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Effect of elevated serum alcohol level on the outcome of severely injured patients


Scheyerer, Max J; Dütschler, Joel; Billeter, Adrian; Zimmermann, Stefan M; Sprengel, Kai; Werner, Clement M L; Simmen, Hans-Peter; Wanner, Guido A (2014). Effect of elevated serum alcohol level on the outcome of severely injured patients. Emergency Medicine Journal, 31(10):813-817.

Abstract

BACKGROUND: The influence of high blood alcohol level (BAL) on the outcome of severely injured patients and the corresponding pathophysiological changes is a controversial issue.
OBJECTIVE: To carry out a prognostic study to compare the physiological values and short-term outcome of severely injured patients depending on their serum alcohol level.
METHODS: A total of 383 severely injured patients with an Injury Severity Score (ISS) ≥17 were admitted to the trauma division between October 2008 and December 2009 and enrolled into this study. Patients were grouped according to their BAL (>0.5‰,'BAL positive' vs <0.5‰,'BAL negative'). Trauma mechanism, pattern of injury and its treatment, and a course of intensive care treatment, physiological parameters and outcome with respect to mortality were analysed.
RESULTS: Both groups had similar ISS. In comparison with the BAL-negative group, patients in the BAL-positive group had a significantly lower Glasgow Coma Scale score (9.64 vs 12 points; p=0.005) and, although not significant, a trend towards higher values of the Abbreviated Injury Score for the head (3.29 vs 2.81 points; p=0.146). Furthermore, significantly higher lactate (3.11 mmol/L vs 2.02 mmol/L; p<0.001) levels and lower median arterial pressure values (87.9 mm Hg vs 99.4 mm Hg; p=0.006) were seen in the BAL-positive group at day of admission. However, the overall in-hospital mortality was comparable to that in BAL-negative patients (19.6% vs 21.5%). Similarly, hospital stay (15.29 vs 17.55 days) and duration of intensive care unit treatment (8.53 vs 8.36 days) were not significantly affected by a high BAL upon admission.
CONCLUSIONS: Severely injured patients with a raised BAL have a higher incidence of severe traumatic brain injury and worse initial physiological parameters. However, the survival rate and in-hospital stay is not influenced. This supports the theory of a neuroprotective role of alcohol.

Abstract

BACKGROUND: The influence of high blood alcohol level (BAL) on the outcome of severely injured patients and the corresponding pathophysiological changes is a controversial issue.
OBJECTIVE: To carry out a prognostic study to compare the physiological values and short-term outcome of severely injured patients depending on their serum alcohol level.
METHODS: A total of 383 severely injured patients with an Injury Severity Score (ISS) ≥17 were admitted to the trauma division between October 2008 and December 2009 and enrolled into this study. Patients were grouped according to their BAL (>0.5‰,'BAL positive' vs <0.5‰,'BAL negative'). Trauma mechanism, pattern of injury and its treatment, and a course of intensive care treatment, physiological parameters and outcome with respect to mortality were analysed.
RESULTS: Both groups had similar ISS. In comparison with the BAL-negative group, patients in the BAL-positive group had a significantly lower Glasgow Coma Scale score (9.64 vs 12 points; p=0.005) and, although not significant, a trend towards higher values of the Abbreviated Injury Score for the head (3.29 vs 2.81 points; p=0.146). Furthermore, significantly higher lactate (3.11 mmol/L vs 2.02 mmol/L; p<0.001) levels and lower median arterial pressure values (87.9 mm Hg vs 99.4 mm Hg; p=0.006) were seen in the BAL-positive group at day of admission. However, the overall in-hospital mortality was comparable to that in BAL-negative patients (19.6% vs 21.5%). Similarly, hospital stay (15.29 vs 17.55 days) and duration of intensive care unit treatment (8.53 vs 8.36 days) were not significantly affected by a high BAL upon admission.
CONCLUSIONS: Severely injured patients with a raised BAL have a higher incidence of severe traumatic brain injury and worse initial physiological parameters. However, the survival rate and in-hospital stay is not influenced. This supports the theory of a neuroprotective role of alcohol.

Citations

4 citations in Web of Science®
5 citations in Scopus®
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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Trauma Surgery
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:October 2014
Deposited On:12 Dec 2013 15:36
Last Modified:05 Apr 2016 17:14
Publisher:BMJ Publishing Group
ISSN:1472-0205
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.1136/emermed-2013-202804
PubMed ID:23850886

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