Trauma center risk conditions for blood alcohol-positive and alcohol misuse patients: a retrospective study

• Published in: International journal of burns and trauma 2022-01, Vol.12 (4), p.149-160
• Main Authors: Dunham, Carl M, Huang, Gregory S, Chance, Elisha A, Hileman, Barbara M
• Format: Article
• Language: English
• Subjects: Original
• ISSN: 2160-2026; 2160-2026

Because few studies have assessed blood alcohol concentration (BAC)-positive risk conditions in trauma activation patients, this retrospective investigation pursued such an analysis. The parent database included consecutive trauma center admissions from January 21 to July 21 for 2018-2020. The supplementary electronic medical record audit of trauma activation patients aged 18-60 years (TA18-60) assessed alcohol misuse, smoking history, and serum bicarbonate levels. An alcohol misuse risk score was created by assigning a value of 0 (no) or 1 (yes) for each risk condition: 1) smoking history, 2) BAC-positive status, 3) BAC ≥ 100 mg/dL with Glasgow Coma Scale score (GCS) ≥ 13, 4) age ≥ 40 years, and 5) bicarbonate level ≥ 20 mmol/L in BAC-positive patients and summing the total score (range, 0-5). Of 2,076 patients, BAC testing occurred in 60.9% (n = 1,265). BAC positivity was greater in TA18-60 (36.9%) than in other patients (20.8%; P < 0.0001; odds ratio [OR] = 2.2). In the TA18-60 audit (n = 742), categorizations were available for BAC status, 98.5%; smoking history, 99.3%; alcohol misuse history, 99.5%; and bicarbonate level, 99.5%. BAC positivity was greater in smokers (41.3%) than in non-smokers (31.5%; P = 0.0061; OR = 1.5). BAC positivity was greater with alcohol misuse (87.0%) than without (17.7%; P < 0.0001; OR = 31.2). BAC-positive was associated with a greater proportion of bicarbonate levels < 20 mmol/L (52.0%) than BAC-negative (31.8%; P < 0.0001; OR = 2.3). The alcohol misuse proportion was greater with an alcohol misuse risk score of 3-5 (74.4% [142/191]) than with a risk score of 0-2 (10.4% [57/546]; P < 0.0001; OR = 24.9; area under the receiver operating characteristic curve = 0.89). This retrospective study demonstrates that BAC positivity is associated with TA18-60, smoking and alcohol misuse histories, and metabolic acidosis. An alcohol misuse history is associated with multiple risk conditions. Trauma center leadership should provide procedures to identify patients who are BAC-positive or have a positive smoking or alcohol misuse history. Then, such patients should be referred to care providers who can offer assistance and guidance for enhancing overall patient wellbeing.