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Biases in the collection of blood alcohol data for adult major trauma patients in Victoria, Australia
  1. Georgina Lau1,
  2. Belinda Gabbe1,2,
  3. Biswadev Mitra1,3,
  4. Paul Dietze4,5,
  5. Sandra Reeder1,6,
  6. Peter Cameron1,3,
  7. David J Read7,8,
  8. Evan Symons9,
  9. Ben Beck1
  1. 1School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
  2. 2Health Data Research UK, Swansea University, Swansea, UK
  3. 3Emergency and Trauma Centre, Alfred Health, Melbourne, Victoria, Australia
  4. 4Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
  5. 5National Drug Research Institute, Curtin University, Melbourne, Victoria, Australia
  6. 6Central Clinical School, Monash University, Melbourne, Victoria, Australia
  7. 7Trauma Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
  8. 8Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
  9. 9Alfred Mental and Addiction Health, Alfred Health, Melbourne, Victoria, Australia
  1. Correspondence to Georgina Lau, School of Public Health and Preventive Medicine, Monash University, Melbourne VIC 3004, Victoria, Australia; georgina.lau{at}monash.edu

Abstract

Background In-hospital alcohol testing provides an opportunity to implement prevention strategies for patients with high risk of experiencing repeated alcohol-related injuries. However, barriers to alcohol testing in emergency settings can prevent patients from being tested. In this study, we aimed to understand potential biases in current data on the completion of blood alcohol tests for major trauma patients at hospitals in Victoria, Australia.

Methods Victorian State Trauma Registry data on all adult major trauma patients from 1 January 2018 to 31 December 2021 were used. Characteristics associated with having a blood alcohol test recorded in the registry were assessed using logistic regression models.

Results This study included 14 221 major trauma patients, of which 4563 (32.1%) had a blood alcohol test recorded. Having a blood alcohol test completed was significantly associated with age, socioeconomic disadvantage level, preferred language, having pre-existing mental health or substance use conditions, smoking status, presenting during times associated with heavy community alcohol consumption, injury cause and intent, and Glasgow Coma Scale scores (p<0.05). Restricting analyses to patients from a trauma centre where blood alcohol testing was part of routine clinical care mitigated most biases. However, relative to patients injured while driving a motor vehicle/motorcycle, lower odds of testing were still observed for patients with injuries from flames/scalds/contact burns (adjusted OR (aOR)=0.33, 95% CI 0.18 to 0.61) and low falls (aOR=0.17, 95% CI 0.12 to 0.25). Higher odds of testing were associated with pre-existing mental health (aOR=1.39, 95% CI 1.02 to 1.89) or substance use conditions (aOR=2.33, 95% CI to 1.47–3.70), and living in a more disadvantaged area (most disadvantaged quintile relative to least disadvantaged quintile: aOR=2.30, 95% CI 1.52 to 3.48).

Conclusion Biases in the collection of blood alcohol data likely impact the surveillance of alcohol-related injuries. Routine alcohol testing after major trauma is needed to accurately inform epidemiology and the subsequent implementation of strategies for reducing alcohol-related injuries.

  • alcohol abuse
  • toxicology
  • wounds and injuries
  • epidemiology

Data availability statement

Data may be obtained from a third party and are not publicly available. All data in this study were obtained from the VSTR, which is governed by the VSTORM group. Access to the VSTR requires approval from the data custodians, VSTORM. Data requests must comply with relevant ethics requirements and can be made through the following link: https://www.monash.edu/medicine/sphpm/vstorm.

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Data availability statement

Data may be obtained from a third party and are not publicly available. All data in this study were obtained from the VSTR, which is governed by the VSTORM group. Access to the VSTR requires approval from the data custodians, VSTORM. Data requests must comply with relevant ethics requirements and can be made through the following link: https://www.monash.edu/medicine/sphpm/vstorm.

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Footnotes

  • Handling editor Ceri Battle

  • Twitter @GeorginaLau_, @Biswadev_M, @DrBenBeck

  • Contributors GL acts as guarantor for this study and was responsible for study design, data analysis and interpretation, and drafting the manuscript. BG, BM, PD, SR and BB contributed to study design, interpretation of data and critical revision of the manuscript. PC, DR and ES assisted with interpretation of data and critical revision of the manuscript.

  • Funding The VSTR is a Department of Health and Human Services, State Government of Victoria and Transport Accident Commission funded project. GL was supported by an Australian Government Research Training Program Scholarship and a Westpac Future Leaders Scholarship. BG was supported by National Health and Medical Research Council Investigator Grant (L2, ID 2009998). PD was supported by a National Health and Medical Research Council Senior Research Fellowship (1136090). PC was supported by an MRFF Practitioner fellowship (MRF1139686). BB was supported by an Australian Research Council Discovery Future Fellowship (FT210100183).

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Commissioned; externally peer reviewed.

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