1
|
Lau G, Ang JY, Kim N, Gabbe BJ, Mitra B, Dietze PM, Reeder S, Beck B. Approaches and reporting of alcohol and other drug testing for injured patients in hospital-based studies: A systematic review. Drug Alcohol Rev 2024; 43:897-926. [PMID: 38316529 DOI: 10.1111/dar.13816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 12/18/2023] [Accepted: 01/02/2024] [Indexed: 02/07/2024]
Abstract
ISSUE Hospital alcohol and/or other drug (AOD) testing is important for identifying AOD-related injuries; however, testing methods vary. This systematic review aimed to examine biological AOD testing methods from hospital-based studies of injured patients and quantify what proportion reported key information on those testing methods. APPROACH Observational studies published in English from 2010 onwards involving biological AOD testing for injured patients presenting to hospital were included. Studies examining single injury causes were excluded. Extracted data included concentration thresholds for AOD detection (e.g., lower limits of detection, author-defined cut-offs), test type (e.g., immunoassay, breathalyser) and approach (e.g., routine, clinical discretion), timing of testing, sample type and the proportion of injured cases tested for AODs. KEY FINDINGS Of 83 included studies, 76 measured alcohol and 37 other drugs. Forty-nine studies defined blood alcohol concentration thresholds (ranging from 0 to 0.1 g/100 mL). Seven studies defined concentration thresholds for other drugs. Testing approach was reported in 39/76 alcohol and 18/37 other drug studies. Sample type was commonly reported (alcohol: n = 69/76; other drugs: n = 28/37); alcohol was typically measured using blood (n = 60) and other drugs using urine (n = 20). Studies that reported the proportion of cases tested (alcohol: n = 53/76; other drugs: n = 28/37), reported that between 0% and 89% of cases were not tested for alcohol and 0% and 91% for other drugs. Timing of testing was often unreported (alcohol: n = 61; other drugs: n = 30). IMPLICATIONS AND CONCLUSION Variation in AOD testing methods alongside incomplete reporting of those methods limits data comparability and interpretation. Standardised reporting of testing methods will assist AOD-related injury surveillance and prevention.
Collapse
Affiliation(s)
- Georgina Lau
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jia Y Ang
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Nayoung Kim
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Health Data Research UK, Swansea University Medical School, Swansea University, Swansea, UK
| | - Biswadev Mitra
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Australia
| | - Paul M Dietze
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
- National Drug Research Institute, Curtin University, Perth, Australia
| | - Sandra Reeder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, Australia
| | - Ben Beck
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| |
Collapse
|
2
|
Hsieh TM, Huang KC, Chuang PC, Liu CT, Wu BY, Hsieh CH, Cheng FJ. Effect of acute alcohol consumption on blunt bowel mesenteric injury: a retrospective analysis. BMC Emerg Med 2024; 24:8. [PMID: 38185667 PMCID: PMC10773100 DOI: 10.1186/s12873-023-00928-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 12/30/2023] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND The effect of alcohol consumption on trauma remains controversial. The effects of alcohol on hemorrhage and peritonitis after blunt abdominal trauma have rarely been discussed. This study aimed to explore the effects of acute alcohol intoxication on the clinical characteristics, injury patterns, and outcomes in a surgical blunt bowel mesenteric injury (BBMI) cohort. METHODS A retrospective data analysis was performed using trauma cases of patients who had been tested for alcohol and had surgically proven BBMI from a Trauma Registry System from 2009 to 2021. Patients were grouped according to their positive blood alcohol concentration (BAC; >0.5% vs. no BAC; less than 0.5% no BAC) upon arrival at the emergency department (ED). The injury characteristics, physiological parameters, and outcomes with respect to post-injury complications and mortality were assessed. RESULTS In total, 142 patients with surgical BBMI were included. Of these, 116 and 26 patients were assigned to the BAC-negative and BAC-positive groups, respectively. The overall injury severity, injury pattern, and age were comparable between the groups. The patients in the BAC-positive group had a significantly lower systolic blood pressure (99 mmHg vs. 119 mmHg; p = 0.046), worse shock index (0.96 vs. 0.82; p = 0.048), and lower percentage and number of packed red blood cells transfused (34.6% vs. 57.8%; p = 0.032 and 0 U vs. 2 U; p = 0.031) than those in the BAC-negative group. Additionally, although not statistically significant, patients in the BAC-positive group had lower leukocyte counts (9,700 cells/mm3 vs. 11,600 cells/mm3; p = 0.165 ) at the ED. However, significantly reduced percentages of leukocytes ≥ 12,000 cells/mm3 (26.9% vs. 48.3%; p = 0.048) and ≥ 12,000 or ≤ 4,000 cells/mm3 (26.9% vs. 50.9%; p = 0.027) were observed in the BAC-positive group at the ED. Furthermore, the 30-day mortality rate did not show statistically significant differences, and there was a higher incidence of bowel-related mortality in the BAC-positive group (11.5% vs. 1.7%, p = 0.043). CONCLUSIONS For patients with BBMI arriving alive to the hospital, acute alcohol consumption was associated with significantly worse hemodynamic parameters, interfered inflammation status, and higher bowel related mortality rate.
Collapse
Affiliation(s)
- Ting-Min Hsieh
- Division of Trauma, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta Pei Road, Niao-Song District, Kaohsiung, Taiwan
| | - Kuo-Chen Huang
- Department of Emergency, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta Pei Road, Niao-Song District, Kaohsiung, Taiwan
| | - Po-Chun Chuang
- Department of Emergency, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta Pei Road, Niao-Song District, Kaohsiung, Taiwan
| | - Chun-Ting Liu
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta Pei Road, Niao-Song District, Kaohsiung, Taiwan
| | - Bei-Yu Wu
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta Pei Road, Niao-Song District, Kaohsiung, Taiwan
| | - Ching-Hua Hsieh
- Division of Plastic Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta Pei Road, Niao-Song District, Kaohsiung, Taiwan
| | - Fu-Jen Cheng
- Department of Emergency, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta Pei Road, Niao-Song District, Kaohsiung, Taiwan.
| |
Collapse
|
3
|
Lau G, Ang JY, Kim N, Gabbe BJ, Mitra B, Dietze PM, Reeder S, Scott D, Beck B. Prevalence of Alcohol and Other Drug Use in Patients Presenting to Hospital for Violence-Related Injuries: A Systematic Review. TRAUMA, VIOLENCE & ABUSE 2024; 25:306-326. [PMID: 36794786 PMCID: PMC10666504 DOI: 10.1177/15248380221150951] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Substance use is a risk factor for being both a perpetrator and a victim of violence. The aim of this systematic review was to report the prevalence of acute pre-injury substance use in patients with violence-related injuries. Systematic searches were used to identify observational studies that included patients aged ≥15 years presenting to hospital after violence-related injuries and used objective toxicology measures to report prevalence of acute pre-injury substance use. Studies were grouped based on injury cause (any violence-related, assault, firearm, and other penetrating injuries including stab and incised wounds) and substance type (any substance, alcohol only, drugs other than alcohol only), and they were summarized using narrative synthesis and meta-analyses. This review included 28 studies. Alcohol was detected in 13%-66% of any violence-related injuries (five studies), 4%-71% of assaults (13 studies), 21%-45% of firearm injuries (six studies; pooled estimate = 41%, 95% CI: 40%-42%, n = 9,190), and 9%-66% of other penetrating injuries (nine studies; pooled estimate = 60%, 95% CI: 56%-64%, n = 6,950). Drugs other than alcohol were detected in 37% of any violence-related injuries (one study), 39% of firearm injuries (one study), 7%-49% of assaults (five studies), and 5%-66% of penetrating injuries (three studies). The prevalence of any substance varied across injury categories: any violence-related injuries = 76%-77% (three studies), assaults = 40%-73% (six studies), firearms = n/a, other penetrating injuries = 26%-45% (four studies; pooled estimate = 30%, 95% CI: 24%-37%, n = 319).Overall, substance use was frequently detected in patients presenting to hospital for violence-related injuries. Quantification of substance use in violence-related injuries provides a benchmark for harm reduction and injury prevention strategies.
Collapse
Affiliation(s)
| | - Jia Y. Ang
- Monash University, Melbourne, VIC, Australia
| | - Nayoung Kim
- Monash University, Melbourne, VIC, Australia
| | - Belinda J. Gabbe
- Monash University, Melbourne, VIC, Australia
- Swansea University, Swansea, UK
| | - Biswadev Mitra
- Monash University, Melbourne, VIC, Australia
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, VIC, Australia
| | - Paul M. Dietze
- Burnet Institute, Melbourne, VIC, Australia
- Curtin University, Perth, WA, Australia
| | | | - Debbie Scott
- Monash University, Melbourne, VIC, Australia
- Turning Point, Melbourne, VIC, Australia
| | - Ben Beck
- Monash University, Melbourne, VIC, Australia
| |
Collapse
|
4
|
Lee S, Oh H. Triage and length of stay in emergency department visits due to alcohol intoxication: A retrospective chart review. Australas Emerg Care 2023; 26:90-95. [PMID: 36028432 DOI: 10.1016/j.auec.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 08/07/2022] [Accepted: 08/08/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Patients with alcohol intoxication are screened and treated at emergency departments (EDs), at the cost of alcohol-related ED visit resource consumption. The purposes of this study were to identify characteristics of patients with alcohol intoxication, in terms of triage, blood alcohol concentration (BAC), and ED length of stay (LOS) and to compare these characteristics by homelessness status. METHODS We conducted a retrospective chart review of all visits and referrals to one drunken center in an ED between January and December 2019. Adults aged over 18 years admitted to the drunken center with a blood alcohol concentration (BAC) of 100 mg/dl or higher were included. RESULTS Approximately 89 % were male, around 30.4 % of the patients with acute alcohol intoxication were homeless. Approximately 46 % of patients were Medicaid or non-insured. Approximately 74.2 % of the patients were classified as KTAS 4 (less urgent) and 5 (nonurgency) upon initial KTAS evaluation. Both BAC and ED LOS were significantly higher in the homeless group. CONCLUSIONS About half of alcohol intoxicated patients who visited ED were vulnerable, and they visited the ED due to the problem of less urgent or non-urgent status of triage. Sobering places, not ED, and connecting patients with social work programs is important.
Collapse
Affiliation(s)
- Sunmi Lee
- National Emergency Medical Center, National Medical Center, Seoul, South Korea
| | - Hyunjin Oh
- Gachon University, Incheon, South Korea.
| |
Collapse
|
5
|
Hadeiy SK, Zamani N, McDonald R, Rezaei O, Kolahi AA, Gholami N, Farnaghi F, Hassanian-Moghaddam H. An interrupted time series analysis of hospital admissions due to alcohol intoxication during the COVID-19 pandemic in Tehran, Iran. Sci Rep 2022; 12:10574. [PMID: 35732680 PMCID: PMC9216300 DOI: 10.1038/s41598-022-14799-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 06/13/2022] [Indexed: 02/06/2023] Open
Abstract
The COVID-19 outbreak affected mental health globally. One of the major concerns following the COVID-19 pandemic was increased incidence of risky behaviors including alcohol consumption. This study evaluates the trend of alcohol poisoning in Loghman-Hakim Hospital (LHH), the main referral center of poisoning in Tehran, during the 2-year period from 1 year prior to 1 year after the onset (February 23rd, 2020) of the COVID-19 epidemic in Iran. All patients admitted with alcohol intoxication from February 23rd, 2019 to February 22nd, 2021 were evaluated and patient data extracted from LHH electronic hospital records. Alcohols were categorized as toxic (methyl alcohol) and non-toxic (ethyl alcohol). Of 2483 patients admitted, 796/14,493 (5.49%) and 1687/13,883 (12.15%) had been hospitalized before and after the onset of the COVID-19 epidemic in Iran, respectively. In total, 140 patients did not survive, of whom 131 (93.6%) were confirmed to have methanol intoxication. Mortality was significantly higher during the outbreak (127 vs 13; P < 0.001; OR: 4.90; CI 95%: 2.75 to 8.73). Among the patients, 503 were younger than age 20. Trend of alcohol intoxication showed increases in children (57 vs 17) and adolescents (246 vs 183) when compared before and after the COVID-19 epidemic outbreak. A total of 955 patients were diagnosed with methanol toxicity which occurred more frequently during the COVID-19 era (877 vs 78; P < 0.001; OR: 10.00; CI 95%: 7.75 to12.82). Interrupted time series analysis (April 2016–February 2021) showed that in the first month of the COVID-19 epidemic (March 2020), there was a significant increase in the alcohol intoxication rate by 13.76% (P < 0.02, CI = [2.42–24.91]). The trend of alcohol intoxication as well as resulting mortality increased in all age groups during the COVID-19 epidemic in Iran, indicating urgent need for the prevention of high-risk alcohol use as well as improved treatment.
Collapse
Affiliation(s)
- Seyed Kaveh Hadeiy
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nasim Zamani
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Clinical Toxicology, Loghman Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, South Karegar Street, Tehran, Iran
| | - Rebecca McDonald
- SERAF, Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
| | - Omidvar Rezaei
- Department of Neurosurgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali-Asghar Kolahi
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Narges Gholami
- Department of Pediatrics, Loghman Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fariba Farnaghi
- Department of Pediatrics, Loghman Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Hassanian-Moghaddam
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. .,Department of Clinical Toxicology, Loghman Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, South Karegar Street, Tehran, Iran.
| |
Collapse
|
6
|
Lau G, Ang JY, Kim N, Gabbe BJ, Mitra B, Dietze PM, Reeder S, Beck B. Prevalence of alcohol and other drug use in patients presenting to hospital for fall-related injuries: a systematic review. Inj Prev 2022; 28:381-393. [PMID: 35508365 DOI: 10.1136/injuryprev-2021-044513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 04/21/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Alcohol and other drug (AOD) use is a key preventable risk factor for serious injuries. Prevention strategies to date have largely focused on transport injuries, despite AOD use being a significant risk factor for other injury causes, including falls. This systematic review aimed to report the prevalence of AOD use in patients presenting to hospital for fall-related injuries. METHODS This systematic review includes studies published in English after the year 2010 that objectively measured the prevalence of AOD use in patients presenting to hospital for a fall-related injury. Screening, data extraction and risk of bias assessments were completed by two independent reviewers. Data were presented using narrative synthesis and, where appropriate, meta-analyses. RESULTS A total of 12 707 records were screened. Full texts were retrieved for 2042 records, of which 29 were included. Four studies reported the combined prevalence of any alcohol and/or drug use, generating a pooled prevalence estimate of 37% (95% CI 25% to 49%). Twenty-two records reported on the prevalence of acute alcohol use alone and nine reported specifically on the prevalence of drugs other than alcohol, with prevalence ranging from 2% to 57% and 7% to 46%, respectively. The variation in prevalence estimates likely resulted from differences in toxicology testing methods across studies. CONCLUSIONS AOD exposure was common in hospitalised fall-related injuries. However, research addressing prevalence across different types of falls and the use of drugs other than alcohol was limited. Future research should address these areas to improve our understanding of which populations should be targeted in AOD and injury prevention strategies . PROSPERO REGISTRATION NUMBER CRD42020188746.
Collapse
Affiliation(s)
- Georgina Lau
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jia Ying Ang
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Nayoung Kim
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Health Data Research UK, Swansea University, Swansea, UK
| | - Biswadev Mitra
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,National Trauma Research Institute, The Alfred Hospital, Melbourne, Victoria, Australia.,Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Paul M Dietze
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Behaviours and Health Risks Program, Burnet Institute, Melbourne, Victoria, Australia.,National Drug Research Institute, Curtin University, Perth, Western Australia, Australia
| | - Sandra Reeder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Ben Beck
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia .,Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| |
Collapse
|
7
|
Thamminaina A, Devendra Prasad KJ, Abhilash T, R. Krishna Moorthy DGS, Rajesh K. The impact of alcohol intoxication on early Glasgow Coma Scale-Pupil reactivity score in patients with traumatic brain injury: A prospective observational study. Int J Crit Illn Inj Sci 2022; 12:28-32. [PMID: 35433390 PMCID: PMC9008286 DOI: 10.4103/ijciis.ijciis_20_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/17/2021] [Accepted: 05/20/2021] [Indexed: 11/04/2022] Open
Abstract
Background: Methods: Results: Conclusion:
Collapse
|
8
|
Rath M, Tawfic J, Abrorkhujaeva A, Sowell S, Wu S, Eans SO, Peris J, McLaughlin JP, Stevens SM, Liu B. Binge ethanol consumption-associated behavioral impairments in male mice using a gelatin-based drinking-in-the dark model. Alcohol 2021; 95:25-36. [PMID: 34029701 PMCID: PMC10629591 DOI: 10.1016/j.alcohol.2021.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/16/2021] [Accepted: 05/11/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Acute intoxication caused by binge ethanol drinking is linked to widespread impairments in brain functions. Various alcohol administration paradigms have been used in animals to model the heterogeneous clinical manifestation of intoxication in people. It is challenging to model a procedure that produces "visible intoxication" in rodents; however, manipulation of variables such as route of alcohol administration, time of availability, frequency, and duration and amount of ethanol exposure has achieved some success. In the current study, we employed a modified drinking-in-the-dark model to assess the validity of this model in producing "post-ethanol consumption intoxication" impairments following prolonged repeated daily voluntary "binge" ethanol consumption. METHODS Adult male C57BL/6J mice were allowed a daily 3-h access to non-alcoholic plain or ethanol-containing gel during the dark cycle for a total of 83 days. After the initial 2-month daily DID, ethanol intake patterns were intensely characterized during the next 3 weeks. Immediately following the last DID session (day 83), plain and ethanol gel-consuming mice were then subjected to behavioral tests of locomotor ability and/or anxiety (cylinder, wire grip, open field) followed by blood ethanol concentration measurement. RESULT Mice exhibited a relatively consistent ethanol consumption pattern during and across daily access periods. Ethanol intake of individual mice positively correlated with blood ethanol concentration that averaged 61.64 ± 2.84 mg/dL (n = 12). Compared to the plain gel-consuming control mice, ethanol gel mice exhibited significant locomotor impairment as well as anxiety-like behavior, with the magnitude of impairments of key indices well correlated with blood ethanol levels. CONCLUSION The gelatin vehicle-based voluntary ethanol drinking-in-the-dark model reliably produced post consumption acute movement impairments as well as anxiety-like behaviors even after 2 months of daily binge ethanol consumption in male mice. Taken together, this mouse binge ethanol model should facilitate the investigation of mechanisms of binge drinking in subjects chronically abusing ethanol and the search for effective novel treatment strategies.
Collapse
Affiliation(s)
- Meera Rath
- Department of Pharmacodynamics, University of Florida, Gainesville, FL, 32610, United States
| | - Jasmin Tawfic
- Department of Pharmacodynamics, University of Florida, Gainesville, FL, 32610, United States
| | - Aziza Abrorkhujaeva
- Department of Pharmacodynamics, University of Florida, Gainesville, FL, 32610, United States
| | - Sam Sowell
- Department of Pharmacodynamics, University of Florida, Gainesville, FL, 32610, United States
| | - Sara Wu
- Department of Pharmacodynamics, University of Florida, Gainesville, FL, 32610, United States
| | - Shainnel O Eans
- Department of Pharmacodynamics, University of Florida, Gainesville, FL, 32610, United States
| | - Joanna Peris
- Department of Pharmacodynamics, University of Florida, Gainesville, FL, 32610, United States
| | - Jay P McLaughlin
- Department of Pharmacodynamics, University of Florida, Gainesville, FL, 32610, United States
| | - Stanley M Stevens
- Department of Cell Biology, Microbiology, and Molecular Biology, University of South Florida, Tampa, FL, 33620, United States
| | - Bin Liu
- Department of Pharmacodynamics, University of Florida, Gainesville, FL, 32610, United States.
| |
Collapse
|
9
|
Hoonpongsimanont W, Ghanem G, Saadat S, Nguyen M, Louis C, Sahota PK, Danishgar L, Carroll C, Barrios C, Lotfipour S. Correlation between Alcohol Use Disorders, Blood Alcohol Content, and Length of Stay in Trauma Patients. J Emerg Trauma Shock 2021; 14:42-47. [PMID: 33911436 PMCID: PMC8054814 DOI: 10.4103/jets.jets_10_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 05/08/2020] [Accepted: 08/22/2020] [Indexed: 01/12/2023] Open
Abstract
Background: Patients with an alcohol use disorder (AUD) have an increased risk of developing complications during their hospital stays; however, how AUD impacts the length of stay (LOS) and the utilization of hospital resources remains inconclusive. Aim: This study aimed to identify the associations between AUD, defined by self-reported alcohol consumption, blood alcohol content (BAC), and hospital LOS (HLOS) including intensive care unit (ICU) LOS in the trauma patient population. Study Design: We conducted a retrospective study analyzing data obtained from 2010 to 2018 at a university-based, level-one trauma emergency department. We identified 1689 adult trauma patients who completed the AUDs identification test (AUDIT) and were admitted to the hospital. We retrieved BAC, age, gender, LOS, and injury severity score (ISS) from the patient charts. The independent samples' median test was used to assess the association of HLOS and ICULOS with ISS, BAC levels, or AUDIT scores. Results: ISS was directly associated with higher HLOS (P < 0.001) and ICULOS (P < 0.001); however there was no statistically significant association between AUDIT scores and ICULOS (P = 0.21) or HLOS (P = 0.86). There was also no statistically significant association between BAC and HLOS (P = 0.09) or ICULOS (P = 0.07). Conclusions: Our study found no associations between AUDIT, BAC, and both hospital and ICU LOS in trauma patients even though the literature supported an increased risk of medical complications in the AUD patients.
Collapse
Affiliation(s)
| | - Ghadi Ghanem
- Department of Emergency Medicine, University of California Irvine, California, USA
| | - Soheil Saadat
- Department of Emergency Medicine, University of California Irvine, California, USA
| | - Maria Nguyen
- Department of Emergency Medicine, University of California Irvine, California, USA
| | - Christine Louis
- Department of Emergency Medicine, University of California Irvine, California, USA
| | - Preet K Sahota
- Department of Emergency Medicine, University of California Irvine, California, USA
| | - Leila Danishgar
- Department of Emergency Medicine, University of California Irvine, California, USA
| | - Christy Carroll
- Center for Trauma and Injury Prevention Research, University of California Irvine, California, USA
| | - Cristobal Barrios
- Department of Surgery, University of California Irvine, California, USA
| | - Shahram Lotfipour
- Department of Emergency Medicine, University of California Irvine, California, USA
| |
Collapse
|
10
|
Time to surgery: Is it truly crucial in initially stable patients with penetrating injury? Injury 2021; 52:195-199. [PMID: 33004205 DOI: 10.1016/j.injury.2020.09.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/02/2020] [Accepted: 09/19/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Treatment recommendations for patients with penetrating abdominal injury are well established. Trauma victims with clear indications for surgery, should undergo immediate operative intervention without any delay or additional imaging. However, the optimal time for surgery remains unclear. There are some significant advantages in preoperative abdominal CT, including gathering essential information regarding a few difficult to reach anatomical areas, avoiding unnecessary explorations associated with increased morbidity and assessing the existence of extra-abdominal injuries that may have non-expectable impact on initial therapeutic plan. The aim of this study was to determine the impact of "time-to-surgery" on final medical outcomes in patients with penetrating abdominal trauma with normal blood pressure on admission. METHODS A retrospective cohort study using the Israeli National Trauma Registry was conducted from 2000- 2018. This study included trauma patients with penetrating injuries and a systolic blood pressure of 90mmHg or above on admission. All patients included in the study were divided into three groups according to the time that lapsed from their admission to surgery: half an hour, an hour, and two hours. We assessed the outcome for each patient, including length of hospital stay, need for intensive care and mortality. Statistical analysis was performed using the Chi-square test, ANOVA test. A p-value of less than 0.05 was considered statistically significant. RESULTS The study included 1,136 penetrating trauma patients. Among these, 78.0% (886) had sustained low-energy penetrating injury (SWPI) and 22.0% (250) had sustained high-energy penetrating injury (FAPI). Males accounted for 93.5% (1,062) of the patients. Mean age was 30.4. About 29% (327) of all the patients underwent surgery within 30 minutes from admission, 42% (475) within 30-60 min, and 29% (334) patients were operated within one to two hours. Patients who underwent surgery within 30 minutes, had worse ISS and GCS scores and were, therefore, more likely to have worse clinical outcomes. No other differences in outcomes were found in patients who were operated upon within 2 hours. CONCLUSIONS Time to surgery within two hours from admission has no impact on final outcomes in trauma patients with penetrating injury and normal blood pressure on admission.
Collapse
|
11
|
Grigorian A, Gambhir S, Al-Khouja L, Gabriel V, Schubl SD, Nastanski F, Lekawa M, Joe V, Nahmias J. Decreased incidence of venous thromboembolism found in trauma patients with positive blood alcohol concentration on admission. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2018; 45:77-83. [PMID: 30084660 DOI: 10.1080/00952990.2018.1504951] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND The reported incidence of venous thromboembolism (VTE) disease in trauma is 1-58% and is considered a preventable cause of mortality. Positive blood alcohol concentration (BAC) is found in 8-45% of trauma admissions; however, its association with VTE is controversial. OBJECTIVES We hypothesized that a positive BAC on admission would be associated with a lower rate of VTE in a large national database of trauma patients. METHODS We queried the largest United States trauma registry, National Trauma Data Bank (2007-2015), for any patient with positive BAC on admission. The primary outcome was VTE and the secondary outcome was mortality. A multivariable logistic regression model was used for analysis. RESULTS From 2,725,032 patients (70.1% male, 29.9% female), 1,800,216 (66.1%) had a negative BAC while 924,816 (33.9%) had a positive BAC. A positive BAC was associated with lower rates of VTE (OR = 0.88, CI = 0.86-0.90, p < 0.001) and mortality (OR = 0.91, CI = 0.90-0.93, p < 0.001). CONCLUSION In a large national database, trauma patients with a positive BAC were associated with a lower rate of VTE compared to those with negative BAC. Additionally, trauma patients with positive BAC had a lower association with mortality. These findings remained after adjustment of well-known risk factors for VTE and mortality, respectively.
Collapse
Affiliation(s)
- Areg Grigorian
- a Department of Surgery, Division of Trauma, Burns and Surgical Critical Care , University of California, Irvine , Orange , CA , USA
| | - Sahil Gambhir
- a Department of Surgery, Division of Trauma, Burns and Surgical Critical Care , University of California, Irvine , Orange , CA , USA
| | - Lutfi Al-Khouja
- a Department of Surgery, Division of Trauma, Burns and Surgical Critical Care , University of California, Irvine , Orange , CA , USA
| | - Viktor Gabriel
- a Department of Surgery, Division of Trauma, Burns and Surgical Critical Care , University of California, Irvine , Orange , CA , USA
| | - Sebastian D Schubl
- a Department of Surgery, Division of Trauma, Burns and Surgical Critical Care , University of California, Irvine , Orange , CA , USA
| | - Frank Nastanski
- a Department of Surgery, Division of Trauma, Burns and Surgical Critical Care , University of California, Irvine , Orange , CA , USA
| | - Michael Lekawa
- a Department of Surgery, Division of Trauma, Burns and Surgical Critical Care , University of California, Irvine , Orange , CA , USA
| | - Victor Joe
- a Department of Surgery, Division of Trauma, Burns and Surgical Critical Care , University of California, Irvine , Orange , CA , USA
| | - Jeffry Nahmias
- a Department of Surgery, Division of Trauma, Burns and Surgical Critical Care , University of California, Irvine , Orange , CA , USA
| |
Collapse
|