The influence of alcohol on prehospital diagnostics and therapy of injured patients.

BACKGROUND

The prehospital assessment and subsequent therapeutic interventions are crucial for the optimal management of severely injured patients. Many trauma patients are alcohol-intoxicated. Therefore, this study investigated the prehospital assessment of the injury pattern and management of alcohol-intoxicated patients.

METHODS

In a retrospective matched-pair analysis of TraumaRegister DGU® data patients from 2015 to 2018 with a blood alcohol level (BAL+) > 1.0‰ and without a blood alcohol level (BAL-: 0.0‰) were investigated, matched by age, gender, injured region, and mechanism. We evaluated injury assessment, prehospital therapy, and transport modalities.

RESULTS

A total of 6468 patients (3234 BAL-, 3234 BAL+) were included. Head injuries were common (56.9%), but BAL+ patients were significantly less often correctly assessed with regard to head (BAL-: 77.8% vs. BAL+: 74.2%) and facial (BAL-: 75.4% vs. BAL+: 70.0%, p < 0.001) injuries. Head and facial injuries were significantly more often improperly overdiagnosed in alcohol-intoxicated patients (head: BAL-: 13.9% vs. BAL+: 21.4%, p < 0.05; face: BAL-: 19.8% vs. BAL+: 24.3%, p < 0.001), and the diagnosis of actual head injuries was underdiagnosed significantly more often in patients with BAL+. Alcohol-intoxicated patients were sedated (BAL-: 64.9% vs. BAL+: 55.6%, p < 0.001) and intubated (BAL-: 39.0% vs. BAL+: 28.3%, p < 0.001) significantly less often and received significantly less fluid therapy (BAL-: 92.6% vs. BAL+: 90.3%, p < 0.001), catecholamines (BAL-: 12.7% vs. BAL+: 8.5%, p < 0.001), or tranexamic acid (BAL-: 10.3% vs. BAL+: 6.3%, p < 0.001). Admission of alcohol-intoxicated patients to hospital was significantly more frequent at weekends and at night, and more frequent in regional and local trauma centers than in supraregional trauma centers.

CONCLUSIONS

There were significant differences in the prehospital assessment of head injuries between alcohol-intoxicated and nonalcohol-intoxicated patients. Alcohol-intoxicated patients were significantly less often correctly assessed, and alcohol-intoxicated patients received fewer prehospital therapeutic interventions.