Intoxicated motor vehicle passengers warrant screening and treatment similar to intoxicated drivers

Randomized Trial of Screening and Brief Intervention to Reduce Injury and Substance Abuse in an urban Level I Trauma Center

BACKGROUND

The TIP (Traumatic Injury Prevention) Project evaluated the impact on post-injury drug use of two brief motivational interventions compared to brief advice (BA) among injured patients who use drugs.

METHOD

Three-group, single blind, randomized controlled trial in a Level 1Trauma Center enrolled 395 admitted patients with drug positive toxicology screen or verbal report of drug use in the previous 30 days. 34% were Hispanic, 45% non-Hispanic White, 16% non-Hispanic Black. 88% smoked marijuana, 28% used cocaine and 11% prescription opioids. Brief Advice (BA) provided advice to abstain from drugs, educational materials and referral to community resources. Brief Motivational Intervention (BMI) additionally included a 30-45 minute session, with assessment feedback, based on motivational interviewing. BMI + B included a telephone booster 4-weeks post-intervention. Drug use as measured by percent days abstinent and total abstinence, derived from the Timeline Follow back was the primary outcome.

RESULTS

A significant reduction from baseline was observed at 3, 6, and 12 months in the primary outcomes of any drug use (excluding alcohol); cannabis and cocaine, the most frequently used drugs, were analyzed individually. There were no between group differences or group X time interactions. Similarly, there were no between groups differences on secondary outcomes including perceived health status, re-injury, arrest, incarceration, alcohol and drug treatment, employment, AA attendance, homelessness, physical abuse, and problems associated with alcohol and drug use.

CONCLUSIONS

The study does not support use of these enhanced motivational interventions over brief advice for trauma patients with a positive screen for drug use.

Retrospective analysis of alcohol testing in trauma team activation patients at a Canadian tertiary trauma centre

OBJECTIVES

Although alcohol screening is an essential requirement of level I trauma centre accreditation, actual rates of compliance with mandatory alcohol testing in trauma patients are seldom reported. Our objective was to determine the prevalence of blood alcohol concentration (BAC) testing in patients requiring trauma team activation (TTA) for whom blood alcohol testing was mandatory, and to elucidate patient-level, injury-level and system-level factors associated with BAC testing.

DESIGN

Retrospective cohort study.

SETTING

Tertiary trauma centre in Halifax, Canada.

PARTICIPANTS

2306 trauma patients who required activation of the trauma team.

PRIMARY OUTCOME MEASURE

The primary outcome was the rate of BAC testing among TTA patients. Trends in BAC testing over time and across patient and injury characteristics were described. Multivariable logistic regression examined patient-level, injury-level and system-level factors associated with testing.

RESULTS

Overall, 61% of TTA patients received BAC testing despite existence of a mandatory testing protocol. Rates of BAC testing rose steadily over the study period from 33% in 2000 to 85% in 2010. Testing varied considerably across patient-level, injury-level and system-level characteristics. Key factors associated with testing were male gender, younger age, lower Injury Severity Score, scene Glasgow Coma Scale score <9, direct transport to hospital and presentation between midnight and 09:00 hours, or on the weekend.

CONCLUSIONS

At this tertiary trauma centre with a policy of empirical alcohol testing for TTA patients, BAC testing rates varied significantly over the 11-year study period and distinct factors were associated with alcohol testing in TTA patients.

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

The treatment of alcohol-impaired drivers injured in a motor vehicle collision (MVC) is a complex public health issue. We conducted a systematic review to describe the legal consequences for alcohol-impaired drivers injured in a MVC and taken to a hospital or trauma center. Methods We searched MEDLINE, Embase, and CINAHL databases from inception until August 2014. We included studies that reported legal consequences including charges or convictions of injured drivers taken to a hospital or trauma center after a MVC with a blood alcohol concentration (BAC) exceeding the legal limit.Results Twenty-six studies met inclusion criteria; twenty studies were conducted in the USA, five in Canada, and one in Sweden. All were cohort studies (23 retrospective, 3 prospective) and included 11,409 patients overall. A total of 5,127 drivers had a BAC exceeding the legal limit, with legal consequences reported in 4937 cases. The median overall DUI/DWI conviction rate was 13% (range 0-85%). The median percentage of drivers with a previous conviction on their record for driving under the influence (DUI) or driving while intoxicated (DWI) was 15.5% (range 6-40%). The median percentage of drivers convicted again for DUI/DWI during the study period was 3.5% (range 2-10%). Heterogeneity between study designs, legal jurisdictions, institutional procedures and policies for obtaining a legally admissible BAC measurement precluded a meta-analysis. Conclusions The majority of intoxicated drivers injured in MVCs and seen in the emergency department are never charged or convicted. A substantial proportion of injured intoxicated drivers had more than one conviction for DUI/DWI on their police record.

Risk factors for subsequent impaired driving by injured passengers

OBJECTIVES

The purpose of this study was to evaluate the rate of, and risk factors for, subsequent impaired driving activity (IDA) in a cohort of injured passengers who were treated for injuries in a Canadian trauma center.

METHODS

We studied adult passengers who were occupants in vehicles involved in motor vehicle crashes (MVCs) and either included in the British Columbia (BC) trauma registry (January 1, 1992-December 31, 2004) or treated in the emergency department (ED) of Vancouver General Hospital (VGH; January 1, 1999-December 31, 2003). Passengers were linked to their driver's license and hence to their driving record using personal health number and demographic information. Injured passengers were stratified into 3 groups based on their blood alcohol concentration (BAC) at time of ED presentation: group 1: BAC = 0, group 2: 0 < BAC ≤ 17.3 mM (0.08%), group 3: BAC > 17.3 mM (0.08%). Two outcome variables were studied: involvement in a subsequent IDA and time to their first subsequent IDA. IDA was defined as a criminal code conviction for impaired driving, a 24-h or 90-day license suspension for impaired driving, and/or involvement in an MVC where police cited alcohol as a factor. Time to first IDA following the index event among passenger BAC groups was compared with Kaplan-Meier survival analysis. Cox proportional hazards models were employed to examine the effect of various potential risk factors on time to engage in first IDA.

RESULTS

Injured passengers with any BAC at the time of ED visit were more likely to engage in IDA and had their first IDA sooner after the index event than those with zero BAC. Among this cohort of injured passengers, 12.1 percent with BAC = 0, 29.9 percent with 0 < BAC ≤ 17.3 mM (0.08%), and 37.8 percent with a BAC > 17.3 mM (0.08%) engaged in IDA. Compared to passengers with BAC = 0, group 3 passengers and group 2 passengers were 2.06 times and 1.79 times more likely to engage in future IDA. Twenty-five percent of injured passengers engaged their first IDA by 57 and 38 months in groups 2 and 3, respectively. Previous IDA and being male were also significant risk factors for future IDA. Those with a history of IDA before the index event were 2.37 times more likely to engage in subsequent IDA.

CONCLUSIONS

Injured alcohol-impaired passengers are at high risk for IDA and should be included in impaired driving prevention programs.

Passengers of impaired drivers

INTRODUCTION

The aims of this study are: (a) to estimate the prevalence of passengers riding with alcohol-impaired drivers; (b) to investigate the role of demographic factors (age, gender, race/ethnicity, educational status) and relevant driving conditions (time of the day, trip origin, vehicle ownership) on shaping the likelihood of alcohol-impaired driving; (c) to identify and estimate the prevalence of passengers as alternative drivers (PADs); and (d) to examine the role that vehicle ownership plays in shaping the occurrence of PADs.

METHOD

Data came from a unique convenience sample of passengers obtained from the 2007 National Roadside Survey, a random sample of drivers from the 48 contiguous states.

RESULTS

The prevalence of PADs in the targeted population (mostly weekend night vehicles) was higher with drivers at .00 Collapse

Key Words

• nrs
• passengers
• alternative drivers
• drinking and driving
• designated driver

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MESH Headings

• Accidents, Traffic/prevention & control
• Adolescent
• Adult
• Alcoholic Intoxication
• Automobile Driving/statistics & numerical data
• Female
• Humans
• Likelihood Functions
• Male
• Middle Aged
• Motor Vehicles
• Social Responsibility
• Young Adult

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Grants

• 27301C0040 NIEHS NIH HHS
• P20 AA017831 NIAAA NIH HHS
• R21 AA018265 NIAAA NIH HHS

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Affiliation(s)

Eduardo Romano Pacific Institute for Research and Evaluation (PIRE), Impaired Driving Center, PIRE, 11720 Beltsville Dr., Suite 900, Calverton, MD USA 20705-3111
Tara Kelley-Baker Pacific Institute for Research and Evaluation (PIRE), Impaired Driving Center, PIRE, 11720 Beltsville Dr., Suite 900, Calverton, MD USA 20705-3111
John Lacey Pacific Institute for Research and Evaluation (PIRE), Impaired Driving Center, PIRE, 11720 Beltsville Dr., Suite 900, Calverton, MD USA 20705-3111

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Driver- and passenger-based estimates of alcohol-impaired driving in the U.S., 2001-2003

BACKGROUND

Alcohol-impaired driving (AID) continues to be a major public health problem in the U.S. The objective of this study was to estimate the number of annual driver- and passenger-reported episodes of AID and explore the effect of sociodemographic characteristics and drinking patterns on both behaviors.

METHODS

Data from a nationally representative random-digit-dial telephone survey of U.S. adults were analyzed in 2007.

RESULTS

From July 23, 2001, to February 7, 2003, an estimated 7 million drivers reported 190 million annual episodes of AID, and an estimated 10.5 million passengers reported 290 million annual episodes of AID. A comparison of estimates from this survey to those from a similar survey conducted in 1994 shows that episodes of both driver- and passenger-reported AID have increased by slightly more than 50%. Multivariable analysis revealed several gender differences in risk factors for both driver- and passenger-reported AID. For example, being of Hispanic ethnicity and not always wearing a seat belt were both associated with an increased risk of AID episodes for men but not women. A strong association between binge drinking and both driver- and passenger-reported AID was found for both genders.

CONCLUSIONS

Episodes of driver- and passenger-reported AID increased substantially between the middle 1990s and the early 2000s. The passenger estimates suggest that drivers may under-report AID by about 50%. Public health interventions to reduce AID should give equal consideration to impaired drivers and their passengers.

A Positive Blood Alcohol Concentration Is the Main Predictor of Recurrent Motor Vehicle Crash

STUDY OBJECTIVE

The identification of risk factors for recurrent motor vehicle crashes is the basis for prevention, but few studies have been published on predictors of recurrence. Our objective is to determine the main variables predicting recurrent crashes in subjects attending an emergency department (ED) for injuries after motor vehicle crash.

METHODS

During a 5-year follow-up period, we studied 2,354 consecutive adult subjects treated in the ED after a motor vehicle crash in 1998. The variables of the original event were tested for predicting recurrence in a Cox proportional hazard model.

RESULTS

During follow-up, 390 of 2,325 (16.8%) survivors were treated for injury after a new crash. The overall event rate was 34 per 1,000 subject-years. Four variables (age < or =32 years, male sex, nighttime crash, and blood alcohol concentration >50 mg/dL) were identified as independent predictors of recurrent crash. After adjustment for sex, age, and nighttime, alcohol was the leading predictor (relative risk 3.73; 95% confidence interval 3.00 to 4.64). In the presence of the 4 variables, the recurrence rate was as high as 145 (117 to 175) events per 1,000 subject-years, and alcohol per se accounted for more than 75% of events. In the absence of the 4 variables, the rate was as low as 11 (7 to 17) events per 1,000 subject-years.

CONCLUSION

Alcohol was the most powerful behavioral factor predicting recurrent events in subjects treated in an ED for injury after motor vehicle crash, along with young age, male sex, and nighttime.