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

IF 1.4 Q3 EMERGENCY MEDICINE
International Journal of Burns and Trauma Pub Date : 2022-08-15 eCollection Date: 2022-01-01
Carl M Dunham, Gregory S Huang, Elisha A Chance, Barbara M Hileman
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引用次数: 0

Abstract

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.

创伤中心血液酒精阳性和酒精滥用患者的危险条件:一项回顾性研究
由于很少有研究评估创伤激活患者血液酒精浓度(BAC)阳性的危险状况,因此本回顾性调查进行了这样的分析。家长数据库包括2018-2020年1月21日至7月21日连续入院的创伤中心。对18-60岁创伤激活患者(TA18-60)进行补充电子病历审核,评估酒精滥用、吸烟史和血清碳酸氢盐水平。通过对每一种危险情况赋予0(否)或1(是)的值来创建酒精滥用风险评分:1)吸烟史,2)BAC阳性状态,3)BAC≥100 mg/dL,格拉斯哥昏迷评分(GCS)≥13,4)年龄≥40岁,5)BAC阳性患者的碳酸碳酸盐水平≥20 mmol/L,并将总分相加(范围0-5)。在2076例患者中,60.9% (n = 1265)进行了BAC检测。TA18-60患者BAC阳性(36.9%)高于其他患者(20.8%;P < 0.0001;优势比[OR] = 2.2)。在TA18-60审核中(n = 742), BAC状态可分类,98.5%;吸烟史,99.3%;酒精滥用史,99.5%;碳酸氢盐含量,99.5%。吸烟者BAC阳性(41.3%)高于非吸烟者(31.5%);P = 0.0061;或= 1.5)。酒精滥用组BAC阳性(87.0%)高于非酒精滥用组(17.7%);P < 0.0001;Or = 31.2)。与bac阴性(31.8%)相比,bac阳性患者碳酸氢盐水平< 20 mmol/L的比例(52.0%)更高;P < 0.0001;Or = 2.3)。酒精滥用风险评分为3-5分者(74.4%[142/191])的酒精滥用比例高于风险评分为0-2分者(10.4% [57/546]);P < 0.0001;Or = 24.9;受者工作特征曲线下面积= 0.89)。这项回顾性研究表明,BAC阳性与TA18-60、吸烟和酒精滥用史以及代谢性酸中毒有关。酒精滥用史与多种危险状况有关。创伤中心的领导应该提供程序来识别bac阳性或有吸烟或酒精滥用史的患者。然后,这些患者应该转介给护理提供者,他们可以提供帮助和指导,以提高患者的整体健康。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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