Effect of alcohol intoxication on hemodynamic physiology and outcome in patients with traumatic cardiac tamponade

Alcohol ingestion is independently associated with complications after work place injuries: a national trauma data bank analysis of injury severity and outcomes

BACKGROUND

Work place injuries have socioeconomic and workforce health implications. Results of clinical studies on the effect of alcohol (ETOH) ingestion on short-term outcomes in trauma are varied. We performed this study to estimate the prevalence of ETOH-related injury in the workplace and its relevance to outcomes.

METHODS

Using the National Trauma Data Bank v. 7.0, incident codes identified as being work related were extracted. The study group comprised those work-related injury cases wherein an ETOH result was documented. The ETOH (+) group was compared with the ETOH (-) group with respect to injury mechanism, injury severity, complications, and mortality. Logistic regression analysis was used to determine independent associations with these outcomes.

RESULTS

There were 31,028 cases who met inclusion criteria. Overall mortality was 2.9% (909, odds ratio [95% confidence interval], p-value) while complication rate was 2.9% (911). The incidence of a ETOH (+) screen was 10.8% (3356). Mortality in the ETOH (+) group was 3.5% (117) versus 2.9% (792) in the ETOH (-) group. This was not significantly different on logistic regression (0.88 [0.69-1.12], 0.30). The overall complication rate in the ETOH (+) group was 5.9% (197) versus 2.6% (714) in the ETOH (-) group (2.27 [1.95-2.65], <0.01). In particular, infectious complications (on post hoc analysis) were significantly increased in the ETOH (+) group (3.7% [125] vs. 1.4% [381]; 2.71 [2.22-3.30], <0.01). On logistic regression analysis, an ETOH (+) screen was not independently associated with death; however, a (+) screen was independently associated with complications.

CONCLUSIONS

The incidence of ETOH-associated workplace injury is potentially significant. Despite variable effects of ETOH ingestion on trauma outcomes, the presence of a ETOH (+) screen is independently associated with complications after occupational injury.

Pedestrian Injuries: The Association of Alcohol Consumption with the Type and Severity of Injuries and Outcomes

BACKGROUND

Literature on the effect of alcohol ingestion on short-term outcomes for trauma patients shows conflicting results. We performed this study to investigate the prevalence of positive alcohol screens and the effect of alcohol level on injury patterns, injury severity, and outcomes in pedestrians and bicyclists involved in a collision with an automobile.

STUDY DESIGN

The study population included all pedestrians and bicyclists older than 10 years, treated in any of the 13 trauma centers in the Los Angeles County Emergency Services System during the calendar year 2003, who were involved in a collision with an automobile and had a blood alcohol level measured. The alcohol negative group was defined as those patients with a blood alcohol level </=0.05 g/dL. Low and high alcohol groups were defined as those having blood alcohol levels>0.05 g/dL to<0.08 g/dL and>/=0.08 g/dL, respectively. We compared the three study groups with respect to demographics, injury patterns, injury severity, complications, and outcomes. Logistic regression was used to determine if alcohol had an independent association with any outcomes.

RESULTS

There were 1,042 patients who met study criteria. Overall, 606 patients (58%) had a negative alcohol screen, 84 (8%) had low alcohol levels, and 352 (34%) had high alcohol levels. Alcohol level was not notably associated with severity of injury, admission hypotension, ICU length of stay, major complications, and injury pattern (head, chest, abdomen, or extremity Area Injury Score). Mortality was similar in the three alcohol level groups, but the overall complication rate and hospital length of stay were markedly higher in the high alcohol level group than they were in the negative alcohol level group.

CONCLUSIONS

In pedestrians and bicyclists involved in a collision with an automobile, a high alcohol level is not associated with body area severity of injury, overall severity of injury, and hospital mortality. But high alcohol level is notably associated with higher overall complication rate and longer hospital length of stay.

Alcohol ingestion before burn injury decreases splanchnic blood flow and oxygen delivery

Recent studies from our laboratory have shown that alcohol and burn injury impair intestinal barrier and immune functions. Although multiple factors can contribute to impaired intestinal barrier function, such an alteration could result from a decrease in intestinal blood flow (BF) and oxygen delivery (DO2). Therefore, in this study, we tested the hypothesis that alcohol ingestion before burn injury reduces splanchnic blood flow and oxygen delivery. Rats (250 g) were gavaged with alcohol to achieve a blood ethanol level in the range of 100 mg/dl before burn or sham injury (25% total body surface area). Day 1 after injury, animals were anesthetized with methoxyflurane. Blood pressure, cardiac output (CO), +/-dP/dt, organ BF (in ml.min(-1).100 g(-1)), and DO2 (in mg.ml(-1).100 g(-1)) were determined. CO and organ BF were determined using a radioactive microsphere technique. Our results indicate that blood pressure, CO, and +dP/dt were decreased in rats receiving a combined insult of alcohol and burn injury compared with rats receiving either burn injury or alcohol alone. This is accompanied by a decrease in BF and DO2 to the liver and intestine. No significant change in BF to the coronary arteries (heart), brain, lung, skin, and muscles was observed after alcohol and burn injury. In conclusion, the results presented here suggest that alcohol ingestion before burn injury reduces splanchnic BF and DO2. Such decreases in BF and DO2 may cause hypoxic insult to the intestine and liver. Although a hypoxic insult to the liver would result in a release of proinflammatory mediators, a similar insult to the intestine will likely perturb both intestinal immune cell and barrier functions, as observed in our previous study.