Fabbri A, Marchesini G, Morselli-Labate A M, Rossi F, Cicognani A, Dente M, Iervese T, Ruggeri S, Mengozzi U, Vandelli A
Dipartimento Emergenza-Urgenza Accettazione, Ospedale G.B. Morgagni, Azienda Unità Sanitaria Locale di Forlì, Italy.
J Trauma. 2001 Mar;50(3):521-8. doi: 10.1097/00005373-200103000-00018.
The effects of blood alcohol on injury after crash are controversial, and safe limits are not settled. We examined if a positive blood alcohol concentration, even in a nontoxic range, affects management and outcome of injured patients after road crashes.
In this prospective cohort study, we recruited all adult subjects admitted to an emergency department within 4 hours after a road crash. Outcomes were mortality or expected permanent disability, and data related to patients' management.
Alcohol-positive trauma patients were more frequently critical at admission (odds ratio [OR], 1.89; 95% confidence interval [CI], 1.18-3.02), and had an increased risk of combined mortality or expected permanent disability (OR, 1.67; 95% CI, 1.08-2.58), need for intensive care (OR, 1.87; 95% CI, 1.01-3.46), surgery (OR, 1.91; 95% CI, 1.37-2.66) and blood transfusions (OR, 2.09; 95% CI, 1.20-3.64), and acute medical complications (OR, 1.94; 95% CI, 1.33-2.85). All these events were explained by higher trauma severity. Only the risk of unsuspected injuries, diagnosed only at final evaluation, was independently associated with a positive blood alcohol concentration (OR, 4.98; 95% CI, 3.62-6.87), in addition to trauma severity and preexisting chronic conditions. Blood alcohol measurement significantly improved the accuracy in predicting unsuspected injuries, from 81.3% to 86.2%.
In injured patients after a road crash, a positive blood alcohol concentration increases the chance that the final diagnosis will include more injuries than initially documented. More careful monitoring is needed in alcohol-positive trauma patients, independent of clinical status, injury severity, and overt symptoms of alcohol intoxication.
血液酒精含量对撞车后受伤情况的影响存在争议，安全限度尚未确定。我们研究了即使血液酒精浓度处于无毒范围内，其阳性结果是否会影响道路交通事故受伤患者的治疗及预后。
在这项前瞻性队列研究中，我们招募了所有在道路交通事故发生后4小时内被收入急诊科的成年患者。观察指标为死亡率或预期永久性残疾以及与患者治疗相关的数据。
酒精检测呈阳性的创伤患者入院时病情更严重（优势比[OR]为1.89；95%置信区间[CI]为1.18 - 3.02），合并死亡率或预期永久性残疾的风险增加（OR为1.67；95%CI为1.08 - 2.58），需要重症监护的风险增加（OR为1.87；95%CI为1.01 - 3.46），接受手术的风险增加（OR为1.91；95%CI为1.37 - 2.66），输血的风险增加（OR为2.09；95%CI为1.20 - 3.64），以及发生急性医疗并发症的风险增加（OR为1.9’4；95%CI为1.33 - 2.85）。所有这些情况都可归因于创伤更严重。除了创伤严重程度和既往慢性病外，仅在最终评估时才被诊断出的未被怀疑的损伤风险与血液酒精浓度阳性独立相关（OR为4.98；95%CI为3.62 - 6.87）。血液酒精检测显著提高了预测未被怀疑损伤的准确性，从81.3%提高到86.2%。
在道路交通事故受伤患者中，血液酒精浓度呈阳性会增加最终诊断出的损伤比最初记录的更多的可能性。对于酒精检测呈阳性的创伤患者，无论其临床状况、损伤严重程度及酒精中毒的明显症状如何，都需要更密切的监测。
