Original Contribution
Alcohol and trauma—in every age group

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Abstract

Background

The purpose was to determine the proportion of alcohol-positive (AlcPos) trauma patients in different age groups and any association with mortality using the National Trauma Data Bank.

Methods

Several variables were extracted from the National Trauma Data Bank (version 6.2) using MS Access 2007: age, alcohol presence, Injury Severity Score (ISS), and discharge status (alive vs dead). Age groups for logistic regression were arbitrarily defined as follows: 0 to 10, 11 to 20, 21 to 39, 40 to 64, and older than 64 years.

Results

Approximately 47% of all trauma survivors were tested for alcohol (621,174 of a total of 1,311,137), and 28% of those were AlcPos (176,107/621,174). The proportion of AlcPos patients gradually increased to maximum at 22 years, when 46% (6797/14,732) tested were AlcPos. The proportion AlcPos gradually declined to 35% by age 50 years, then to 15% (2516/16,244) by age 66 to 70 years. The ISSs were significantly higher in AlcPos patients in all age groups (P < .01). Mortality rates were higher in AlcPos children (up to age 20 years) and in adults older than 40 years. The AlcPos patients who were 21 to 39 years old had lower mortality compared with alcohol-negative patients. Logistic regression analysis (controlling for ISSs) revealed that being AlcPos did not play a role in mortality until age 21 to 39 years (AlcPos lower mortality) and in age 40 to 64 years and older than 65 years (AlcPos higher mortality).

Conclusions

Trauma patients of all ages may be AlcPos. Being AlcPos is a marker for greater injury in all age groups. After controlling for ISSs, trauma patients 40 years and older who were AlcPos have increased mortality. This study suggests a role for alcohol testing in all age groups.

Introduction

Alcohol use has been related to a variety of acute and chronic medical conditions as well as traumatic injuries across all age groups from rural to urban settings [1], [2], [3], [4]. Emergency department (ED) visits attributable to alcohol are on the rise [5]. Although the greatest number of alcohol-related trauma survivors is among young adults, children and the elderly account for a significant proportion [6], [7], [8], [9], [10], [11], [12].

Several studies reveal the effectiveness of different alcohol screening and brief intervention (SBI) programs in the acute care setting [5], [13], [14], [15], [16], [17], [18], [19], [20]. The American College of Surgeons (ACS) Committee on Trauma passed a resolution requiring all ACS-verified Level I trauma centers to have a mechanism to screen injured patients for an alcohol-use disorder and additionally to provide an intervention to those who screen positive starting spring 2007 [21]. Few studies have evaluated these SBI programs in older and younger trauma survivors.

Screening and brief intervention requires increased resources; therefore, understanding the magnitude of alcohol-related injuries and mortality across all ages is imperative. Furthermore, the effectiveness of different alcohol SBI initiatives may vary by age group. As more alcohol SBI programs are developed, this information will help in investigating the most efficient and cost-effective methodology for screening the different age groups.

The objective of this study was to estimate the proportion of alcohol-related trauma survivors across all age groups using the National Trauma Data Bank (NTDB). In addition, as several studies have suggested that patients positive for alcohol are more likely to suffer serious injury, we evaluated if mortality rates and Injury Severity Scores (ISSs) varied based on the patient's age in those testing alcohol positive compared with those testing alcohol negative [1], [2], [3], [22].

Section snippets

Materials and methods

This study was performed using a query of the NTDB. The ACS Committee on Trauma created this data bank in 1989. It is the largest trauma data bank currently available with more than 2 million records from more than 600 trauma centers and includes data voluntarily submitted by trauma centers of all levels of designation from the United States and Puerto Rico [23]. The NTDB administrators subject the data to quality and logistic checks [24]. The NTDB includes data on demographic information,

Results

There were 1,311,137 cases with ISS, age, and mortality data. Of these, 621,174 (47%) had alcohol test results. There are approximately 246,000 pediatric patients (age < 18 years). Approximately 11% suffered penetrating trauma, 87% had blunt trauma, and 2% were burn survivors. Approximately 35% were female. Testing for alcohol started at 26% for children aged 0 to 5 years and gradually increased through older age groups to approximately 50% starting at age 16 to 20 years through 50 years (Fig. 1

Discussion

This study found that the proportion of trauma survivors positive for alcohol had substantial variation in different age groups. After a surprising number of AlcPos preschoolers (ages 0-5 years), the AlcPos rate decreases in the 6- to 10-year-old patients and then sharply rises in the 21- to 25-years old patients, where it peaks at 42% being positive for alcohol. Although the peak occurs in this age group, as seen in Fig. 2, there appears to be a plateau of high proportion of being positive for

Limitations

When using a database, there are a number of limitations. Data entry errors can occur. Only 47% of all trauma patients were tested for alcohol, and this may skew the proportion positive in the different age groups. In addition, the rate of testing was different for every age group (Fig. 1), which makes it difficult to predict with any certainty what the actual rate of AlcPos patients is in a particular age group. Given that most patients were not tested, there may have been selection bias in

Conclusion

This study suggests that AlcPos trauma patients are present in all age groups. A significant percentage of very young and elderly patients presented AlcPos. Expanded testing for alcohol beyond the obvious young intoxicated adult may be beneficial. In addition, further research into why alcohol-related traumas have higher ISSs across all age groups is needed.

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    The contents of this manuscript were presented at the 2010 Western Regional Research Forum and Medical Student Forum, University of California, Davis, Sonoma, California, March 19-20, 2010, and SAEM Annual Meeting, Phoenix, Arizona, June 3-6, 2010.

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