Waller Patricia F, Hill Elizabeth M, Maio Ronald F, Blow Frederic C
Department of Psychology, University of Michigan, USA.
Alcohol Clin Exp Res. 2003 Apr;27(4):695-703. doi: 10.1097/01.ALC.0000062758.18918.7C.
Although alcohol is frequently present in injured patients, whether it exacerbates injury and whether tolerance to alcohol changes such a relationship is less clear. Most clinical studies do not consider other important predictors of injury, making interpretation of their findings problematic.
To examine alcohol's role in injuries, taking into account other important factors, and to examine the effect of tolerance, if any.
Prospective cohort study.
University hospital and community hospital emergency departments and morgue.
1362 Motor Vehicle Crash patients age >/=18, treated and released, admitted, and deceased.
Excess injury measured by Injury Severity Scale (ISS) 90, Weighted Revised Trauma Score (WRTS), and G-Score.
Using regression analysis, the best predictors of injury severity were vehicle crush (TAD), safety belt use, and their interaction, and age. Alcohol use further predicted injury. Using the final regression model, the effect of alcohol was to increase ISS90, on average, by about 30% (from a predicted ISS90 of 5.1 to 6.8, all else being equal). The adjusted odds ratio for serious injury (ISS90>15), was 1.59 for a patient with a positive blood alcohol concentration (alc+) compared to a alc- patient. This potentiating effect is seen even for patients with low levels of alcohol (<22 mmol/liter; <0.100 BAC) but is not linear with increasing alcohol level. Tolerance to alcohol did not affect the potentiation of injury by alcohol.
When other relevant variables are considered, alcohol increases injury, but the effects of alcohol level and alcohol tolerance are less clear. These findings have important implications for injury prevention, treatment, and research.
尽管受伤患者中经常存在酒精，但酒精是否会加重损伤以及对酒精的耐受性是否会改变这种关系尚不清楚。大多数临床研究没有考虑其他重要的损伤预测因素，这使得对其研究结果的解释存在问题。
考虑其他重要因素，研究酒精在损伤中的作用，并研究耐受性（若有）的影响。
前瞻性队列研究。
大学医院和社区医院急诊科及停尸房。
1362名年龄≥18岁的机动车碰撞患者，包括接受治疗并出院、入院和死亡的患者。
用损伤严重度评分（ISS）90、加权修订创伤评分（WRTS）和G评分衡量的额外损伤。
通过回归分析，损伤严重程度的最佳预测因素是车辆挤压（TAD）、安全带使用情况及其相互作用以及年龄。饮酒进一步可预测损伤情况。使用最终回归模型，酒精的作用是使ISS90平均增加约30%（从预测的ISS90为5.1增加到6.8，其他条件均相同）。血液酒精浓度为阳性（alc+）的患者与酒精浓度为阴性（alc-）的患者相比，严重损伤（ISS90>15）的调整比值比为1.59。即使对于酒精含量低（<22 mmol/升；<0.100 BAC）的患者，也可观察到这种增强作用，但与酒精水平的增加不成线性关系。对酒精的耐受性并不影响酒精对损伤的增强作用。
当考虑其他相关变量时，酒精会增加损伤，但酒精水平和酒精耐受性的影响尚不清楚。这些发现对损伤预防、治疗和研究具有重要意义。
