ALCOHOL AND INJURY Presented by The American College of Surgeons Committee on Trauma Trauma...
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Transcript of ALCOHOL AND INJURY Presented by The American College of Surgeons Committee on Trauma Trauma...
ALCOHOL AND INJURY Presented by
The American College of Surgeons
Committee on Trauma
Trauma Prevention Series
© ACS 2000© ACS 2000
OVERVIEW
• Leading cause of death between 1 and 40 years of age
• 80 percent teenage deaths
• 60 percent childhood deaths
• Increased risk in elderly
STATISTICS
•Deaths = 150,000
•Injured = 70,000,000
•Temporarily disabled = 11,000,000
•Permanently disabled = 450,000
TIP OF THE ICEBERG
• Death from injury is just the tip of the iceberg !
• Injury:2.6 million hospital discharges /year37 million emergency department visits/year
CAUSES
TOTAL OF 150,000 DEATHS
•2/3 from unintentional traumaMotor vehicle crashesFallsWork-related accidentsRecreational and home mishaps
•1/3 from violence
TRAUMAISNO
ACCIDENT!
ALCOHOL CONSUMPTION
People who reported drinking in the past month
• >60% of those aged 21-49 years• 70% of men 26-34 years of age• 54% of women 26-34 years of age
RISK• Those who drink have a greater
chance of dying from injury and sustaining nonfatal injury
• Even those who drink at “relatively low levels” (1 drink/day) are at greater risk of injury
CONTRIBUTORY ROLEOF ALCOHOL
• 40% of motor vehicle crash deaths involve alcohol
• 40% of pedestrians killed had been drinking
• The deadly triad:AlcoholMinor grievanceWeapon
MAGNITUDE OF PROBLEM
ALCOHOL IS A
DRUG
COMMON MISCONCEPTION
AN UNUSUAL DRUG
• Requires no digestion
• Is rapidly and completely absorbed from stomach and upper intestine
CONCENTRATES IN THE BRAIN
EFFECTS ON REACTIONS
• First effects are on the brain, including:ThinkingJudgmentReasoningReflex activityControl
EFFECTS ON OPERATION OF MOTOR VEHICLE
• Shortens attention span
• Slows reaction time
• Decreases performance of motor tasks
• Causes misconceptions
EFFECTS ON BEHAVIOR
FATE OF INGESTED ALCOHOL
METABOLIZED BY:
Liver (80%)
Lungs/kidneys (10%)
Other sites (10%)
HOW THE LIVER METABOLIZES ALCOHOL
ALCOHOL METABOLISM
• Rate is limited
• Equivalent to approximately 1 drink per hour
RELATIONSHIP OFNUMBER OF DRINKS AND
BLOOD ALCOHOL CONCENTRATION
RELATIONSHIP OF BLOOD ALCOHOL CONCENTRATION AND
CRASH RESPONSIBILITY
CARNAGE ON THE HIGHWAY
ALCOHOL AND TRAUMA
• Emergency department patients with positive blood alcohol concentrations (100 mg/dL or less):
15%-25% of total
• Trauma center patients with positive blood alcohol concentrations:
26%-52% of men14%-42% of women
ALCOHOL,OTHER DRUGS,AND TRAUMA
• 50% of the time, other illicit drugs are used with alcohol:
Marijuana (3%-37%)Cocaine (5%-34%)Opiates (12%-17%)
PREVENTION STRATEGIES
PRINCIPLE OF DETERRENCE
Certainty of detection is more is more effective than the severity of the punishment
ALCOHOL ADDICTION
• Injury episode may be the first symptom of a treatable alcohol problem
• 15%-50% injured patients in the emergency department have alcohol dependence, compared with 7%-8% of the general population
WHAT IS SOCIAL DRINKING?
• Moderate social drinking:No more than 2 drinks per day for menNo more than 1 drink per day for women
(National Institute on Alcohol Abuse and Alcoholism, 1995)
ALCOHOL AND TRAUMA RECIDIVISM
• Five-year follow-up of 246 patients44% readmission rate20% mortality rate
• 77% of deaths were due to continuing substance abuse
IDENTIFICATION OFSUBSTANCE ABUSE
• Injury episode is a great opportunity
• History of :Previous injury when under the influenceA drunk/impaired driving conviction
LABORATORY TESTS
• Positive blood alcohol concentration
• Positive “tox screen”
• Abnormal liver function test
QUESTIONNAIRES• CAGE (4 questions):
Cutting down on drinking?Annoyed by criticism?Guilt feelings?Eye opening ability?
• Audit (10 questions):Alcohol use disorders identification test
• BMAST (10 questions):Brief Michigan Alcoholism Screening Test
DOES INTERVENTION WORK?
• Of a total of 3,358 trauma patients, 2,524 were screened
–762 positive patients were randomized396 to control366 to intervention
–304 of 366 completed intervention
(Harborview Medical Center, 1999)
DOES INTERVENTION WORK?
• 47% reduction in return to emergency department (1 year)
• 48% reduction in in-patient readmits (3 years)
• All other outcomes (traffic violations, DUI, arrests, and so on) less in intervention group
(Harborview Medical Center, 1999)
SUMMARY
• Alcohol intervention has significant potential as injury prevention
• Actively promoting alcohol intervention may have a major impact on long-term health and future injury risk
DRINKING AND DRIVINGDON’T MIX