Transcript No Slide Title

© 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