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Steyerberg EW, Wiegers E, Sewalt C, Buki A, Citerio G, De Keyser V, Ercole A, Kunzmann K, Lanyon L, Lecky F, Lingsma H, Manley G, Nelson D, Peul W, Stocchetti N, von Steinbüchel N, Vande Vyvere T, Verheyden J, Wilson L, Maas AIR, Menon DK. Case-mix, care pathways, and outcomes in patients with traumatic brain injury in CENTER-TBI: a European prospective, multicentre, longitudinal, cohort study. Lancet Neurol 2020; 18:923-934. [PMID: 31526754 DOI: 10.1016/s1474-4422(19)30232-7] [Citation(s) in RCA: 270] [Impact Index Per Article: 67.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/21/2019] [Accepted: 05/23/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND The burden of traumatic brain injury (TBI) poses a large public health and societal problem, but the characteristics of patients and their care pathways in Europe are poorly understood. We aimed to characterise patient case-mix, care pathways, and outcomes of TBI. METHODS CENTER-TBI is a Europe-based, observational cohort study, consisting of a core study and a registry. Inclusion criteria for the core study were a clinical diagnosis of TBI, presentation fewer than 24 h after injury, and an indication for CT. Patients were differentiated by care pathway and assigned to the emergency room (ER) stratum (patients who were discharged from an emergency room), admission stratum (patients who were admitted to a hospital ward), or intensive care unit (ICU) stratum (patients who were admitted to the ICU). Neuroimages and biospecimens were stored in repositories and outcome was assessed at 6 months after injury. We used the IMPACT core model for estimating the expected mortality and proportion with unfavourable Glasgow Outcome Scale Extended (GOSE) outcomes in patients with moderate or severe TBI (Glasgow Coma Scale [GCS] score ≤12). The core study was registered with ClinicalTrials.gov, number NCT02210221, and with Resource Identification Portal (RRID: SCR_015582). FINDINGS Data from 4509 patients from 18 countries, collected between Dec 9, 2014, and Dec 17, 2017, were analysed in the core study and from 22 782 patients in the registry. In the core study, 848 (19%) patients were in the ER stratum, 1523 (34%) in the admission stratum, and 2138 (47%) in the ICU stratum. In the ICU stratum, 720 (36%) patients had mild TBI (GCS score 13-15). Compared with the core cohort, the registry had a higher proportion of patients in the ER (9839 [43%]) and admission (8571 [38%]) strata, with more than 95% of patients classified as having mild TBI. Patients in the core study were older than those in previous studies (median age 50 years [IQR 30-66], 1254 [28%] aged >65 years), 462 (11%) had serious comorbidities, 772 (18%) were taking anticoagulant or antiplatelet medication, and alcohol was contributory in 1054 (25%) TBIs. MRI and blood biomarker measurement enhanced characterisation of injury severity and type. Substantial inter-country differences existed in care pathways and practice. Incomplete recovery at 6 months (GOSE <8) was found in 207 (30%) patients in the ER stratum, 665 (53%) in the admission stratum, and 1547 (84%) in the ICU stratum. Among patients with moderate-to-severe TBI in the ICU stratum, 623 (55%) patients had unfavourable outcome at 6 months (GOSE <5), similar to the proportion predicted by the IMPACT prognostic model (observed to expected ratio 1·06 [95% CI 0·97-1·14]), but mortality was lower than expected (0·70 [0·62-0·76]). INTERPRETATION Patients with TBI who presented to European centres in the core study were older than were those in previous observational studies and often had comorbidities. Overall, most patients presented with mild TBI. The incomplete recovery of many patients should motivate precision medicine research and the identification of best practices to improve these outcomes. FUNDING European Union 7th Framework Programme, the Hannelore Kohl Stiftung, OneMind, and Integra LifeSciences Corporation.
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Affiliation(s)
- Ewout W Steyerberg
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands; Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands
| | - Eveline Wiegers
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Charlie Sewalt
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Andras Buki
- Department of Neurosurgery, Medical School, University of Pécs, Pécs, Hungary; Neurotrauma Research Group, János Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Giuseppe Citerio
- NeuroIntensive Care, ASST di Monza, Monza, Italy; School of Medicine and Surgery, Università Milano Bicocca, Milan, Italy
| | | | - Ari Ercole
- Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Kevin Kunzmann
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - Linda Lanyon
- International Neuroinformatics Coordinating Facility, Karolinska Institute, Stockholm, Sweden
| | - Fiona Lecky
- Centre for Urgent and Emergency Care Research, Health Services Research Section, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Hester Lingsma
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Geoffrey Manley
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - David Nelson
- Department of Physiology and Pharmacology, Section of Perioperative Medicine and Intensive Care, Karolinska Institute, Stockholm, Sweden
| | - Wilco Peul
- Leiden University Medical Centre and Haaglanden Medical Centre, University Neurosurgical Centre Holland, The Hague and Leiden, Netherlands
| | - Nino Stocchetti
- Department of Pathophysiology and Transplantation, Milan University, Milan, Italy; Neuroscience Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicole von Steinbüchel
- Institute of Medical Psychology and Medical Sociology, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Thijs Vande Vyvere
- Department of Radiology, Antwerp University Hospital, Edegem, Belgium; Division of Psychology, University of Stirling, Stirling, UK
| | | | - Lindsay Wilson
- Division of Psychology, University of Stirling, Stirling, UK
| | - Andrew I R Maas
- Department of Neurosurgery, Antwerp University Hospital, Edegem, Belgium; University of Antwerp, Edegem, Belgium.
| | - David K Menon
- Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
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Drummer OH, Gerostamoulos D, Di Rago M, Woodford NW, Morris C, Frederiksen T, Jachno K, Wolfe R. Odds of culpability associated with use of impairing drugs in injured drivers in Victoria, Australia. ACCIDENT; ANALYSIS AND PREVENTION 2020; 135:105389. [PMID: 31812899 DOI: 10.1016/j.aap.2019.105389] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 11/25/2019] [Accepted: 11/28/2019] [Indexed: 06/10/2023]
Abstract
Culpability analysis was conducted on 5000 drivers injured as a result of a vehicular collision and in whom comprehensive toxicology testing in blood was conducted. The sample included 1000 drivers for each of 5 years from approximately 5000-6000 drivers injured and taken to hospital in the State of Victoria. Logistic regression was used to investigate differences in the odds of culpability associated with alcohol and drug use and other selected crash attributes using the drug-free driver as the reference group. Adjusted odds ratios were obtained from multivariable logistic regression models in which other potentially explanatory driver and crash attributes were included. Drivers with alcohol present showed large increases in the odds of culpability similar to that seen in other studies investigating associations between blood alcohol concentration and crash risk. Methylamphetamine also showed a large increase in the odds of culpability (OR 19) compared to the reference group at both below and above 0.1 mg/L, whereas those drivers with Δ9-tetrahydrocannabinol (THC) present showed only modest increase in odds when all concentrations were assessed (OR 1.9, 95 %CI 1.2-3.1). Benzodiazepines in drivers also gave an increase in odds (3.2, 95 %CI 1.6-6.1), but not other medicinal drugs such as antidepressants, antipsychotics and opioids. Drivers that had combinations of impairing drugs generally gave a large increase in odds, particularly combinations of alcohol with THC or benzodiazepines, and those drivers using both THC and methamphetamine.
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Affiliation(s)
- Olaf H Drummer
- Victorian Institute of Forensic Medicine and the Department of Forensic Medicine, Monash University, School of Public Health and Preventive Medicine, 65 Kavanagh Street, Southbank 3006, Victoria, Australia.
| | - Dimitri Gerostamoulos
- Victorian Institute of Forensic Medicine and the Department of Forensic Medicine, Monash University, School of Public Health and Preventive Medicine, 65 Kavanagh Street, Southbank 3006, Victoria, Australia
| | - Matthew Di Rago
- Victorian Institute of Forensic Medicine and the Department of Forensic Medicine, Monash University, School of Public Health and Preventive Medicine, 65 Kavanagh Street, Southbank 3006, Victoria, Australia
| | - Noel W Woodford
- Victorian Institute of Forensic Medicine and the Department of Forensic Medicine, Monash University, School of Public Health and Preventive Medicine, 65 Kavanagh Street, Southbank 3006, Victoria, Australia
| | - Carla Morris
- Road Policing Drug and Alcohol Section, Victoria Police, 20 Dawson St., Brunswick 3056, Victoria, Australia
| | - Tania Frederiksen
- Road Policing Drug and Alcohol Section, Victoria Police, 20 Dawson St., Brunswick 3056, Victoria, Australia
| | - Kim Jachno
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne 3004, Victoria, Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne 3004, Victoria, Australia
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DiRago M, Gerostamoulos D, Morris C, Fredericksen T, Woodford NW, Drummer OH. Prevalence of drugs in injured drivers in Victoria, Australia. AUST J FORENSIC SCI 2019. [DOI: 10.1080/00450618.2019.1687753] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Matthew DiRago
- Victorian Institute of Forensic Medicine, Southbank, Australia
- Department of Forensic Medicine, School of Public Health and Preventive Medicine, Monash University, Southbank, Australia
| | - Dimitri Gerostamoulos
- Victorian Institute of Forensic Medicine, Southbank, Australia
- Department of Forensic Medicine, School of Public Health and Preventive Medicine, Monash University, Southbank, Australia
| | - Carla Morris
- Victoria Police, Road Policing Drug and Alcohol Section, Victoria, Australia
| | - Tania Fredericksen
- Victoria Police, Road Policing Drug and Alcohol Section, Victoria, Australia
| | - Noel W. Woodford
- Victorian Institute of Forensic Medicine, Southbank, Australia
- Department of Forensic Medicine, School of Public Health and Preventive Medicine, Monash University, Southbank, Australia
| | - Olaf H. Drummer
- Victorian Institute of Forensic Medicine, Southbank, Australia
- Department of Forensic Medicine, School of Public Health and Preventive Medicine, Monash University, Southbank, Australia
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Barone R, Pelletti G, Garagnani M, Giusti A, Marzi M, Rossi F, Roffi R, Fais P, Pelotti S. Alcohol and illicit drugs in drivers involved in road traffic crashes in Italy. An 8-year retrospective study. Forensic Sci Int 2019; 305:110004. [PMID: 31707239 DOI: 10.1016/j.forsciint.2019.110004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/16/2019] [Accepted: 10/21/2019] [Indexed: 02/06/2023]
Abstract
This study aims to investigate the prevalence of alcohol and drugs of abuse in Italian drivers involved in road traffic crashes between 2011 and 2018. Toxicological analyses were performed on the whole blood of 7593 injured drivers. Alcohol and illicit drugs, namely tetrahydrocannabinol (THC; cut-off 2ng/ml), cocaine (cut-off 10ng/ml), illicit opiates (cut-off 10ng/ml) and amphetamines (amphetamine, methamphetamine, MDMA, MDA; cut-off 20ng/ml) were investigated. The age and gender of the driver, the time of the crash (weekend/weekday and day/night), the road crash year and Blood Alcohol Concentration (BAC) were also considered. The 16.2% of samples tested positive for alcohol, 2.5% for cocaine, followed by opiates (2.0%), cannabinoids (1.5%), and amphetamines (0.5%). The overall prevalence of alcohol and drugs was lower than those reported in previous epidemiological studies of the DRUID project. The year 2011 showed the highest prevalence of drug-positive cases (24.1%), while the lowest prevalence was found in 2016 (16.8%), after the update of the Road Traffic Law (RTL) that increased punishments for driving under the influence. A progressive increase in the number of alcohol-positive female drivers was observed from 2011 to 2018, and the highest prevalence was found in the 26-35-year-old age range. Illicit drugs showed the highest overall prevalence in drivers <26 years of age but, if considering single drugs, cocaine and opiates were mostly found in subjects older than 36 years of age. A higher percentage of drug-positive drivers was found on weekend nights for alcohol and on both weekend and weekday nights for drugs. The types of drugs used by drivers did not change during the studied period.
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Affiliation(s)
- Rossella Barone
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126, Bologna, Italy.
| | - Guido Pelletti
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126, Bologna, Italy.
| | - Marco Garagnani
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126, Bologna, Italy.
| | - Alessio Giusti
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126, Bologna, Italy.
| | - Mattia Marzi
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126, Bologna, Italy.
| | - Francesca Rossi
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126, Bologna, Italy.
| | - Raffaella Roffi
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126, Bologna, Italy.
| | - Paolo Fais
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126, Bologna, Italy.
| | - Susi Pelotti
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126, Bologna, Italy.
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Azagba S, Latham K, Shan L, Qeadan F. Positive drug test trends in fatally-injured drivers in the United States from 2007 to 2017. Subst Abuse Treat Prev Policy 2019; 14:43. [PMID: 31653263 PMCID: PMC6815059 DOI: 10.1186/s13011-019-0228-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 09/09/2019] [Indexed: 11/29/2022] Open
Abstract
Background The last two decades have seen tremendous changes in the U.S. environment surrounding drugs. Driving under the influence of drugs is a growing public health hazard. The present study examined trends in drug involvement in fatally-injured drivers in the U.S. Methods Data were drawn from the 2007–2017 Fatality Analysis Reporting System. Cochran–Armitage tests were performed to assess the statistical significance of changes in the yearly prevalence of positive drug tests in fatally-injured drivers over time. In addition, analyses were stratified by sex, race, and age. Results The yearly prevalence of positive drug tests in fatally-injured drivers increased significantly from 20.7% in 2007 to 30.7% in 2017, with results showing a higher prevalence among males, those aged 21–44, and Whites. The gap between Blacks and Whites narrowed in 2017. There was a decline in the yearly prevalence in all age groups between 2016 and 2017, although the decrease in the 21–44 age group was much smaller than other age groups. Among drivers who tested positive for drugs, 34.6% had a blood alcohol concentration (BAC) above the threshold of per se evidence for impaired driving, and 63% had a BAC below the threshold. Conclusions Our results indicate that the overall yearly prevalence of fatally-injured drivers who tested positive for drugs increased significantly from 2007 to 2017, with similar results found for subgroups. Findings further highlight that drugged driving remains a public health priority, and more action is needed to stem this disturbing trend.
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Affiliation(s)
- Sunday Azagba
- Department of Family and Preventive Medicine, Division of Public Health, University of Utah School of Medicine, 375 Chipeta Way, Suite A, Salt Lake City, UT, 84108, USA.
| | - Keely Latham
- Department of Family and Preventive Medicine, Division of Public Health, University of Utah School of Medicine, 375 Chipeta Way, Suite A, Salt Lake City, UT, 84108, USA
| | - Lingpeng Shan
- Department of Family and Preventive Medicine, Division of Public Health, University of Utah School of Medicine, 375 Chipeta Way, Suite A, Salt Lake City, UT, 84108, USA
| | - Fares Qeadan
- Department of Family and Preventive Medicine, Division of Public Health, University of Utah School of Medicine, 375 Chipeta Way, Suite A, Salt Lake City, UT, 84108, USA
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Evaluation of a Road Safety Education Program Based on Driving Under Influence and Traffic Risks for Higher Secondary School Students in Belgium. SAFETY 2019. [DOI: 10.3390/safety5020034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Road safety education has been recognized as an instrument for reducing road accidents. This study aims to evaluate the road safety education program “Traffic Weeks” among higher secondary school students (age 16–19) in Belgium. The program focuses on driving under influence (DUI) and traffic risks. This study investigates whether the program has an effect on socio-cognitive variables using a questionnaire based on the theory of planned behavior. During the pre-test, 445 students filled in the questionnaire, while 253 students filled in the questionnaire during the post-test. Of these, 175 questionnaires could be matched. The results indicate that the students already had quite a supportive view of road safety at pre-test, with female students showing a more supportive view of road safety than male students. The DUI workshop had a positive effect on most socio-cognitive variables (attitude, subjective norm-friends, and intention) of female students in general education, while the traffic risks workshop only affected perceived behavioral control of female students. In terms of appreciation, students had a significantly higher appreciation of the DUI workshop compared to the traffic risks workshop. During the focus groups, students gave recommendations to improve the program.
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Mundenga MM, Sawe HR, Runyon MS, Mwafongo VG, Mfinanga JA, Murray BL. The prevalence of alcohol and illicit drug use among injured patients presenting to the emergency department of a national hospital in Tanzania: a prospective cohort study. BMC Emerg Med 2019; 19:15. [PMID: 30678633 PMCID: PMC6346498 DOI: 10.1186/s12873-019-0222-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 01/04/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Alcohol and illicit drugs have been found to be major contributing factors leading to severe injuries in a variety of settings. In Tanzania, the use of these substances among injured patients has not been studied. We investigated the prevalence of positive tests for alcohol and illicit drug use among injured patients presenting to the emergency medicine department (ED) of Muhimbili National Hospital (MNH). METHODS This was a prospective cohort study of a consecutive sample of patients > 18 years of age presenting to the ED-MNH with injury related complaints in October and November 2015. A structured data sheet was used to record demographic information, mechanism of injury, clinical presentation, alcohol and illicit drug test results, and ED disposition. Alcohol levels and illicit drug use were tested by breathalyser device or swab stick alcohol test and multidrug urine panel, respectively. Patients were followed up for 24 h and 30 days using medical chart reviews and phone calls. Descriptive statistics and relative risk were used to describe the results. RESULTS We screened 1011 patients and we enrolled all 143 (14.1%) patients who met inclusion criteria. 123 (86.0%) were male, the median age was 30 years (IQR: 23-36 years). The most frequent mechanism of injury was road traffic accidents (84.6%). 67/143 (46.9%) patients tested positive for alcohol and 44/122 (36.1%) patients tested positive for drugs. 29 (26.1%) tested positive for alcohol and drugs. The most frequently detected illicit drug was marijuana in 30/122 (24.5%) injured patients. 23/53 (43.4%) patients with positive alcohol testing self-reported alcohol use. 3/25 patients with positive illicit drug tests who were able to provide self-reports, self-reported drug use. At 30-day followup, 43 (64.2%) injured patients who tested positive for alcohol had undergone major surgery, 6 (9.0%) had died, and 36 (53.7%) had not yet returned to their baseline. CONCLUSIONS The prevalence of alcohol and illicit drugs is very high in patients presenting to the ED-MNH with injury. Further studies are needed to generalise the results in Tanzania. Public health initiatives to decrease drinking and/or illicit drug use and driving should be implemented.
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Affiliation(s)
- Müller M Mundenga
- Department of Emergency Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania. .,Heal Africa Hospital, Goma, Democratic Republic of Congo.
| | - Hendry R Sawe
- Department of Emergency Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Department of Emergency Medicine, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Michael S Runyon
- Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC, USA
| | - Victor G Mwafongo
- Department of Emergency Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Juma A Mfinanga
- Department of Emergency Medicine, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Brittany L Murray
- Department of Emergency Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Division of Pediatric \Emergency Medicine, Emory University School of Medicine/Children's Healthcare of Atlanta, Atlanta, GA, USA
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Simonsen KW, Linnet K, Rasmussen BS. Driving under the influence of alcohol and drugs in the eastern part of Denmark in 2015 and 2016: Abuse patterns and trends. TRAFFIC INJURY PREVENTION 2018; 19:468-475. [PMID: 29370543 DOI: 10.1080/15389588.2018.1428743] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 01/11/2018] [Indexed: 06/07/2023]
Abstract
OBJECTIVES The objective of this study was to examine the frequency of psychoactive drugs and alcohol in drivers under suspicion of driving under the influence of drugs and alcohol in 2015 and 2016 in the eastern part of Denmark. The trends in the number of traffic cases sent for drug analysis since 2000 and alcohol analysis since 2011 are also discussed. METHODS Blood samples from drivers suspected of being under the influence of alcohol and/or medication and/or illicit drugs in 2015 and 2016 were investigated as requested by the police. The blood samples were screened for alcohol and/or tetrahydrocannabinol (THC) alone, for other drugs (covering all drugs, except THC, listed in the Danish list of narcotic drugs), or for THC and other drugs. Age and gender were also recorded. The number of drug traffic cases since 2000 and the number of alcohol cases since 2011 were extracted from our Laboratory Information Management System (LIMS). RESULTS In total, 11,493 traffic cases were investigated. Alcohol and/or drugs exceeded the legal limit in 9,657 (84%) cases. Men constituted 95% of the drivers investigated for drugs and 88% of the alcohol cases. The drivers investigated for drugs consisted primarily of young men, whereas drivers investigated for alcohol were older. The frequency was higher for positive alcohol cases above the legal limit (87%) than for drug cases (76%) above the fixed concentration limit. THC (67-69%) was the most frequently detected drug above the legal limit, followed by cocaine (27-28.5%), amphetamine (17%), and clonazepam (6-7%) in both years. Morphine (5.4%), included among the 5 most frequent drugs in 2015, was replaced by methadone (4.6%) in 2016. Few new psychoactive drugs (NPS) were detected. The number of traffic cases sent for drug analysis has increased more than 30-fold since 2000-2006, and the number of traffic cases submitted in 2016 for drug analysis was higher than the number for alcohol analysis; the latter has decreased since 2011. CONCLUSION Overall, alcohol was the most frequent compound detected above the legal limit in both years, followed by the well-known illicit drugs THC, cocaine, and amphetamine. NPS were seldom seen. One consequence of the increased focus on drugs in traffic has been an immense increase in drug traffic cases sent for analysis since 2006 in the eastern part of Denmark. Although this survey revealed only minimal changes compared to earlier investigations, surveys like this are invaluable for monitoring abuse patterns and trends in drugged and drunken driving.
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Affiliation(s)
- Kirsten Wiese Simonsen
- a Section of Forensic Chemistry, Department of Forensic Medicine, Faculty of Health Sciences , University of Copenhagen , Copenhagen , Denmark
| | - Kristian Linnet
- a Section of Forensic Chemistry, Department of Forensic Medicine, Faculty of Health Sciences , University of Copenhagen , Copenhagen , Denmark
| | - Brian Schou Rasmussen
- a Section of Forensic Chemistry, Department of Forensic Medicine, Faculty of Health Sciences , University of Copenhagen , Copenhagen , Denmark
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Rezaee-Zavareh MS, Salamati P, Ramezani-Binabaj M, Saeidnejad M, Rousta M, Shokraneh F, Rahimi-Movaghar V. Alcohol consumption for simulated driving performance: A systematic review. Chin J Traumatol 2017; 20:166-172. [PMID: 28502603 PMCID: PMC5473736 DOI: 10.1016/j.cjtee.2017.04.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 05/21/2016] [Accepted: 05/30/2016] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Alcohol consumption can lead to risky driving and increase the frequency of traffic accidents, injuries and mortalities. The main purpose of our study was to compare simulated driving performance between two groups of drivers, one consumed alcohol and the other not consumed, using a systematic review. METHODS In this systematic review, electronic resources and databases including Medline via Ovid SP, EMBASE via Ovid SP, PsycINFO via Ovid SP, PubMed, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINHAL) via EBSCOhost were comprehensively and systematically searched. The randomized controlled clinical trials that compared simulated driving performance between two groups of drivers, one consumed alcohol and the other not consumed, were included. Lane position standard deviation (LPSD), mean of lane position deviation (MLPD), speed, mean of speed deviation (MSD), standard deviation of speed deviation (SDSD), number of accidents (NA) and line crossing (LC) were considered as the main parameters evaluating outcomes. After title and abstract screening, the articles were enrolled for data extraction and they were evaluated for risk of biases. RESULTS Thirteen papers were included in our qualitative synthesis. All included papers were classified as high risk of biases. Alcohol consumption mostly deteriorated the following performance outcomes in descending order: SDSD, LPSD, speed, MLPD, LC and NA. Our systematic review had troublesome heterogeneity. CONCLUSION Alcohol consumption may decrease simulated driving performance in alcohol consumed people compared with non-alcohol consumed people via changes in SDSD, LPSD, speed, MLPD, LC and NA. More well-designed randomized controlled clinical trials are recommended.
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Affiliation(s)
| | - Payman Salamati
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | | | - Mina Saeidnejad
- Islamic Azad University, Tehran Medical Branch, Tehran, Iran
| | - Mansoureh Rousta
- Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Farhad Shokraneh
- Research Center for Pharmaceutical Nanotechnology, Iranian Center for Evidence-based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Pelição FS, Peres MD, Pissinate JF, de Paula DML, de Faria MDGC, Nakamura-Palacios EM, De Martinis BS. Predominance of alcohol and illicit drugs among traffic accidents fatalities in an urban area of Brazil. TRAFFIC INJURY PREVENTION 2016; 17:663-667. [PMID: 26891425 DOI: 10.1080/15389588.2016.1146824] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 01/21/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE The objective of this study was to determine the prevalence of alcohol and illicit drug use among victims of fatal traffic accidents in the Metropolitan Region of Vitória, Brazil, during the period 2011-2012. METHODS Blood samples were collected and analyzed for the presence of drugs from 391 deceased victims of traffic crashes that occurred in the Metropolitan Region of Vitória, Brazil. The victims included drivers, passengers, and pedestrians. Sociodemographic variables such as age, gender, day of the week, and period of the year in which the accidents occurred were recorded. The analyses were performed by a gas chromatography-flame ionization method for alcohol and by a gas chromatography-mass spectrometry for amphetamines, cocaine, and cannabis. RESULTS The results showed that 44.8% (n = 175) of all cases were positive for alcohol and/or illicit drugs. The detection of alcohol and/or drugs was more frequent in young males, aged 17 to 34, whose samples were positive in 46.8% of cases. Small differences among drivers, passengers, and pedestrians were observed (drivers = 45.9%, passengers = 46.4%, and pedestrians = 45.6%). In general, the most prevalent drug was alcohol, with 141 positive cases (36.1%), followed by cocaine, with 47 positive cases (12%). Amphetamines and cannabis had positivity rates of 4.1 and 4.3%, with 16 and 17 positive cases, respectively. The combined use of alcohol and other drugs was found in 36 cases (9.2%). Crack cocaine use was observed in 27.7% of the positive cases for cocaine. CONCLUSIONS For the effective reduction of traffic accidents related to driving under influence of drugs (DUID), we suggest the intensification of enforcement actions against the use of alcohol by drivers, the definition of which illicit drugs should be surveyed, as well the cutoff values, the promotion of changing legislation to oblige drivers to provide samples for toxicological testing, and the establishment of public information programs and specific actions aimed at young drivers to promote behavioral changes.
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Affiliation(s)
- Fabrício Souza Pelição
- a Departamento Médico Legal, Serviço de Laboratório Médico Legal , Polícia Civil do Espírito Santo , Vitória , Brazil
- b Departamento de Análises Clínicas , Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo , Ribeirão Preto , Brazil
| | - Mariana Dadalto Peres
- a Departamento Médico Legal, Serviço de Laboratório Médico Legal , Polícia Civil do Espírito Santo , Vitória , Brazil
- b Departamento de Análises Clínicas , Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo , Ribeirão Preto , Brazil
| | - Jauber Fornaciari Pissinate
- a Departamento Médico Legal, Serviço de Laboratório Médico Legal , Polícia Civil do Espírito Santo , Vitória , Brazil
| | | | | | - Ester Miyuki Nakamura-Palacios
- c Departamento de Ciências Fisiológicas , Centro de Ciências da Saúde, Universidade Federal do Espírito Santo , Vitória , Brazil
| | - Bruno Spinosa De Martinis
- d Departamento de Química , Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Universidade de São Paulo , Ribeirão Preto , Brazil
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Salvatore S, Bramness JG, Røislien J. Exploring functional data analysis and wavelet principal component analysis on ecstasy (MDMA) wastewater data. BMC Med Res Methodol 2016; 16:81. [PMID: 27406032 PMCID: PMC4942983 DOI: 10.1186/s12874-016-0179-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 06/08/2016] [Indexed: 11/10/2022] Open
Abstract
Background Wastewater-based epidemiology (WBE) is a novel approach in drug use epidemiology which aims to monitor the extent of use of various drugs in a community. In this study, we investigate functional principal component analysis (FPCA) as a tool for analysing WBE data and compare it to traditional principal component analysis (PCA) and to wavelet principal component analysis (WPCA) which is more flexible temporally. Methods We analysed temporal wastewater data from 42 European cities collected daily over one week in March 2013. The main temporal features of ecstasy (MDMA) were extracted using FPCA using both Fourier and B-spline basis functions with three different smoothing parameters, along with PCA and WPCA with different mother wavelets and shrinkage rules. The stability of FPCA was explored through bootstrapping and analysis of sensitivity to missing data. Results The first three principal components (PCs), functional principal components (FPCs) and wavelet principal components (WPCs) explained 87.5-99.6 % of the temporal variation between cities, depending on the choice of basis and smoothing. The extracted temporal features from PCA, FPCA and WPCA were consistent. FPCA using Fourier basis and common-optimal smoothing was the most stable and least sensitive to missing data. Conclusion FPCA is a flexible and analytically tractable method for analysing temporal changes in wastewater data, and is robust to missing data. WPCA did not reveal any rapid temporal changes in the data not captured by FPCA. Overall the results suggest FPCA with Fourier basis functions and common-optimal smoothing parameter as the most accurate approach when analysing WBE data. Electronic supplementary material The online version of this article (doi:10.1186/s12874-016-0179-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stefania Salvatore
- Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway.
| | - Jørgen G Bramness
- Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
| | - Jo Røislien
- Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway.,Oslo Centre for Biostatistics and Epidemiology, Institute of Basic Medical Sciences, Oslo, Norway
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Abstract
Alcohol consumption with psychostimulants is very common among drug addicts. There is little known about the possible pharmacological interactions between alcohol and psychostimulants. Among most commonly co-abused psychostimulants with alcohol are methamphetamine, cocaine, 3,4-methylenedioxymethamphetaminen, and nicotine. Co-abuse of alcohol with psychostimulants can lead to several neurophysiological dysfunctions such as decrease in brain antioxidant enzymes, disruption of learning and memory processes, cerebral hypo-perfusion, neurotransmitters depletion as well as potentiation of drug seeking behaviour. Moreover, co-abuse of alcohol and psychostimulants can lead to increase in heart rate, blood pressure, myocardial oxygen consumption and cellular stress, and the risk of developing different types of cancer. Co-abuse of alcohol with psychostimulants during pregnancy can lead to fetal brain abnormalities. Further studies are needed to investigate the pharmacokinetics, pharmacodynamics, and neurochemical changes on co-abuse of alcohol and psychostimulants.
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Affiliation(s)
- Yusuf S Althobaiti
- University of Toledo, College of Pharmacy and Pharmaceutical Sciences, Department of Pharmacology and Experimental Therapeutics, Toledo, OH, USA
| | - Youssef Sari
- University of Toledo, College of Pharmacy and Pharmaceutical Sciences, Department of Pharmacology and Experimental Therapeutics, Toledo, OH, USA
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Brubacher JR, Chan H, Martz W, Schreiber W, Asbridge M, Eppler J, Lund A, Macdonald S, Drummer O, Purssell R, Andolfatto G, Mann R, Brant R. Prevalence of alcohol and drug use in injured British Columbia drivers. BMJ Open 2016; 6:e009278. [PMID: 26966054 PMCID: PMC4800149 DOI: 10.1136/bmjopen-2015-009278] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Determine the prevalence of drug use in injured drivers and identify associated demographic factors and crash characteristics. DESIGN Prospective cross-sectional study. SETTING Seven trauma centres in British Columbia, Canada (2010-2012). PARTICIPANTS Automobile drivers who had blood obtained within 6 h of a crash. MAIN OUTCOME MEASURES We analysed blood for cannabis, alcohol and other impairing drugs using liquid chromatography/mass spectrometry (LCMS). RESULTS 1097 drivers met inclusion criteria. 60% were aged 20-50 years, 63.2% were male and 29.0% were admitted to hospital. We found alcohol in 17.8% (15.6% to 20.1%) of drivers. Cannabis was the second most common recreational drug: cannabis metabolites were present in 12.6% (10.7% to 14.7%) of drivers and we detected Δ-9-tetrahydrocannabinol (Δ-9-THC) in 7.3% (5.9% to 9.0%), indicating recent use. Males and drivers aged under 30 years were most likely to use cannabis. We detected cocaine in 2.8% (2.0% to 4.0%) of drivers and amphetamines in 1.2% (0.7% to 2.0%). We also found medications including benzodiazepines (4.0% (2.9% to 5.3%)), antidepressants (6.5% (5.2% to 8.1%)) and diphenhydramine (4.7% (3.5% to 6.2%)). Drivers aged over 50 years and those requiring hospital admission were most likely to have used medications. Overall, 40.1% (37.2% to 43.0%) of drivers tested positive for alcohol or at least one impairing drug and 12.7% (10.7% to 14.7%) tested positive for more than one substance. CONCLUSIONS Alcohol, cannabis and a broad range of other impairing drugs are commonly detected in injured drivers. Alcohol is well known to cause crashes, but further research is needed to determine the impact of other drug use, including drug-alcohol and drug-drug combinations, on crash risk. In particular, more work is needed to understand the role of medications in causing crashes to guide driver education programmes and improve public safety.
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Affiliation(s)
- Jeffrey R Brubacher
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Herbert Chan
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Walter Martz
- Provincial Toxicology Centre, Vancouver, British Columbia, Canada
| | - William Schreiber
- Provincial Toxicology Centre, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Mark Asbridge
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jeffrey Eppler
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Adam Lund
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Scott Macdonald
- University of Victoria, Centre for Addiction Research of British Columbia, Vancouver, British Columbia, Canada
| | - Olaf Drummer
- Department of Forensic Medicine, Monash University, Melbourne, Victoria, Australia
| | - Roy Purssell
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Provincial Health Services Authority, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Gary Andolfatto
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Robert Mann
- Provincial Health Services Authority, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Rollin Brant
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Salvatore S, Bramness JG, Reid MJ, Thomas KV, Harman C, Røislien J. Wastewater-Based Epidemiology of Stimulant Drugs: Functional Data Analysis Compared to Traditional Statistical Methods. PLoS One 2015; 10:e0138669. [PMID: 26394227 PMCID: PMC4578919 DOI: 10.1371/journal.pone.0138669] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 09/02/2015] [Indexed: 12/03/2022] Open
Abstract
Background Wastewater-based epidemiology (WBE) is a new methodology for estimating the drug load in a population. Simple summary statistics and specification tests have typically been used to analyze WBE data, comparing differences between weekday and weekend loads. Such standard statistical methods may, however, overlook important nuanced information in the data. In this study, we apply functional data analysis (FDA) to WBE data and compare the results to those obtained from more traditional summary measures. Methods We analysed temporal WBE data from 42 European cities, using sewage samples collected daily for one week in March 2013. For each city, the main temporal features of two selected drugs were extracted using functional principal component (FPC) analysis, along with simpler measures such as the area under the curve (AUC). The individual cities’ scores on each of the temporal FPCs were then used as outcome variables in multiple linear regression analysis with various city and country characteristics as predictors. The results were compared to those of functional analysis of variance (FANOVA). Results The three first FPCs explained more than 99% of the temporal variation. The first component (FPC1) represented the level of the drug load, while the second and third temporal components represented the level and the timing of a weekend peak. AUC was highly correlated with FPC1, but other temporal characteristic were not captured by the simple summary measures. FANOVA was less flexible than the FPCA-based regression, and even showed concordance results. Geographical location was the main predictor for the general level of the drug load. Conclusion FDA of WBE data extracts more detailed information about drug load patterns during the week which are not identified by more traditional statistical methods. Results also suggest that regression based on FPC results is a valuable addition to FANOVA for estimating associations between temporal patterns and covariate information.
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Affiliation(s)
- Stefania Salvatore
- Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
- * E-mail:
| | | | | | | | | | - Jo Røislien
- Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
- Department of Biostatistics, Institute of Basic Medical Sciences, Oslo, Norway
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Kumar S, Bansal YS, Singh D, Medhi B. Alcohol and Drug Use in Injured Drivers - An Emergency Room Study in a Regional Tertiary Care Centre of North West India. J Clin Diagn Res 2015; 9:HC01-4. [PMID: 26393144 DOI: 10.7860/jcdr/2015/14840.6239] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Accepted: 06/17/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Statistics show an increasing proportion of alcohol and drug use in drivers in more recent times throughout the world. It has been found that among the various human factors, alcohol consumption, using drugs and subsequent driving on the roads are major risk factors. Traffic regulations in India penalises drivers who drive beyond permissible alcohol limit of 30 mg%. Consumption of psychoactive drugs such as opioid, cannabis and benzodiazepines has been reported mainly among youngsters. Hardly any data is available in Indian context particularly from North-West Zone of India. STUDY OBJECTIVE To study the pattern of alcohol, opioid, cannabis and benzodiazepines use in injured drivers presenting to a designated trauma centre in Chandigarh zone of North-West India. MATERIALS AND METHODS Consenting injured drivers who presented to the trauma centre in Chandigarh from September 2013 to January 2014 were included. Urine samples collected from the subjects were screened for abusive drug exposure (opioid, cannabis and benzodiazepines) and alcohol using commercial bedside urine immunoassay kits. In urine alcohol positive cases blood samples were collected and analysed for alcohol concentration using standard gas chromatography. Retrograde extrapolation method was used to assess BAC at the time of accident. RESULTS A total of 200 injured drivers were included in this study. We found substance consumption in 54.5% of drivers and alcohol (40.5%) was the most prevalent substance consumed followed by opiates (13%), cannabis (7%) and benzodiazepines (7%). More than one substance was shown in urine of 11.5% of drivers. Among 81 alcohol positive screening cases, the quantitative analysis was successfully done for 76 cases. Except one, all cases showed BAC value more than 30 mg% which is the legal limit for driving any vehicle in India. The values of alcohol concentration in blood at the time of accident were in the range of 20 to 391 mg%. CONCLUSION This study has shown that drivers are consuming not only alcohol but other psychoactive drugs also. Indian traffic regulatory authorities are penalising drunk drivers by doing road side breath alcohol testing with no protocols for drug screening. Appropriate measures should be adopted to screen traffic offenders for psychoactive drugs also.
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Affiliation(s)
- Senthil Kumar
- Senior Resident, Department of Forensic Medicine, PGIMER , Chandigarh, India
| | | | - Dalbir Singh
- Professor, Department of Forensic Medicine, PGIMER , Chandigarh, India
| | - Bikash Medhi
- Additional Professor, Department of Pharmacology, PGIMER , Chandigarh, India
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Asante LS, Newell M, Yun M, Yun-Welch S, Chun S. Comparative study of the impact of intoxication on injuries in china and Korea. Osong Public Health Res Perspect 2015; 6:27-33. [PMID: 25737828 PMCID: PMC4346591 DOI: 10.1016/j.phrp.2015.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 12/15/2014] [Accepted: 12/16/2014] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVES Alcohol misuse has been widely studied as a substantial contributor to injured patients' visits to emergency departments. The current research studied differences in alcohol-related injury variables in China and Korea. METHODS Data were collected from a sample of 4,509 patients (2,862 males and 1,667 females) reporting at emergency departments in China and Korea using the World Health Organization collaborative study on alcohol and injuries protocol. RESULTS More injuries were reported by men, young people aged 25-34 years, employed individuals, and persons who had at least a high-school education. The proportion of injury cases among intoxicated patients was 14% for Chinese and 20% for Koreans. The odds of intentional injuries to intoxicated patients increased significantly when the perpetrator had been drinking, especially for severely intoxicated victims in both countries. The odds of injuries for intoxicated persons in both countries were high during sports and leisure activities; odds ratio (OR) = 3.93, 95% confidence interval (CI) = 2.76-5.59 for Chinese and OR = 10.97, 95% CI = 6.06-19.85 for Koreans. CONCLUSION These findings are a contribution to research in the two Asian countries about the effect of intoxication on injuries especially when both victim and perpetrator are intoxicated.
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Affiliation(s)
- Lydia Sarponmaa Asante
- Department of Health-Bio Convergence Science, Sahmyook University, Seoul, Korea ; Korean Institute on Alcohol Problems, Sahmyook University, Seoul, Korea
| | - Maxine Newell
- Department of Health Management, Sahmyook University, Seoul, Korea ; Korean Institute on Alcohol Problems, Sahmyook University, Seoul, Korea
| | - Mieun Yun
- Korean Institute on Alcohol Problems, Sahmyook University, Seoul, Korea ; Department of Public Health, Sahmyook University, Seoul, Korea
| | - Sunmee Yun-Welch
- Korean Institute on Alcohol Problems, Sahmyook University, Seoul, Korea ; Department of Public Health, Sahmyook University, Seoul, Korea
| | - Sungsoo Chun
- Department of Health-Bio Convergence Science, Sahmyook University, Seoul, Korea ; Department of Health Management, Sahmyook University, Seoul, Korea ; Korean Institute on Alcohol Problems, Sahmyook University, Seoul, Korea ; Department of Public Health, Sahmyook University, Seoul, Korea
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Abstract
Alcohol is the most common drug detected in forensic cases, is often associated with increased aggression and other disinhibitory behaviors in criminal matters, and frequently contributes to the cause of death in medical examiner cases. Significant adverse effects of alcohol generally manifest at blood alcohol concentrations above 100 mg/dL. In postmortem cases, a number of factors can affect the accuracy of the blood measurement, including site of sampling and putrefactive formation. This paper provides an overview of the pharmacology, pharmacokinetics, and interpretation of alcohol and its concentrations in key specimens, with application to forensic medical cases.
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Affiliation(s)
- Olaf H. Drummer
- Department of Forensic Medicine at Monash University and (Forensic Scientific Services) at the Victorian Institute of Forensic Medicine
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19
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Ahlner J, Holmgren A, Jones AW. Prevalence of alcohol and other drugs and the concentrations in blood of drivers killed in road traffic crashes in Sweden. Scand J Public Health 2013; 42:177-83. [PMID: 24265165 DOI: 10.1177/1403494813510792] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Drunk or drug-impaired drivers represent a major public health and societal problem worldwide. Because over 95% of drivers killed on the roads in Sweden are autopsied, reliable information is available about the use of alcohol and/or other drug before the crash. METHODS This retrospective 4-year study (2008-2011) used a forensic toxicology database (TOXBASE) to evaluate the concentrations of alcohol and other drugs in blood samples from drivers killed in road-traffic crashes. RESULTS The mean age of all victims (N = 895) was 48 ± 20 years, and the majority were male (86%). In 504 drivers (56%), the results of toxicological analysis were negative and these victims were older; mean age (± SD) 47 ± 20 years, than alcohol positive cases (35 ± 14 years) and illicit drug users (34 ± 15 years). In 21% of fatalities, blood-alcohol concentration (BAC) was above the statutory limit for driving (0.2 g/L), although the median BAC was appreciably higher (1.72 g/L). Illicit drugs (mainly amphetamine and cannabis) were identified in ~7% of victims, either alone (2.5%), together with alcohol (1.8%) or a prescription drug (2%). The psychoactive prescription drugs identified were mainly benzodiazepines, z-hypnotics and tramadol, which were found in the blood of 7.6% of crash victims. CONCLUSIONS The high median BAC in fatally-injured drivers speaks strongly towards alcohol-induced impairment as being responsible for the crash. Compared with alcohol, the prevalence of illicit and psychoactive prescription drugs was fairly low despite a dramatic increase in the number of drug-impaired drivers arrested by the police after a zero-tolerance law was introduced in 1999.
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Affiliation(s)
- Johan Ahlner
- 1Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Sweden
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20
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Legrand SA, Silverans P, de Paepe P, Buylaert W, Verstraete AG. Presence of psychoactive substances in injured Belgian drivers. TRAFFIC INJURY PREVENTION 2013; 14:461-468. [PMID: 23682981 DOI: 10.1080/15389588.2012.716881] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To estimate the percentage of drivers involved in a traffic crash in Belgium who have alcohol and drugs in their blood. METHODS Blood samples of the drivers injured in a traffic crash and admitted to the emergency departments of 5 hospitals in Belgium between January 2008 and May 2010 were analyzed for ethanol (with an enzymatic method) and 22 other psychoactive substances (with ultra-performance liquid chromatography with tandem mass spectrometry or gas chromatography-mass spectrometry). RESULTS One thousand seventy-eight drivers were included in the study. Alcohol (≥0.1 g/L) was the most common substance (26.2%). A large majority of the drivers (64%) who were positive for alcohol had a blood alcohol concentration (BAC) ≥1.3 g/L (legal limit in Belgium: 0.5 g/L). These high BACs were most frequent among male injured drivers. Cannabis was the most prevalent illicit drug (5.3%) and benzodiazepines (5.3%) were the most prevalent medicinal drugs. Approximately 1 percent of the drivers were positive for cocaine and amphetamines. No drivers tested positive for illicit opioids. Medicinal drugs were more likely to be found among female drivers and drivers older than 35 years, and alcohol and illicit drugs were more likely to be found among male drivers and drivers younger than 35 years. CONCLUSION A high percentage of the injured drivers were positive for a psychoactive substance at the time of injury. Alcohol was the most common substance, with 80 percent of the positive drivers having a BAC ≥0.5 g/L. Compared to a roadside survey in the same area, drivers/riders with high BACs and combinations of drugs were overrepresented. Efforts should be made to increase alcohol and drug enforcement. The introduction of a categorization and labeling system might reduce driving under the influence of medicinal drugs by informing health care professionals and patients.
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Affiliation(s)
- Sara-Ann Legrand
- Department of Clinical Chemistry, Microbiology and Immunology, Ghent University, Ghent, Belgium
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Legrand SA, Isalberti C, der Linden TV, Bernhoft IM, Hels T, Simonsen KW, Favretto D, Ferrara SD, Caplinskiene M, Minkuviene Z, Pauliukevicius A, Houwing S, Mathijssen R, Lillsunde P, Langel K, Blencowe T, Verstraete AG. Alcohol and drugs in seriously injured drivers in six European countries. Drug Test Anal 2012; 5:156-65. [DOI: 10.1002/dta.1393] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Revised: 06/29/2012] [Accepted: 07/08/2012] [Indexed: 11/11/2022]
Affiliation(s)
- Sara-Ann Legrand
- Department of Clinical Chemistry, Microbiology and Immunology; Ghent University; De Pintelaan 185; 9000 Ghent; Belgium
| | - Cristina Isalberti
- Department of Clinical Chemistry, Microbiology and Immunology; Ghent University; De Pintelaan 185; 9000 Ghent; Belgium
| | - Trudy Van der Linden
- National Institute of Criminalistics and Criminology; Vilvoordsesteenweg 100; 1120 Brussels; Belgium
| | - Inger Marie Bernhoft
- Department of Transport; Technical University of Denmark; Bygningstorvet 116B; DK - 2800 Kgs. Lyngby; Denmark
| | - Tove Hels
- Department of Transport; Technical University of Denmark; Bygningstorvet 116B; DK - 2800 Kgs. Lyngby; Denmark
| | - Kirsten Wiese Simonsen
- Section of Forensic Chemistry, Department of Forensic Medicine; Copenhagen University; Frederik V's Vej 11; DK-2100 Copenhagen; Denmark
| | - Donata Favretto
- Department of Molecular Medicine, Forensic Toxicology and Antidoping; University of Padova; Italy
| | - Santo Davide Ferrara
- Department of Molecular Medicine, Forensic Toxicology and Antidoping; University of Padova; Italy
| | - Marija Caplinskiene
- VTMT State Forensic Medicine Service under the Ministry of Justice of the Republic of Lithuania; Didlaukio g. 86E; LT - 08303 Vilnius; Lithuania
| | - Zita Minkuviene
- VTMT State Forensic Medicine Service under the Ministry of Justice of the Republic of Lithuania; Didlaukio g. 86E; LT - 08303 Vilnius; Lithuania
| | - Alvydas Pauliukevicius
- VTMT State Forensic Medicine Service under the Ministry of Justice of the Republic of Lithuania; Didlaukio g. 86E; LT - 08303 Vilnius; Lithuania
| | - Sjoerd Houwing
- SWOV Institute for Road Safety Research; P.O. Box 1090, 2260 BB; Leidschendam; The Netherlands
| | - René Mathijssen
- SWOV Institute for Road Safety Research; P.O. Box 1090, 2260 BB; Leidschendam; The Netherlands
| | - Pirjo Lillsunde
- Alcohol and Drug Analytics Unit; National Institute for Health and Welfare; PO Box 30, FI-00271; Finland
| | - Kaarina Langel
- Alcohol and Drug Analytics Unit; National Institute for Health and Welfare; PO Box 30, FI-00271; Finland
| | - Tom Blencowe
- Alcohol and Drug Analytics Unit; National Institute for Health and Welfare; PO Box 30, FI-00271; Finland
| | - Alain G. Verstraete
- Department of Clinical Chemistry, Microbiology and Immunology; Ghent University; De Pintelaan 185; 9000 Ghent; Belgium
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