Prevalence of use and impairment from drugs and alcohol among trauma patients: A national prospective observational study

Serum Ethanol Concentrations in Relation to Sex and Age in Patients Admitted to a Large Emergency Department During 2015-2020

We examined the number of patients tested for serum ethanol concentration (SEC) at admission to a large Emergency Department (ED) and the relationship of SEC with sex and age. SEC was analysed by enzymatic method. We retrieved SEC in patient samples from the ED during 2015-2020 from the laboratory information system. Altogether, 174 378 patients were admitted, and 7.3% were tested for SEC. Of these, 35.3% had a positive test. The percentage of patients tested increased from 4.8% in 2015 to 14.4% in 2020. A total of 416 patients had more than one positive SEC. For individual data, we included the first positive test per patient, n = 3607. Of these, 73% were men and 27% were women. The median SEC for both men and women was 1.9 g/L. About 4.4% had a SEC ≥ 3.5 g/L. The median SEC in patients aged 30-59 years was 0.2 g/L higher than the 12-29 and ≥ 60 age groups. In conclusion, the increase in the percentage of patients tested did not lead to a corresponding increase in ethanol-positive tests. There was a large predominance of men, the median SEC was the same for men and women and highest in the 30-59 age group.

Incidence, severity and changes of abnormal vital signs in trauma patients: A national population-based analysis

BACKGROUND

Physiological criteria are used to assess the potential severity of injury in the early phase of a trauma patient's care trajectory. Few studies have described the extent of abnormality in vital signs and different combinations of these at a national level. Aim of the study was to identify physiologic abnormalities in trauma patients and describe different combinations of abnormalities and changes between the pre-hospital and emergency department (ED) settings.

METHOD

Norwegian Trauma Registry (NTR) data between 01.01.15 - 31.12.18, where evaluated on the prevalence and characteristics of abnormal physiologic variables. Primary outcome were rates of hypoventilation (respiratory rate [RR] < 10 breaths per min), hyperventilation (RR > 29 breaths per min), hypotension (systolic blood pressure [SBP] < 90 mmHg), and reduced level of consciousness (Glasgow Coma Scale [GCS] < 13).

RESULTS

A total of 24,482 patients were included. Documented values for RR, SBP and GCS were 77.6%, 78.5% and 81.9% in the pre-hospital phase, and the corresponding percentages in the ED were 95.5%, 99.2% and 98.6%, respectively. In the pre-hospital phase, 3,615 (14.8%) patients had at least one abnormal vital sign, whereas the corresponding numbers in the ED, were 3,616 (14.8%) patients. The most frequent combination was low GCS and hyperventilation. A worsened RTS-score from pre-hospital phase to the ED was observed for RR, SBP and GCS in 3.9%, 1.2% and 1.9% of incidents, respectively. Overall 30-day mortality was 3.1% (n=752). Of these, 60.8% had abnormal vital signs, with decreased GCS as the most prevalent (61.3%).

CONCLUSION

Most trauma patients had normal vital signs. According to the RTS-score, there were few deteriorations in RR, SBP and GCS between pre-hospital phase and the ED. The most frequent abnormality was low GCS, with a higher proportion in those who died within 30 days.

Identifying excessive chronic alcohol use with phosphatidylethanol in patients with suspected severe injury-results from the IDART study

INTRODUCTION

Acute and chronic alcohol use are well-known risk factors for accidents and injuries, and concurrent psychoactive drug use can increase injury risk further. Phosphatidylethanol (PEth) 16:0/18:1 is a biomarker used to determine alcohol consumption the previous 3-4 weeks. The aim was to investigate the prevalence of chronic alcohol use in trauma patients, as determined by PEth 16:0/18:1 concentrations, and how excessive chronic alcohol use relate to demographic variables, injury mechanisms and drug use.

SETTING

Patients received at Norwegian trauma hospitals from March 2019 to February 2020. The study is part of the Impairing Drugs and Alcohol as Risk factors for Traumatic Injuries study.

METHODS

All patients aged ≥ 16 years received with trauma team were included in the study. Data on injury date and mechanism, gender and age was registered. Blood samples were analyzed for 22 psychoactive medicinal and illicit drugs, ethanol and phosphatidylethanol 16:0/18:1. Regression analyses were conducted to assess associations between alcohol use and gender, age, injury mechanism and drug use.

RESULTS AND CONCLUSION

Of the 4845 patients included in the study, 10% had PEth 16:0/18:1 concentration ≥ 600 nM (~430 ng/mL), indicative of excessive chronic alcohol use. Being male, between 44-61 years old, involved in violence, and testing positive for medicinal drugs was associated with excessive chronic alcohol use.Excessive chronic alcohol use was common among males, middle-aged, patients with violence as injury mechanism and those with medicinal drug use. These findings emphasize the need to detect and treat excessive chronic alcohol use among trauma patients.