ALCOHOL AND INJURY Presented by

The American College of Surgeons

Committee on Trauma

Trauma Prevention Series

© ACS 2000© ACS 2000

OVERVIEW

• Leading cause of death between 1 and 40 years of age

• 80 percent teenage deaths

• 60 percent childhood deaths

• Increased risk in elderly

STATISTICS

•Deaths = 150,000

•Injured = 70,000,000

•Temporarily disabled = 11,000,000

•Permanently disabled = 450,000

TIP OF THE ICEBERG

• Death from injury is just the tip of the iceberg !

• Injury:2.6 million hospital discharges /year37 million emergency department visits/year

CAUSES

TOTAL OF 150,000 DEATHS

•2/3 from unintentional traumaMotor vehicle crashesFallsWork-related accidentsRecreational and home mishaps

•1/3 from violence

TRAUMAISNO

ACCIDENT!

ALCOHOL CONSUMPTION

People who reported drinking in the past month

• >60% of those aged 21-49 years• 70% of men 26-34 years of age• 54% of women 26-34 years of age

RISK• Those who drink have a greater

chance of dying from injury and sustaining nonfatal injury

• Even those who drink at “relatively low levels” (1 drink/day) are at greater risk of injury

CONTRIBUTORY ROLEOF ALCOHOL

• 40% of motor vehicle crash deaths involve alcohol

• 40% of pedestrians killed had been drinking

• The deadly triad:AlcoholMinor grievanceWeapon

MAGNITUDE OF PROBLEM

ALCOHOL IS A

DRUG

COMMON MISCONCEPTION

AN UNUSUAL DRUG

• Requires no digestion

• Is rapidly and completely absorbed from stomach and upper intestine

CONCENTRATES IN THE BRAIN

EFFECTS ON REACTIONS

• First effects are on the brain, including:ThinkingJudgmentReasoningReflex activityControl

EFFECTS ON OPERATION OF MOTOR VEHICLE

• Shortens attention span

• Slows reaction time

• Decreases performance of motor tasks

• Causes misconceptions

EFFECTS ON BEHAVIOR

FATE OF INGESTED ALCOHOL

METABOLIZED BY:

Liver (80%)

Lungs/kidneys (10%)

Other sites (10%)

HOW THE LIVER METABOLIZES ALCOHOL

ALCOHOL METABOLISM

• Rate is limited

• Equivalent to approximately 1 drink per hour

RELATIONSHIP OFNUMBER OF DRINKS AND

BLOOD ALCOHOL CONCENTRATION

RELATIONSHIP OF BLOOD ALCOHOL CONCENTRATION AND

CRASH RESPONSIBILITY

CARNAGE ON THE HIGHWAY

ALCOHOL AND TRAUMA

• Emergency department patients with positive blood alcohol concentrations (100 mg/dL or less):

15%-25% of total

• Trauma center patients with positive blood alcohol concentrations:

26%-52% of men14%-42% of women

ALCOHOL,OTHER DRUGS,AND TRAUMA

• 50% of the time, other illicit drugs are used with alcohol:

Marijuana (3%-37%)Cocaine (5%-34%)Opiates (12%-17%)

PREVENTION STRATEGIES

PRINCIPLE OF DETERRENCE

Certainty of detection is more is more effective than the severity of the punishment

ALCOHOL ADDICTION

• Injury episode may be the first symptom of a treatable alcohol problem

• 15%-50% injured patients in the emergency department have alcohol dependence, compared with 7%-8% of the general population

WHAT IS SOCIAL DRINKING?

• Moderate social drinking:No more than 2 drinks per day for menNo more than 1 drink per day for women

(National Institute on Alcohol Abuse and Alcoholism, 1995)

ALCOHOL AND TRAUMA RECIDIVISM

• Five-year follow-up of 246 patients44% readmission rate20% mortality rate

• 77% of deaths were due to continuing substance abuse

IDENTIFICATION OFSUBSTANCE ABUSE

• Injury episode is a great opportunity

• History of :Previous injury when under the influenceA drunk/impaired driving conviction

LABORATORY TESTS

• Positive blood alcohol concentration

• Positive “tox screen”

• Abnormal liver function test

QUESTIONNAIRES• CAGE (4 questions):

Cutting down on drinking?Annoyed by criticism?Guilt feelings?Eye opening ability?

• Audit (10 questions):Alcohol use disorders identification test

• BMAST (10 questions):Brief Michigan Alcoholism Screening Test

DOES INTERVENTION WORK?

• Of a total of 3,358 trauma patients, 2,524 were screened

–762 positive patients were randomized396 to control366 to intervention

–304 of 366 completed intervention

(Harborview Medical Center, 1999)

DOES INTERVENTION WORK?

• 47% reduction in return to emergency department (1 year)

• 48% reduction in in-patient readmits (3 years)

• All other outcomes (traffic violations, DUI, arrests, and so on) less in intervention group

(Harborview Medical Center, 1999)

SUMMARY

• Alcohol intervention has significant potential as injury prevention

• Actively promoting alcohol intervention may have a major impact on long-term health and future injury risk

DRINKING AND DRIVINGDON’T MIX