Alcohol-positive polytrauma patients: injury patterns, ICU resource use and mortality at a German Level I trauma center.

BACKGROUND

In most countries, alcohol consumption is so culturally ingrained that even small amounts are permitted while driving. Even at a blood alcohol concentration of 0.5 g/L, ethanol impairs mental and cognitive performance. Studies from the US and Europe estimate that elevated blood alcohol levels may be detected in 10%-40% of all emergency department patients. Against this background, we investigated the impact of alcohol consumption on injury severity, injury patterns, as well as primary and secondary outcomes in polytrauma patients.

MATERIALS AND

METHODS

This retrospective, single-center cohort study included patients admitted to a Level I trauma center via the trauma room and documented in the TraumaRegister DGU® between 2015 and 2023. Serum ethanol was determined routinely in all adolescent and adult trauma room patients. Patients without serum ethanol measurement or younger than 13 years were excluded. Patients with detectable serum ethanol (> 1 mg/dL, detection limit of the laboratory; ALC) were compared with patients without (noALC) using the χ² and Mann-Whitney U tests. Multivariable logistic and linear regression analyses were adjusted for age, sex, Injury Severity Score (ISS), severe traumatic brain injury (TBI) and pre-injury ASA classification. A dose-response analysis was performed using serum ethanol categories.

RESULTS

A total of 1,524 patients were analyzed: 431 (28.3%) were alcohol-positive (ALC) and 1,093 (71.7%) were not (noALC). ALC patients were younger, more often male and had a lower prehospital Glasgow Coma Scale (GCS) score (p < 0.001), whereas the ISS did not differ (p = 0.396). They were more frequently victims of violent crime and were overrepresented among pedestrians and falls from < 3 m, whereas motorcyclists were more often sober. Alcohol-positive patients were more often treated in the ICU (90.0% vs. 86.3%; p = 0.048), but this association was attenuated after multivariable adjustment (adjusted odds ratio [aOR] 1.40; 95% CI 0.96-2.03). Length of ICU stay and duration of mechanical ventilation did not differ, and alcohol was not independently associated with mortality (aOR 0.91; 95% CI 0.56-1.47). Severe TBI was more frequent in alcohol-positive patients (38.5% vs. 29.5%), increased with serum ethanol concentration, and was the strongest predictor of ICU treatment and mortality.

CONCLUSION

Nearly one in three severely injured patients had detectable serum ethanol. After adjustment for confounders, alcohol was not independently associated with mortality or intensive care resource use, and no dose-response relationship was found for these outcomes. The more frequent ICU treatment of alcohol-positive patients appears to be explained by their distinct injury pattern, particularly the concentration-dependent increase in severe TBI.