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The alcohol-intoxicated trauma patient: impact on imaging and radiation exposure


Weber, Christian David; Schmitz, Jana Kristina; Garving, Christina; Horst, Klemens; Pape, Hans-Christoph; Hildebrand, Frank; Kobbe, Philipp (2018). The alcohol-intoxicated trauma patient: impact on imaging and radiation exposure. European Journal of Trauma and Emergency Surgery:Epub ahead of print.

Abstract

INTRODUCTION The purpose of this study was to investigate the effects of alcohol intoxication in trauma patients in regard to its impact on application of computed tomography (CT) and associated radiation exposure.
METHODS We conducted a retrospective study from a continuous patient cohort.
INCLUSION CRITERIA admission to the emergency room of an urban Level 1 trauma center with trauma team activation during a 12-month period (Jan 1st-Dec 31st 2012). Patients with incomplete data, age ≤ 12 years and with neurological diseases were excluded. Demographics, mechanisms, severity and patterns of injury (Abbreviated Injury Scale, Injury Severity Score, Glasgow Coma Scale), blood alcohol concentration (BAC, in permille, ‰), imaging studies (head/whole body CT), radiation exposure, and hospital length of stay, surgical procedures and mortality were evaluated with SPSS statistics (Version 25, IBM Inc., Armonk, New York).
RESULTS A positive BAC (mean 1.80 ± 0.767) was reported in 19.2% (n = 41/214) of the cohort. Alcohol intoxication was associated with higher utilization of head CT (65.9 vs. 46.8%, p = 0.017) and radiation exposure (231.75 vs. 151.25 mAS, p = 0.045; dose-length product, 583.03 vs. 391.04, p = 0.006). In general, the presence of alcohol was associated with over-triage (p = 0.001), despite minor injury severity (ISS < 9) and a comparable rate of head injuries (p = 0.275). Head injury (AIS ≥ 3) and positive BAC (OR 2.34, 95% CI 1.096-5.001) were identified as strongest independent predictors for head CT.
CONCLUSION Alcohol intoxication is a common finding in trauma patients, and the rate of moderate and serious head injuries seems to be comparable to a more severely injured control group. Furthermore, head CT utilization in intoxicated patients is associated with significant radiation exposure, despite poor image quality, due to motion artifacts (27%). Future strategies are required to exclude head injuries safely, while reducing the rate of head CT and associated radiation exposure in intoxicated patients.

Abstract

INTRODUCTION The purpose of this study was to investigate the effects of alcohol intoxication in trauma patients in regard to its impact on application of computed tomography (CT) and associated radiation exposure.
METHODS We conducted a retrospective study from a continuous patient cohort.
INCLUSION CRITERIA admission to the emergency room of an urban Level 1 trauma center with trauma team activation during a 12-month period (Jan 1st-Dec 31st 2012). Patients with incomplete data, age ≤ 12 years and with neurological diseases were excluded. Demographics, mechanisms, severity and patterns of injury (Abbreviated Injury Scale, Injury Severity Score, Glasgow Coma Scale), blood alcohol concentration (BAC, in permille, ‰), imaging studies (head/whole body CT), radiation exposure, and hospital length of stay, surgical procedures and mortality were evaluated with SPSS statistics (Version 25, IBM Inc., Armonk, New York).
RESULTS A positive BAC (mean 1.80 ± 0.767) was reported in 19.2% (n = 41/214) of the cohort. Alcohol intoxication was associated with higher utilization of head CT (65.9 vs. 46.8%, p = 0.017) and radiation exposure (231.75 vs. 151.25 mAS, p = 0.045; dose-length product, 583.03 vs. 391.04, p = 0.006). In general, the presence of alcohol was associated with over-triage (p = 0.001), despite minor injury severity (ISS < 9) and a comparable rate of head injuries (p = 0.275). Head injury (AIS ≥ 3) and positive BAC (OR 2.34, 95% CI 1.096-5.001) were identified as strongest independent predictors for head CT.
CONCLUSION Alcohol intoxication is a common finding in trauma patients, and the rate of moderate and serious head injuries seems to be comparable to a more severely injured control group. Furthermore, head CT utilization in intoxicated patients is associated with significant radiation exposure, despite poor image quality, due to motion artifacts (27%). Future strategies are required to exclude head injuries safely, while reducing the rate of head CT and associated radiation exposure in intoxicated patients.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Department of Trauma Surgery
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:22 March 2018
Deposited On:10 Apr 2018 12:51
Last Modified:13 Apr 2018 11:55
Publisher:Springer
ISSN:1863-9933
OA Status:Closed
Publisher DOI:https://doi.org/10.1007/s00068-018-0945-4
PubMed ID:29569001

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