ALCOHOL AND INJURY Presented by The American College of Surgeons Committee on Trauma Trauma Prevention Series © 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 /year 37 million emergency department visits/year

CAUSES TOTAL OF 150,000 DEATHS 2/3 from unintentional trauma Motor vehicle crashes Falls Work-related accidents Recreational and home mishaps 1/3 from violence

TRAUMA IS NO ACCIDENT!

ALCOHOL CONSUMPTION People who reported drinking in the past month >60% of those aged years 70% of men years of age 54% of women 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 ROLE OF ALCOHOL 40% of motor vehicle crash deaths involve alcohol 40% of pedestrians killed had been drinking The deadly triad: Alcohol Minor grievance Weapon

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: Thinking Judgment Reasoning Reflex activity Control

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 OF NUMBER 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 men 14%-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 men No 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 patients 44% readmission rate 20% mortality rate 77% of deaths were due to continuing substance abuse

IDENTIFICATION OF SUBSTANCE ABUSE Injury episode is a great opportunity History of : Previous injury when under the influence A 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 randomized 396 to control 366 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 DRIVING DONT MIX