Elevated blood alcohol impacts hospital mortality following motorcycle injury: A National Trauma Data Bank analysis

Ahmed, Nasim; Kuo, Yen-Hong; Sharma, Jyoti; Kaul, Sanjeev

doi:10.1016/j.injury.2019.10.005

Cited by 20 publications

(12 citation statements)

References 18 publications

(58 reference statements)

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“…Notably, our COVID cohort was more likely to have CHF and be uninsured, both of which are known risk factors for mortality in trauma [ 26 – 29 ]. Additionally, COVID patients were less likely to be alcohol positive, though we doubt alcohol contributed to increased mortality as its relationship to mortality in trauma is controversial and some studies have even suggested it improves mortality [ 30 – 36 ]. Our COVID cohort also had a higher ISS and a higher percentage of patients with hypotension, though this did not reach statistical significance.…”

Section: Discussionmentioning

confidence: 99%

COVID-19 in trauma: a propensity-matched analysis of COVID and non-COVID trauma patients

Yeates

Grigorian

Schellenberg

et al. 2021

Eur J Trauma Emerg Surg

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Purpose There is mounting evidence that surgical patients with COVID-19 have higher morbidity and mortality than patients without COVID-19. Infection is prevalent amongst the trauma population, but any effect of COVID-19 on trauma patients is unknown. We aimed to evaluate the effect of COVID-19 on a trauma population, hypothesizing increased mortality and pulmonary complications for COVID-19-positive (COVID) trauma patients compared to propensity-matched COVID-19-negative (non-COVID) patients. Methods A retrospective analysis of trauma patients presenting to 11 Level-I and II trauma centers in California between 1/1/2019–6/30/2019 and 1/1/2020–6/30/2020 was performed. A 1:2 propensity score model was used to match COVID to non-COVID trauma patients using age, blunt/penetrating mechanism, injury severity score, Glasgow Coma Scale score, systolic blood pressure, respiratory rate, and heart rate. Outcomes were compared between the two groups. Results A total of 20,448 trauma patients were identified during the study period. 53 COVID trauma patients were matched with 106 non-COVID trauma patients. COVID patients had higher rates of mortality (9.4% vs 1.9%, p = 0.029) and pneumonia (7.5% vs. 0.0%, p = 0.011), as well as a longer mean length of stay (LOS) (7.47 vs 3.28 days, p < 0.001) and intensive care unit LOS (1.40 vs 0.80 days, p = 0.008), compared to non-COVID patients. Conclusion This multicenter retrospective study found increased rates of mortality and pneumonia, as well as a longer LOS, for COVID trauma patients compared to a propensity-matched cohort of non-COVID patients. Further studies are warranted to validate these findings and to elucidate the underlying pathways responsible for higher mortality in COVID trauma patients.

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Section: Discussionmentioning

confidence: 99%

COVID-19 in trauma: a propensity-matched analysis of COVID and non-COVID trauma patients

Yeates

Grigorian

Schellenberg

et al. 2021

Eur J Trauma Emerg Surg

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show abstract

“…Finally, we adjusted for anatomical severity and injury mechanism; however, the traumatic energy was unknown. Some studies have reported that alcohol worsens the ISS 4,11,12 ; hence, there is a possibility that the drinking group might be injured with lower energy than the nondrinking group when adjusting for anatomical severity, and this might reduce the mortality rate in the drinking group. Therefore, further prospective studies are required.…”

Section: Discussionmentioning

confidence: 99%

“…5,6 There are numerous studies on alcohol-associated trauma, with results ranging from worsening prognosis to improvement. [7][8][9][10][11][12][13][14][15][16] However, all these studies were undertaken on European or American populations, who genetically possess superior alcohol metabolism to Japanese individuals. Accordingly, these results would be inapplicable in Japan, and no studies on the impact of alcohol on Japanese trauma patients have been carried out.…”

Section: Introductionmentioning

confidence: 99%

Alcohol does not increase in‐hospital mortality due to severe blunt trauma: an analysis of propensity score matching using the Japan Trauma Data Bank

Sasaki

Obinata

Yokobori

et al. 2021

Acute Medicine & Surgery

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Aim Alcohol‐related problems, including trauma, are a great burden on global health. Alcohol metabolism in the Japanese population is genetically inferior to other races. This study aimed to evaluate the effects of alcohol use among a Japanese severe blunt trauma cohort. Methods This retrospective observational study analyzed the data of trauma patients registered in the Japan Trauma Data Bank between 2004 and 2019. The primary outcome of this study was in‐hospital mortality. The lengths of hospital and intensive care unit stay were the secondary outcomes. Propensity score matching was used to adjust the anatomical severity and patient background to reduce the potential alcohol use bias. Results We analyzed 46,361 patients categorized into nondrinking ( n = 37,818) and drinking ( n = 8,543) groups. After a 1:1 propensity score matching ( n = 8,428, respectively), despite the Glasgow Coma Scale and Revised Trauma Score scores being significantly lower in the drinking group (14 vs. 13 and 7.84 vs. 7.55, P < 0.001, respectively) and intensive care unit length of stay being significantly longer in the drinking group (6 vs. 7 days, P = 0.002), in‐hospital mortality was significantly lower in the alcohol group (11.8% vs. 9.0%, P < 0.001) and there were no differences in the duration of hospital stay (19 vs. 19 days, P = 0.848). Conclusion Despite increasing physiological severity on admission, after adjusting for anatomical severity, alcohol consumption could be beneficial in severe blunt trauma patients as regards in‐hospital mortality.

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“…Anesthesiologists, emergency doctors, surgeons, and other medical personnel face enormous challenges when confronted with patients who need to undergo surgical procedures but are under the influence of alcohol 5 , 6 . Each case has to be weighted individually with no definitive guidelines on how to adapt various anesthetic and analgesic agents.…”

Section: Introductionmentioning

confidence: 99%

Ethanol reduces the minimum alveolar concentration of sevoflurane in rats

Müller

Plöchl

Mühlbacher

et al. 2022

Sci Rep

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A high number of trauma patients are under the influence of alcohol. Since many of them need immediate surgical procedures, it is imperative to be aware of the interaction of alcohol with general anesthesia. To counter challenges that arise from clinical studies, we designed an animal experiment in which 48 adult Wistar rats either received 1 g · kg−1 ethanol, 2 g · kg−1 ethanol or placebo via intraperitoneal application. Subsequently, they were anesthetized with an individual concentration of sevoflurane. The minimum alveolar concentration (MAC) of the different groups was assessed using Dixon’s up-and-down design and isotonic regression methods. The bootstrap estimate of the MAC of sevoflurane in the placebo group was 2.24 vol% (95% CI 1.97–2.94 vol%). In the low dose ethanol group, the bootstrap estimate was 1.65 vol% (95% CI 1.40–1.98 vol%), and in the high dose ethanol group, it was 1.08 vol% (95% CI 0.73–1.42 vol%). We therefore report that intraperitoneal application of 1 g · kg−1 or 2 g · kg−1 ethanol both resulted in a significant reduction of the MAC of sevoflurane in adult Wistar rats: by 26.3% and 51.8% respectively as compared to placebo.

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Elevated blood alcohol impacts hospital mortality following motorcycle injury: A National Trauma Data Bank analysis

Cited by 20 publications

References 18 publications

COVID-19 in trauma: a propensity-matched analysis of COVID and non-COVID trauma patients

COVID-19 in trauma: a propensity-matched analysis of COVID and non-COVID trauma patients

Alcohol does not increase in‐hospital mortality due to severe blunt trauma: an analysis of propensity score matching using the Japan Trauma Data Bank

Ethanol reduces the minimum alveolar concentration of sevoflurane in rats

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