Alcohol and injury severity: reappraisal of the continuing controversy.

It is well recognized that alcohol increases the risk of injury. It is controversial, however, whether alcohol also has an effect on the degree and outcome of injury after controlling for the severity of impact. This review examines the evidence from experimental studies in animals regarding the potentiating effects of alcohol on trauma, and the methodologic issues that may have contributed to the contradictory findings of clinical and epidemiologic studies. Most experimental studies indicate that alcohol can adversely affect the degree and outcome of injury. In controlled laboratory conditions, alcohol is found to reduce cardiac output, to increase the susceptibility to hemorrhagic shock, and to increase the pulmonary vascular resistance after standardized experimental injuries. However, it is difficult to extrapolate these findings to humans, partly because the interactive effects of chronic and acute alcohol use on trauma are rarely considered in experimental studies. The conflicting results in studies involving trauma patients are due in part to the differences in study design, particularly selection of study populations, and in measuring and controlling for kinetic forces on the body. Studies indicating that alcohol is associated with an increased risk of serious or fatal injury are usually based on data from emergency departments or police departments. The alcohol-injury severity relationship reported in these studies is attributable to a great extent to the effects of correlates of alcohol, such as speeding and not wearing seat belts, rather than the biological effects of alcohol. Studies indicating that alcohol is not associated with the degree and outcomes of injury are mostly those involving patients who were admitted to hospitals or trauma centers. Methodologic issues concerning the alcohol-injury severity controversy, including conceptual models and future research needs, are discussed.

[1]  C J Cherpitel,et al.  Alcohol and casualties: a comparison of emergency room and coroner data. , 1994, Alcohol and alcoholism.

[2]  W. Collins,et al.  Experimental spinal cord trauma: potentiation by alcohol. , 1981, The Journal of trauma.

[3]  J. D. Beard,et al.  Effects of alcohol ingestion on the production of and response to experimental hemorrhagic stress. , 1963, The New England journal of medicine.

[4]  P. Feustel,et al.  Effects of ethanol in traumatic brain injury. , 1993, Journal of neurotrauma.

[5]  P. Dischinger,et al.  Psychoactive substance dependence among trauma center patients. , 1992, JAMA.

[6]  W. Haddon,et al.  A controlled investigation of the characteristics of adult pedestrians fatally injured by motor vehicles in Manhattan. , 1961, Journal of chronic diseases.

[7]  R. Gamelli,et al.  Intoxication and injury. , 1992, The Journal of trauma.

[8]  D. Vinson,et al.  Alcohol and injury. A case-crossover study. , 1995, Archives of family medicine.

[9]  D. Newell,et al.  The effects of alcohol intoxication on the initial treatment and hospital course of patients with acute brain injury. , 1992, The Journal of trauma.

[10]  E. Moore,et al.  Acute ethanol intoxication increases the risk of infection following penetrating abdominal trauma , 1992 .

[11]  F P Rivara,et al.  Effects of alcohol intoxication on the initial assessment of trauma patients. , 1992, Annals of emergency medicine.

[12]  R Honkanen,et al.  The role of alcohol in accidental falls. , 1983, Journal of studies on alcohol.

[13]  J. Stutts,et al.  The potentiating effects of alcohol on driver injury. , 1986, JAMA.

[14]  F P Rivara,et al.  The effect of acute alcohol intoxication and chronic alcohol abuse on outcome from trauma. , 1993, JAMA.

[15]  J. Hoek,et al.  Alcohol and membrane-associated signal transduction. , 1990, Alcohol and alcoholism.

[16]  S. Lindahl,et al.  Early post-traumatic changes in hemodynamics and pulmonary ventilation in alcohol-pretreated pigs. , 1988, The Journal of trauma.

[17]  Mary A. Linzer,et al.  Risk factors for fatal residential fires , 1992, The New England journal of medicine.

[18]  H. Meislin,et al.  A prospective investigation of the impact of alcohol consumption on helmet use, injury severity, medical resource utilization, and health care costs in bicycle-related trauma. , 1995, The Journal of trauma.

[19]  B. W. Williams,et al.  Ethanol causes decreased partitioning into biological membranes without changes in lipid order. , 1989, Archives of biochemistry and biophysics.

[20]  E. Moore,et al.  Protracted metabolic acidosis: the impact of acute ethanol in hemorrhagic shock. , 1992, The Journal of emergency medicine.

[21]  H. Garrison,et al.  Effect of ethanol on lactic acidosis in experimental hemorrhagic shock. , 1984, Annals of emergency medicine.

[22]  L. Midanik,et al.  The demographic distribution of US drinking patterns in 1990: description and trends from 1984. , 1994, American journal of public health.

[23]  R Honkanen,et al.  The role of alcohol in nonfatal bicycle injuries. , 1990, Accident; analysis and prevention.

[24]  R. Honkanen,et al.  Impact of acute alcohol intoxication on patterns of non-fatal trauma: cause-specific analysis of head injury effect. , 1991, Injury.

[25]  P. Feustel,et al.  Effects of ethanol on respiratory function in traumatic brain injury. , 1995, Journal of neurosurgery.

[26]  W. Haddon,et al.  A controlled study of fatal automobile accidents in New York City , 1962 .

[27]  J. Shepherd,et al.  The relationship between alcohol intoxication, injury severity and Glasgow Coma Score in assault patients. , 1995, Injury.

[28]  M C Frick,et al.  Alcohol's effect on fatality risk from a physical insult. , 1993, Journal of studies on alcohol.

[29]  Ronald V. Maier,et al.  The influence of ethanol intoxication on outcome of injured motorcyclists. , 1983 .

[30]  R. Cracco,et al.  Alcohol-associated acute head trauma in human subjects is associated with early deficits in serum ionized Mg and Ca. , 1995, Alcohol.

[31]  K. Murphy,et al.  The rate and kinetic order of ethanol elimination. , 1984, Forensic science international.

[32]  B. Tulloh,et al.  Positive correlation between blood alcohol level and ISS in road trauma. , 1994, Injury.

[33]  M. Schuckit,et al.  Correlations between drinking intensity and reactions to ethanol and diazepam in healthy young men. , 1991, Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology.

[34]  S. Schenker,et al.  Ethanol effects on active Na+ and K+ transport in cultured fetal rat hepatocytes. , 1989, Biochemical pharmacology.

[35]  K. Dickersin,et al.  Publication Bias: The Problem That Won't Go Away , 1993, Annals of the New York Academy of Sciences.

[36]  M. A. Desiderio The potentiation of the response to blunt cardiac trauma by ethanol in dogs. , 1986, Journal of Trauma.

[37]  D. B. Goldstein,et al.  Membrane-disordering action of ethanol: variation with membrane cholesterol content and depth of the spin label probe. , 1981, Molecular pharmacology.

[38]  E. Flamm,et al.  Ethanol potentiation of central nervous system trauma. , 1977, Journal of neurosurgery.

[39]  R. Maier,et al.  EFFECT OF ACUTE ETHANOLISM ON THE HOSPITAL COURSE AND OUTCOME OF INJURED AUTOMOBILE DRIVERS , 1982 .

[40]  L Li,et al.  Personal and behavioral predictors of automobile crash and injury severity. , 1995, Accident; analysis and prevention.

[41]  F. Rivara,et al.  The CAGE questionnaire and the Short Michigan Alcohol Screening Test in trauma patients: comparison of their correlations with biological alcohol markers. , 1994, The Journal of trauma.

[42]  M. G. Fuller Alcohol use and injury severity in trauma patients. , 1995, Journal of addictive diseases.

[43]  W. Haddon,et al.  The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. , 1974, The Journal of trauma.

[44]  J A Waller,et al.  Methodologic issues in hospital-based injury research. , 1988, The Journal of trauma.

[45]  A. Liedtke,et al.  Effects of alcohol on cardiovascular performance after experimental nonpenetrating chest trauma. , 1975, The American journal of cardiology.

[46]  A. Bradbury Pattern and severity of injury sustained by pedestrians in road traffic accidents with particular reference to the effect of alcohol. , 1991, Injury.

[47]  C. Cherpitel Alcohol in fatal and nonfatal injuries: a comparison of coroner and emergency room data from the same county. , 1996, Alcoholism, clinical and experimental research.

[48]  Barry A. McLellan,et al.  The relative influence of alcohol and seatbelt usage on severity of injury from motor vehicle crashes , 1990 .

[49]  J. Jagger,et al.  Effect of alcohol intoxication on the diagnosis and apparent severity of brain injury. , 1984, Neurosurgery.

[50]  J R Stewart Estimating the effects over time of alcohol on injury severity. , 1989, Accident; analysis and prevention.

[51]  R. E. Ward,et al.  Effects of ethanol ingestion on the severity and outcome of trauma. , 1982, American journal of surgery.

[52]  H. Wechsler,et al.  Alcohol level and home accidents. , 1969, Public health reports.