lee, Seung Hwan (Department of Surgery, Yonsei University College of Medicine) ;
  • Kim, Hyung Won (Department of Surgery, Yonsei University College of Medicine) ;
  • Shim, Hong Jin (Department of Surgery, Yonsei University Wonju College of Medicine) ;
  • Lee, Jae Gil (Department of Surgery, Yonsei University College of Medicine)
  • 홍태화 (연세대학교 의과대학 외과학교실) ;
  • 장지영 (연세대학교 원주의과대학 외과학교실) ;
  • 이승환 (연세대학교 의과대학 외과학교실) ;
  • 김형원 (연세대학교 의과대학 외과학교실) ;
  • 심홍진 (연세대학교 원주의과대학 외과학교실) ;
  • 이재길 (연세대학교 의과대학 외과학교실)
  • Received : 2014.10.14
  • Accepted : 2015.12.07
  • Published : 2015.12.31
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: The aim of this study was to evaluate the effects of blood alcohol concentration (BAC) on the clinical parameters in trauma patients. Methods: From January 2011 to March 2013, the records of a total of 102 trauma patients with BAC data were analyzed retrospectively. The revised trauma score (RTS), injury severity score (ISS), presence of shock, use of mechanical ventilation and blood transfusion, length of hospital stay, and mortality were collected. Patients were divided into four groups in accordance with the level of BAC: group A (<100 mg/dL), B (100~200 mg/dL), C (200~250 mg/dL), and D (>250 mg/dL). Patients were also divided into two groups depending on the presence of the shock, and gender, ISS, BAC, and presence of active bleeding were compared between these two groups. Results: No statistically significant differences in the ISS, RTS, presence of active bleeding, use of mechanical ventilation, and mortality were noted between groups A to D. However, the presence of shock was significantly higher in group D. After patients with severe chest injuries had been excluded, mechanical ventilation was found to have been applied more frequently in the higher BAC groups (C and D). A logistic regression analysis of these factors showed that extremely high BAC (>250 mg/dL) was an independent indicator of shock. Conclusion: High BAC is a predicator of shock and the need for mechanical ventilation in patients with trauma, regardless of injury severity. Alcohol intoxication leads to an overestimate of the clinical condition and aggressive management for trauma patients. Thus, a guideline for the diagnosis and treatment of patients intoxicated with alcohol is necessary.

Keywords

References

  1. Choi YH, Kim GB, Lee DH, Eo EK, Jung KY, Kim JS, et al. Effect of Alcohol Ingestion on the Severity and Outcome in Trauma Patients. J Korean Soc Emerg Med 2006; 17: 231-7.
  2. Dunn CW, Donovan DM, Gentilello LM. Practical guidelines for performing alcohol interventions in trauma centers. J Trauma 1997; 42: 299-304. https://doi.org/10.1097/00005373-199702000-00021
  3. Gentilello LM, Ebel BE, Wickizer TM, Salkever DS, Rivara FP. Alcohol interventions for trauma patients treated in emergency departments and hospitals: a cost benefit analysis. Ann Surg 2005; 241: 541-50. https://doi.org/10.1097/01.sla.0000157133.80396.1c
  4. Rivara FP, Jurkovich GJ, Gurney JG, Seguin D, Fligner CL, Ries R, et al. The magnitude of acute and chronic alcohol abuse in trauma patients. Arch Surg 1993; 128: 907-12; discussion 12-3. https://doi.org/10.1001/archsurg.1993.01420200081015
  5. Soderstrom CA, Smith GS, Dischinger PC, McDuff DR, Hebel JR, Gorelick DA, et al. Psychoactive substance use disorders among seriously injured trauma center patients. JAMA 1997; 277: 1769-74. https://doi.org/10.1001/jama.1997.03540460033029
  6. Yoonhee C, Jung K, Eo E, Lee D, Kim J, Shin D, et al. The relationship between alcohol consumption and injury in ED trauma patients. The American journal of emergency medicine 2009; 27: 956-60. https://doi.org/10.1016/j.ajem.2008.07.035
  7. Chrastina J, Hrabovsky D, Riha I, Steinerova K, Novak Z. [The effect of age, alcohol intoxication and type of brain injury on the prognosis of patients operated on for craniocerebral trauma]. Rozhl Chir 2013; 92: 135-42.
  8. Hu G, Mamady K. Alcohol-related road traffic injury and Global Burden of Disease 2010. Lancet 2013; 382: 1092-3. https://doi.org/10.1016/S0140-6736(13)62014-0
  9. Ye Y, Bond JC, Cherpitel CJ, Borges G, Monteiro M, Vallance K. Evaluating recall bias in a case-crossover design estimating risk of injury related to alcohol: data from six countries. Drug Alcohol Rev 2013; 32: 512-8.
  10. Lee WJ, Youn CS, Kyong YY, Woo SH, Jeong SK, Choi SM, et al. Effect of Alcohol Ingestion on Clinical Features of Acute Drug Intoxicated Patients. J Korean Soc Emerg Med 2009; 20: 115-21.
  11. Okorie ON, Dellinger P. Lactate: biomarker and potential therapeutic target. Crit Care Clin 2011; 27: 299-326. https://doi.org/10.1016/j.ccc.2010.12.013
  12. Phelan H, Stahls P, Hunt J, Bagby GJ, Molina PE. Impact of alcohol intoxication on hemodynamic, metabolic, and cytokine responses to hemorrhagic shock. J Trauma 2002; 52: 675-82.
  13. Horton JW. Cardiac contractile effects of ethanolism and hemorrhagic shock. Am J Physiol 1992; 262: H1096-103.
  14. Molina PE, Zambell KL, Norenberg K, Eason J, Phelan H, Zhang P, et al. Consequences of alcohol-induced early dysregulation of responses to trauma/hemorrhage. Alcohol 2004; 33: 217-27. https://doi.org/10.1016/j.alcohol.2004.07.002
  15. Brackett DJ, Gauvin DV, Lerner MR, Holloway FA, Wilson MF. Dose- and time-dependent cardiovascular responses induced by ethanol. The Journal of pharmacology and experimental therapeutics 1994; 268: 78-84.
  16. Gulati A SR, Bhargava HN. Effect of varying concentration of ethanol on systemic hemodynamics and regional circulation. Alcohol 1989; 6: 9-15. https://doi.org/10.1016/0741-8329(89)90067-0
  17. Koskinen P, Kupari M, Nieminen MS, Suokas A, Totterman K, Pajari R, et al. Effects of alcohol on systemic and pulmonary hemodynamics in normal humans. Clinical cardiology 1986; 9: 479-82. https://doi.org/10.1002/clc.4960091002
  18. Hirvonen JI KL, Vitanen KS. Inhibition of the secretory function of the hypothalamo-hypophyseal system by ethanol in the rat. . Ann Med Exp Biol Fenn 1966; 44: 52-7.
  19. Taivainen H, Laitinen K, Tahtela R, Kilanmaa K, Valimaki MJ. Role of plasma vasopressin in changes of water balance accompanying acute alcohol intoxication. Alcoholism, clinical and experimental research 1995; 19: 759-62. https://doi.org/10.1111/j.1530-0277.1995.tb01579.x
  20. McDonough KH, Giaimo ME, Miller HI, Gentilello LM. Low-dose ethanol alters the cardiovascular, metabolic, and respiratory compensation for severe blood loss. J Trauma 2002; 53: 541-8; discussion 8. https://doi.org/10.1097/00005373-200209000-00024
  21. Zink BJ, Sheinberg MA, Wang X, Mertz M, Stern SA, Betz AL. Acute ethanol intoxication in a model of traumatic brain injury with hemorrhagic shock: effects on early physiological response. J Neurosurg 1998; 89: 983-90. https://doi.org/10.3171/jns.1998.89.6.0983
  22. Cherpitel CJ. Drinking patterns and problems and drinking in the event: an analysis of injury by cause among casualty patients. Alcoholism, clinical and experimental research 1996; 20: 1130-7. https://doi.org/10.1111/j.1530-0277.1996.tb01958.x
  23. Deutch SR CC, Hoyer S, Christensen EF, Dragsholt C, Hansen AC, et al. Drug and alcohol use among patients admitted to a Danish trauma centre: a prospective study from a regional trauma centre in Scandinavia. European journal of emergency medicine: official journal of the European Society for Emergency Medicine 2004; 11: 318-22. https://doi.org/10.1097/00063110-200412000-00004