The magnitude of acute and chronic alcohol abuse in trauma patients

F. P. Rivara, G. J. Jurkovich, J. G. Gurney, D. Seguin, C. L. Fligner, R. Ries, V. A. Raisys and M. Copass
Harborview Injury Prevention and Research Center, Harborview Medical Center, Seattle, Wash.

OBJECTIVE: To assess the incidence of acute alcohol intoxication and the proportion of trauma patients with evidence of chronic alcohol abuse. DESIGN: Prospective cohort study. SETTING: Regional level I trauma center. PARTICIPANTS: Patients aged 18 years and older admitted with blunt or penetrating trauma. MAIN OUTCOME MEASURES: Admission blood alcohol concentrations (BACs), the Short Michigan Alcohol Screening Test (SMAST), and biochemical markers for chronic alcohol abuse. RESULTS: Of the 2657 patients enrolled, 47.0% had a positive BAC and 35.8% were intoxicated (BAC > or = 100 mg/dL) on admission to the emergency department. Intoxicated patients were more likely to be 25 to 34 years old, male, and nonwhite; the highest proportion of intoxicated patients was among victims of stab wounds. Three fourths of acutely intoxicated patients had evidence of chronic alcoholism as indicated by a positive SMAST, and 25% to 35% of acutely intoxicated patients had biochemical evidence of chronic alcohol abuse. CONCLUSIONS: The high prevalence of both acute intoxication and chronic alcoholism in trauma patients indicates the need to diagnose and appropriately treat this pervasive problem in trauma victims.

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