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Effect of elevated serum alcohol level on the outcome of severely injured patients
  1. Max J Scheyerer,
  2. Joel Dütschler,
  3. Adrian Billeter,
  4. Stefan M Zimmermann,
  5. Kai Sprengel,
  6. Clement M L Werner,
  7. Hans-Peter Simmen,
  8. Guido A Wanner
  1. Department of Surgery, Division of Trauma Surgery, University Hospital, Zurich, Switzerland
  1. Correspondence to Dr Max J Scheyerer, Department of Surgery, Division of Trauma Surgery, University Hospital Zurich, Raemistrasse 100, 8091 Zürich, Switzerland; maxjscheyerer{at}gmx.ch

Abstract

Background The influence of high blood alcohol level (BAL) on the outcome of severely injured patients and the corresponding pathophysiological changes is a controversial issue.

Objective To carry out a prognostic study to compare the physiological values and short-term outcome of severely injured patients depending on their serum alcohol level.

Methods A total of 383 severely injured patients with an Injury Severity Score (ISS) ≥17 were admitted to the trauma division between October 2008 and December 2009 and enrolled into this study. Patients were grouped according to their BAL (>0.5‰,‘BAL positive’ vs <0.5‰,‘BAL negative’). Trauma mechanism, pattern of injury and its treatment, and a course of intensive care treatment, physiological parameters and outcome with respect to mortality were analysed.

Results Both groups had similar ISS. In comparison with the BAL-negative group, patients in the BAL-positive group had a significantly lower Glasgow Coma Scale score (9.64 vs 12 points; p=0.005) and, although not significant, a trend towards higher values of the Abbreviated Injury Score for the head (3.29 vs 2.81 points; p=0.146). Furthermore, significantly higher lactate (3.11 mmol/L vs 2.02 mmol/L; p<0.001) levels and lower median arterial pressure values (87.9 mm Hg vs 99.4 mm Hg; p=0.006) were seen in the BAL-positive group at day of admission. However, the overall in-hospital mortality was comparable to that in BAL-negative patients (19.6% vs 21.5%). Similarly, hospital stay (15.29 vs 17.55 days) and duration of intensive care unit treatment (8.53 vs 8.36 days) were not significantly affected by a high BAL upon admission.

Conclusions Severely injured patients with a raised BAL have a higher incidence of severe traumatic brain injury and worse initial physiological parameters. However, the survival rate and in-hospital stay is not influenced. This supports the theory of a neuroprotective role of alcohol.

  • Accident prevention
  • Drug abuse
  • Emergency department
  • Trauma, head
  • Trauma

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