Coronavirus lockdown: Excessive alcohol consumption and illicit substance use in DUI subjects

Sex differences and driving impairment related to psychoactive substances

OBJECTIVE

The first aim of the study was to identify sex differences in the use of psychoactive substances among subjects with a previous driving under the influence (DUI) episode. The secondary objective was to propose specific strategies for medico-legal improvements.

METHODS

This was a retrospective observational study that took place between June 1, 2019, and August 31, 2023. It was conducted on DUI subjects examined for reinstatement of their driver's license using an integrated medico-legal and toxicological approach. Ethyl glucuronide (EtG) and illicit psychoactive substances were determined from hair samples. We performed descriptive statistical analyses for the entire sample as well as separately by sex. Additionally, we conducted binary logistic regression analyses separately for males and females to identify protective/risk factors associated with previous road accidents and judgments of unfitness to drive due to excessive alcohol consumption (EtG ≥ 30 pg/mg).

RESULTS

The study included 2,221 subjects, comprising 1,970 men and 251 women. Men exhibited a higher prevalence of tobacco, alcohol, and illicit psychoactive substance use. Women were more frequently co-users of alcohol and psychoactive substances and involved in road accidents at the time of DUI. Among the men, being married or having a partner was found to be a protective factor concerning past traffic accidents. For both sexes, a DUI episode with a blood alcohol concentration (BAC) exceeding 1.5 g/L or the co-ingestion of alcohol and drugs was identified as a risk factor for road accident involvement. For men, smoking more than 20 cigarettes per day and, for women, having a DUI episode with a BAC over 1.5 g/L were the main factors indicating unfitness to drive, as determined through high hair EtG levels (> 30 pg/mg). Women with a previous history of road accidents were less likely to have EtG levels of 30 pg/mg or more.

CONCLUSIONS

The study confirmed sex differences in subjects with a previous DUI episode. A BAC exceeding 1.5 g/L or the simultaneous use of alcohol and drugs at the time of DUI necessitate careful assessment of both men and women seeking driver's license reinstatement. In women, a BAC exceeding 1.5 g/L is considered a risk factor for a subsequent judgment of unfitness to drive. The medico-legal assessment should also involve a thorough investigation of smoking habits in men, as these habits could be related to an increased risk of excessive alcohol consumption.

Driving license regranting: Hair EtG, serum CDT, and the role of sociodemographic and medicolegal variables

Driving under the influence (DUI) of alcohol is a road safety problem. Driving license regranting is based on the evaluation of medicolegal and toxicological variables that may include serum carbohydrate-deficient transferrin (CDT) and hair ethyl glucuronide (hEtG). The aim of the study was to compare the diagnostic performance of CDT and hEtG in a population of DUI offenders. Other factors potentially associated with heavy alcohol use were explored. The population included DUI offenders examined during the period of January 1, 2019, through June 30, 2022. Sociodemographic, medicolegal, and toxicological variables were collected. CDT in serum and EtG in head hair were determined in all subjects. Excessive alcohol intake (hEtG ≥30 pg/mg) was considered cause for unfitness to drive. Cohen's kappa coefficient was calculated. Descriptive analyses were performed using chi-square and Mann-Whitney tests. Variables significantly different between the groups were included in a multivariate binary logistic regression model. The sample encompassed 838 subjects (case group: 179, comparison group: 689). CDT exhibited poor agreement (κ = 0.053) with hEtG as the reference test. Lower education, age at DUI, heavy smoking, and GGT levels associated with heavy alcohol consumption differentiated the two groups. For DUI offenders, the use of CDT to assess heavy alcohol consumption is limited, possibly due to the time-window assessed, the time required for normalization, and the different amount of ethanol needed to reach higher CDT levels, in comparison to hEtG; thus, hEtG assessment is strongly recommended for this population. Heavy smoking, GGT, education, and age could be related to heavy alcohol consumption and higher risk of DUI.

Impact of easing COVID-19 safety measures on trauma computed tomography imaging volumes

PURPOSE

The coronavirus disease 2019 (COVID-19) pandemic has led to substantial disruptions in healthcare staffing and operations. Stay-at-home (SAH) orders and limitations in social gathering implemented in spring 2020 were followed by initial decreases in healthcare and imaging utilization. This study aims to evaluate the impact of subsequent easing of SAH on trauma volumes, demand for, and turnaround times for trauma computed tomography (CT) exams, hypothesizing that after initial decreases, trauma volumes have increased as COVID safety measures have been reduced.

METHODS

Patient characteristics, CT imaging volumes, and turnaround time were analyzed for all adult activated emergency department trauma patients requiring CT imaging at a single Level-I trauma center (1/2018-2/2022) located in the sixth most populous county in the USA. Based on COVID safety measures in place in the state of California, three time periods were compared: baseline (PRE, 1/1/2018-3/19/2020), COVID safety measures (COVID, 3/20/2020-1/25/2021), and POST (1/26/2021-2/28/2022).

RESULTS

There were 16,984 trauma patients across the study (PRE = 8289, COVID = 3139, POST = 5556). The average daily trauma patient volumes increased significantly in the POST period compared to the PRE and COVID periods (13.9 vs. 10.3 vs. 10.1, p < 0.001), with increases in both blunt (p < 0.001) and penetrating (p = 0.002) trauma. The average daily number of trauma CT examinations performed increased significantly in the POST period compared to the PRE and COVID periods (56.7 vs. 48.3 vs. 47.6, p < 0.001), with significant increases in average turnaround time (47 min vs. 31 and 37, p < 0.001).

CONCLUSION

After initial decreases in trauma radiology volumes following stay-at-home orders, subsequent easing of safety measures has coincided with increases in trauma imaging volumes above pre-pandemic levels and longer exam turnaround times.

Driving under the influence of alcohol during the COVID-19 pandemic

AIM

The main objective of this study was to evaluate the effects of the COVID-19 pandemic on the pattern of alcohol use in drivers.

MATERIALS

and methods. At the National Institute of Legal Medicine from Bucharest, we performed a retrospective study on toxicology reports between January 1st^, 2019 and December 31st, 2020. Breath alcohol concentration (BrAC) was tested using Dräger breathalyzers by police units at the scene, and blood alcohol concentration (BAC) was evaluated using headspace gas chromatography. Most drivers gave two blood samples, separated by a one-hour interval, case in which they could request a retrograde extrapolation of the BAC at the time when they were stopped in traffic.

RESULTS

The distribution of the number of cases depending on the month showed a sharp decline in the first six months of the lockdown, with a slow upward trend afterward. Mean overall values for BrAC were 0.49 +/- 0.40 mg/L, for 1st sample BAC - 1.15 +/- 0.99 g/L and for 2nd sample BAC - 1.29 +/- 0.81 g/L. Mean values obtained for BrAC were 0.48 +/- 0.39 mg/L before the pandemic and 0.52 +/- 0.43 mg/L during the pandemic. The increase was similar in absolute numbers in both male and female drivers (0.03 versus 0.04 mg/L respectively for BrAC and 0.02 g/L for both genders for 1st sample BAC). However, the percentage increase was significantly higher in women. There were 253 cases in which BrAC had values between 0.01 and 0.05, of which 138 occurred before the pandemic and 115 during the pandemic, the increase being highly statistically significant. The percentage of drivers with BAC levels below and above 0.8 g/L (the threshold value for which DUI is a felony in Romania) were similar before and during the pandemic.

CONCLUSIONS

During the lockdown, the number of alcohol tests in traffic has decreased significantly. This reduction was not associated with statistically significant changes in BrAC or BAC. We have seen a substantial increase in the number of minimally elevated BrAC and negative BAC cases, changes that could be caused by an increased use of alcohol-based hand sanitizers.