PMID- 18333825
OWN - NLM
STAT- MEDLINE
DCOM- 20080710
LR  - 20080312
IS  - 1936-9719 (Print)
IS  - 1936-9719 (Linking)
VI  - 66
IP  - 1
DP  - 2008
TI  - The effects of alcohol on in-hospital mortality in drivers admitted after motor 
      vehicle accidents.
PG  - 27-34
AB  - BACKGROUND: The effects of alcohol on morbidity and mortality following motor 
      vehicle accidents (MVAs) are controversial. This study was performed to address 
      the effect of alcohol on in-hospital mortality for drivers in MVAs admitted to a 
      trauma center before and after controlling for injury severity, safety device 
      use, and patient demographics. METHODS: A retrospective study was performed using 
      data from the National Trauma Data Bank, version 4.3. The cohort consisted of 
      drivers in an MVA who were 15 years of age or older, had been admitted to the 
      hospital on the same day as the accident, were screened for alcohol, and had no 
      documentation of drugs in their system. Analyses were performed to explore the 
      relationships between patient age, gender, race, presence of head injury, 
      comorbid- ity status, injury severity score (ISS), and presence of alcohol and 
      in-hospital mortality. RESULTS: The cohort consisted of 67,021 patients, 38.3% of 
      whom were drivers involved in an MVA and, following screening, were found to have 
      alcohol present in their system. Drivers who had alcohol present were more likely 
      to be younger, male, White, not using a safety device, and to have sustained a 
      head injury, than drivers who had no alcohol present in their system (alcohol 
      absent driv- ers) at hospital presentation. After controlling for potential 
      confounding variables, risk factors for in-hospital mortality included male sex, 
      older age, and higher injury severity, while protective factors included the 
      presence of alcohol and use of safety devices. The single strongest predictor of 
      mortality was ISS. Sensitivity analyses to relect the impact of inlation in true 
      ISS scores in the subgroup of patients who had alcohol present as well as a head 
      injury revealed that the protective effect of alcohol diminished and became 
      nonsignificant when the ISS was reduced by 9% and became a significant risk 
      factor for in-patient mortality when the false elevation in ISS was estimated at 
      21%. CONCLUSIONS: These results suggest the importance of carefully considering 
      the consequences that falsely inlated ISS scores might have for patients with 
      alcohol present. Future work should evaluate the possible inlation of ISS and 
      attempt to reconcile different interpreta- tions of the effects that the presence 
      of alcohol may have on MVA mortality based by jointly considering crash site and 
      in-hospital data.
FAU - Koval, Kenneth J
AU  - Koval KJ
AD  - Department of Orthopaedics, Darthmouth Hitchcock Medical Center, Lebanon, New 
      Hampshire, USA. kjkmd@yahoo.com
FAU - Cooley, Michael
AU  - Cooley M
FAU - Cantu, Robert V
AU  - Cantu RV
FAU - Spratt, Kevin F
AU  - Spratt KF
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Bull NYU Hosp Jt Dis
JT  - Bulletin of the NYU hospital for joint diseases
JID - 101300541
SB  - IM
MH  - Accidents, Traffic/*mortality
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Alcoholic Intoxication/*complications/mortality
MH  - Cohort Studies
MH  - Female
MH  - Hospital Mortality
MH  - Hospitalization/statistics & numerical data
MH  - Humans
MH  - Injury Severity Score
MH  - Male
MH  - Middle Aged
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Wounds and Injuries/*mortality
EDAT- 2008/03/13 09:00
MHDA- 2008/07/11 09:00
CRDT- 2008/03/13 09:00
PHST- 2008/03/13 09:00 [pubmed]
PHST- 2008/07/11 09:00 [medline]
PHST- 2008/03/13 09:00 [entrez]
PST - ppublish
SO  - Bull NYU Hosp Jt Dis. 2008;66(1):27-34.