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© ACS 2000 ALCOHOL AND INJURY Presented by The American College of Surgeons Committee on Trauma Trauma Prevention Series 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 /year 37 million emergency department visits/year CAUSES TOTAL OF 150,000 DEATHS •2/3 from unintentional trauma Motor vehicle crashes Falls Work-related accidents Recreational and home mishaps •1/3 from violence TRAUMA IS NO 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 ROLE OF ALCOHOL • 40% of motor vehicle crash deaths involve alcohol • 40% of pedestrians killed had been drinking • The deadly triad: Alcohol Minor grievance Weapon 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: Thinking Judgment Reasoning Reflex activity Control 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 OF NUMBER 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 men 14%-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 men No 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 patients 44% readmission rate 20% mortality rate • 77% of deaths were due to continuing substance abuse IDENTIFICATION OF SUBSTANCE ABUSE • Injury episode is a great opportunity • History of : Previous injury when under the influence A 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 randomized 396 to control 366 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 DRIVING DON’T MIX