School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Health Data Research UK, Swansea University Medical School, Swansea University, Swansea, UK.
Injury. 2024 Nov;55(11):111782. doi: 10.1016/j.injury.2024.111782. Epub 2024 Aug 8.
Alcohol is commonly detected in patients presenting to hospital after major trauma and is a key preventable risk factor for injury. While it has been suggested that alcohol intoxication at the time of injury results in worse acute patient outcomes, there is currently limited knowledge on the impact of alcohol on health outcomes following hospital discharge. The aim of this study was to examine the relationship between acute pre-injury alcohol exposure and the self-reported health outcomes of survivors of major trauma 12-months post-injury.
Data from the Victorian State Trauma Registry (January 1, 2018 to December 31, 2020) were used to identify major trauma patients who: (1) were aged ≥18 years; (2) survived to 12-months post-injury; and (3) had blood alcohol data available in the registry. Logistic regression analyses were used to examine differences in self-reported health status (EQ-5D) and return to work at 12-months post-injury by blood alcohol concentration (BAC) at the time of presentation to hospital. Analyses were adjusted for potential confounders including a range of demographic, hospital and injury characteristics.
A total of 2957 patients met inclusion criteria, of which 857 (29.0 %) had a BAC >0 and 690 (23.3 %) had a BAC ≥0.05 g/100 mL. After adjusting for potential confounders, having any alcohol detected (i.e., BAC >0) was associated with lower odds of reporting problems on the EQ-5D mobility (aOR = 0.72, 95 %CI = 0.53 to 0.99) and usual activities dimensions (aOR = 0.79, 95 %CI = 0.63 to 0.99). Having a BAC ≥0.05 g/100 mL was only associated with lower adjusted odds of reporting problems on the usual activities dimension (aOR = 0.69, 95 %CI = 0.55 to 0.88) of the EQ-5D. Alcohol detection was not associated with the self-care, pain/discomfort or anxiety/depression dimensions of the EQ-5D, or with return to work in adjusted analyses.
Acute pre-injury alcohol exposure was not associated with increased reporting of problems on the EQ-5D or with return to work at 12-months post-injury. Further research is needed to understand why patients with alcohol detections were sometimes associated with paradoxically better 12-month post-injury outcomes relative to patients without alcohol detections.
在因重大创伤而住院的患者中，通常会检测到酒精，且酒精是可预防的损伤的关键风险因素。虽然有研究表明，受伤时的酒精中毒会导致更严重的急性患者结局，但目前对于酒精对出院后健康结局的影响知之甚少。本研究的目的是检查重大创伤幸存者在受伤后 12 个月时，急性损伤前酒精暴露与自我报告的健康结局之间的关系。
使用维多利亚州创伤登记处（2018 年 1 月 1 日至 2020 年 12 月 31 日）的数据，确定符合以下条件的重大创伤患者：（1）年龄≥18 岁；（2）在受伤后 12 个月存活；（3）登记处中有血液酒精数据。使用逻辑回归分析检查在受伤时的血液酒精浓度（BAC）时，通过 BAC 对自我报告的健康状况（EQ-5D）和 12 个月后重返工作岗位的差异。分析调整了潜在的混杂因素，包括一系列人口统计学、医院和损伤特征。
共有 2957 名患者符合纳入标准，其中 857 名（29.0%）有 BAC>0，690 名（23.3%）有 BAC≥0.05 g/100 mL。在调整了潜在的混杂因素后，任何酒精检测（即 BAC>0）与较低的 EQ-5D 移动性（调整比值比[aOR]=0.72，95%CI=0.53 至 0.99）和日常活动维度（aOR=0.79，95%CI=0.63 至 0.99）报告问题的可能性相关。BAC≥0.05 g/100 mL 仅与 EQ-5D 日常活动维度报告问题的调整后可能性较低相关（aOR=0.69，95%CI=0.55 至 0.88）。酒精检测与 EQ-5D 的自我护理、疼痛/不适或焦虑/抑郁维度或调整后的 12 个月工作回归均无关。
急性损伤前的酒精暴露与 EQ-5D 报告问题的增加或 12 个月后重返工作岗位无关。需要进一步研究以了解为什么与没有酒精检测的患者相比，有时酒精检测患者的 12 个月后结局反而更好。
