Alcohol as a trigger for medical emergencies

Unintentional injuries after TBI: Potential risk factors, impacts, and prevention

BACKGROUND

The top three causes of fatal unintentional injuries are falls, motor vehicle crashes, and being struck against or struck by objects or persons. These etiologies also happen to be the leading causes of TBI, a serious public health problem, in the US. Reduced cognitive functioning, poor decision making, increased risk taking, disinhibition, diminished safety skills and substance use, place individuals with TBI at an increased risk for subsequent unintentional injuries. The caregiving, psychological, social and financial burden of initial injuries is enormous. Unintentional injuries post-TBI add to that burden significantly. Many unintentional injuries can be prevented with simple education and environment and lifestyle changes. Injury prevention requires collaboration among many.

OBJECTIVE

This literature review will share information regarding potential triggers or causes of unintentional injuries after TBI to identify potential issues. The many impacts of these injuries will be reviewed. Best practices in prevention will be presented.

CONCLUSION

Ultimately, education, discussion, and awareness across multiple stakeholders can aid in preventing unintentional injuries after TBI.

The rate ratio of injury and aggressive incident for alcohol alone, cocaine alone and simultaneous use before the event: a case-crossover study

OBJECTIVES

(i) To estimate the rate ratio (RR) of use of alcohol alone, cocaine alone, and both substances simultaneously on acute injury or an aggressive incident, (ii) to compare the RRs for simultaneous use within 3 or 6h of the event; and (iii) to compare the RRs of two measures of exposure, "hours of feeling effects" vs estimates based on self-reported quantity and frequency of use.

METHODS

The study employed a case-crossover design with the frequency approach. Clients (N=616) in substance abuse treatment for alcohol or cocaine issues from 2009 to 2012 completed a self-administered questionnaire on their substance use within 3 and 6h before a recent injury or physically aggressive incident. Clients also reported detailed quantity and frequency information in relation to their typical substance use, as well as information on "feeling effects". The RR of acute harms due to substance use was estimated using the Mantel-Haenszel estimator.

RESULTS

In the 6-h window before the event, use of cocaine alone, alcohol alone and simultaneous alcohol and cocaine use were each significantly (P<0.05) related to a recent injury and aggressive incident. Simultaneous use was not significantly greater than use of either drug alone. Estimates of RR based on simultaneous use for a 3-h window before the event were consistently larger than those based on a 6-h window, and comparisons were significant (P<0.05) for an aggressive incident but not an injury. With reference to the two measures of exposure, three of eight comparisons of RRs were significantly larger for feeling the effects of the substance in comparison to quantity and frequency of substance use.

CONCLUSION

These findings are consistent with increased likelihood of harms related to the acute effects of alcohol alone, cocaine alone or simultaneous use. The results are suggestive that the acute effects of these drugs may be better measured within a 3-h time window than a 6-h window. Finally, we found that "hours of feeling effects" yielded higher estimates of RR than the quantity-frequency approach; however both measures support the overall findings.