Legal consequences for alcohol-impaired drivers injured in motor vehicle collisions: A systematic review

Should we throw the book at 'em? Charge combinations and conviction rates among alcohol-influenced drivers involved in motorcycle crashes

INTRODUCTION

Motorcycle fatality rates are increasing, and impaired driving is a major contributing factor. Impaired driving laws are a main component of state efforts to reduce drunk driving, but motorcycle crash charge and conviction outcomes have yet to be studied. The purpose of this study was to evaluate driver charge and conviction outcomes following alcohol-related motorcycle crashes.

METHODS

Data for this study were drawn from Iowa crash, charge, and conviction data from 2011 to 2018. The study sample included 480 alcohol-influenced drivers (428 motorcyclists and 52 other vehicle drivers) involved in motorcycle crashes. Driver crash-related charges were categorized by type: Alcohol, Moving Violations, and Administrative/Miscellaneous. Factors associated with convictions were determined and estimated with multivariable logistic regression models. The main factor of interest was charge combination.

RESULTS

Over three-quarters (78.5%) of the 480 alcohol-influenced drivers in crashes received any charge type and 68.1% received an alcohol-related charge. Among drivers with any charge, 88.6% were convicted, and among drivers with alcohol charges, 87.2% were convicted on an alcohol charge. After adjusting for BAC, drivers with a combination of Alcohol, Administrative, and Moving Violation charges had more than three times the odds of conviction of any charge compared to drivers with alcohol only charges (OR = 3.21, 95% CI = 1.00-10.26). However, charge combinations had little impact on alcohol-related convictions.

CONCLUSIONS

Convictions were more likely when the impaired driver was charged with multiple types of offenses than with a single offense. An increased variety of charges was not associated with greater rates of conviction on alcohol-specific charges, which had high conviction rates overall.

PRACTICAL APPLICATIONS

Law enforcement officers should be informed that lesser infractions impact driver conviction outcomes in alcohol-related crashes and procedures for issuing charges should be evaluated to assure equitable enforcement and to hold drivers accountable for unsafe driving behaviors.

Acute alcohol consumption increases systemic endotoxin bioactivity for days in healthy volunteers-with reduced intestinal barrier loss in female

OBJECTIVE

Trauma is the most common cause of death among young adults. Alcohol intoxication plays a significant role as a cause of accidents and as a potent immunomodulator of the post-traumatic response to tissue injury. Polytraumatized patients are frequently at risk to developing infectious complications, which may be aggravated by alcohol-induced immunosuppression. Systemic levels of integral proteins of the gastrointestinal tract such as syndecan-1 or intestinal fatty acid binding proteins (FABP-I) reflect the intestinal barrier function. The exact impact of acute alcohol intoxication on the barrier function and endotoxin bioactivity have not been clarified yet.

METHODS

22 healthy volunteers received a precisely defined amount of alcohol (whiskey-cola) every 20 min over a period of 4 h to reach the calculated blood alcohol concentration (BAC) of 1‰. Blood samples were taken before alcohol drinking as a control, and after 2, 4, 6, 24 and 48 h after beginning with alcohol consumption. In addition, urine samples were collected. Intestinal permeability was determined by serum and urine values of FABP-I, syndecan-1, and soluble (s)CD14 as a marker for the endotoxin translocation via the intestinal barrier by ELISA. BAC was determined.

RESULTS

Systemic FABP-I was significantly reduced 2 h after the onset of alcohol drinking, and remained decreased after 4 h. However, at 6 h, FABP-I significantly elevated compared to previous measurements as well as to controls (p < 0.05). Systemic sCD14 was significantly elevated after 6, 24 and 48 h after the onset of alcohol consumption (p < 0.05). Systemic FABP-I at 2 h after drinking significantly correlated with the sCD14 concentration after 24 h indicating an enhanced systemic LPS bioactivity. Women showed significantly lower levels of syndecan-1 in serum and urine and urine for all time points until 6 h and lower FABP-I in the serum after 2 h.

CONCLUSIONS

Even relative low amounts of alcohol affect the immune system of healthy volunteers, although these changes appear minor in women. A potential damage to the intestinal barrier and presumed enhanced systemic endotoxin bioactivity after acute alcohol consumption is proposed, which represents a continuous immunological challenge for the organism and should be considered for the following days after drinking.

Effect of Lowering the Blood Alcohol Concentration Limit to 0.03 Among Hospitalized Trauma Patients in Southern Taiwan: A Cross-Sectional Analysis

Background

In June 2013, the legal blood alcohol concentration (BAC) limit for driving was lowered from 0.05 to 0.03 mg/mL in Taiwan. Thus, this study aimed to assess the epidemiological changes in terms of drinking among drivers in southern Taiwan before and after the law was imposed.

Methods

Only patients who had undergone the BAC test at the emergency room were included in the study. The patients during the study period before (n = 2735) and after (n = 2413) the implementation of the law were selected for comparison. Drunk patients were defined as those who had a BAC ≥0.005 and were considered as driving under the influence (DUI) of alcohol. Meanwhile, driving while intoxicated (DWI) was defined as a BAC ≥0.05, which was the level adopted in the new law.

Results

Since the BAC limit lowered to 0.03, the number of DUI patients significantly decreased from 340 (12.4%) to 171 (7.1%), and that of DWI patients significantly reduced from 273 (10.0%) to 146 (6.1%) based on the alcohol test. In addition, after the implementation of the law, the number of associated injuries did not significantly decrease from that before the law was implemented in patients involved in alcohol-related crashes.

Conclusion

After lowering the legal BAC limit from 0.05 to 0.03, responsiveness to the change in law was observed among the studied population. However, such responsiveness may not be observed in some citizens who may need special interventions to help reduce their behavior of drinking and driving.

Life-threatening alcohol-related traffic crashes in adverse weather: a double-matched case-control analysis from Canada

IMPORTANCE

Drunk driving is a major cause of death in North America, yet physicians rarely counsel patients on the risks of drinking and driving.

OBJECTIVE

To test whether the risks of a life-threatening alcohol-related traffic crash were further accentuated by adverse weather.

DESIGN

Double matched case-control analysis of hospitalised patients.

SETTING

Canada's largest trauma centre between 1 January 1995 and 1 January 2015.

PARTICIPANTS

Patients hospitalised due to a life-threatening alcohol-related traffic crash.

EXPOSURE

Relative risk of a crash associated with adverse weather estimated by evaluating the weather at the place and time of the crash (cases) compared with the weather at the same place and time a week earlier and a week later (controls).

RESULTS

A total of 2088 patients were included, of whom the majority were drivers injured at night. Adverse weather prevailed among 312 alcohol-related crashes and was significantly more frequent compared with control circumstances. The relative risk of a life-threatening alcohol-related traffic crash was 19% higher during adverse weather compared with normal weather (95% CI: 5 to 35, p=0.006). The absolute increase in risk amounted to 43 additional crashes, extended to diverse groups of patients, applied during night-time and daytime, contributed to about 793 additional patient-days in hospital and was distinct from the risks for drivers who were negative for alcohol.

CONCLUSIONS

Adverse weather was associated with an increased risk of a life-threatening alcohol-related traffic crash. An awareness of this risk might inform warnings to patients about traffic safety and counselling alternatives to drinking and driving.

The prevalence of alcohol-related trauma recidivism: A systematic review

OBJECTIVE

Recurrent admission to a hospital or trauma centre for separate incidents of traumatic injury is known as trauma recidivism. Although use of alcohol is a known risk factor for injury and associated with trauma recidivism, the scale of alcohol-related trauma recidivism has not been well described. The purpose of this review was to search the published literature for studies that evaluated the prevalence of alcohol use among trauma recidivists. Our primary objective was to determine the proportion of trauma recidivism related to alcohol use. The association between alcohol and trauma recidivism was evaluated as a secondary objective.

METHODS

Four electronic databases (MEDLINE, Embase, CINAHL, Web of Science) were searched from inception until December 2015 for all articles that might provide evidence on the proportion of trauma recidivism related to use of alcohol. After removal of duplicates, the search strategy yielded 2470 records for screening. Only primary studies that reported on repeated admissions to a hospital or trauma centre for traumatic injuries specifically related to alcohol use were included. Descriptive statistics were used to assess study characteristics and the prevalence of trauma recidivism related to alcohol use. An aggregate weighted estimate of alcohol-related trauma recidivism was calculated.

RESULTS

A total of 12 studies met all inclusion criteria. Studies were published between 1989 and 2014. Overall, there were 3386 trauma recidivists among included studies. The proportion of trauma recidivists with evidence of alcohol use on admission ranged from 26.7% to 76.9% (median 46.4%). The aggregated sample produced a weighted estimate of 41.0% (1388/3386) for alcohol-related trauma recidivism. In four studies, the association between alcohol and trauma recidivism was examined; all four found a positive association between alcohol use and repeated admission for traumatic injury. Studies varied considerably in design, trauma populations, periods for evaluating recidivism, definitions for positive alcohol on admission, and methods used to determine alcohol use.

CONCLUSION

Evidence from current literature suggests that 41.0% of trauma recidivism is related to use of alcohol. Due to methodological limitations among the studies included for review, this may underestimate the actual prevalence of alcohol-related trauma recidivism.