Alqirnas Muhannad Q, Aljarwan Rafeef M, Alhamadh Moustafa S, Khallaf Sadeem A, Alsomali Faisal A, Albaqami Faris M, AlMudaiheem Najd R, AlKhashan Munira A, Al Deeb Mohammad
College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Ministry of the National Guard-Health Affairs, Riyadh, Saudi Arabia.
King Abdullah International Medical Research Center, Ministry of the National Guard-Health Affairs, Riyadh 11481, Saudi Arabia.
Arch Acad Emerg Med. 2024 Oct 22;13(1):e13. doi: 10.22037/aaem.v13i1.2427. eCollection 2025.
Several studies suggest a causal link between psychoactive agents and motor vehicle accidents (MVA). This study aimed to evaluate the impact of substance abuse and alcohol intoxication on the prognosis of high-speed MVA victims.
This is a single-center retrospective cross-sectional study involving adult multiple trauma cases who were admitted to the emergency department for high-speed MVA and underwent toxicological screening. The cohort was conducted based on two main outcomes; the survival status and the neurological outcomes.
894 patients with the mean age of 27.8 ± 9.24 (range:18-37) years were studied (97.9% male). The most common indicators of severity were car rollover and ejection from the car. 296 of the patients had severe traumatic brain injury (TBI). 622 of the patients had a positive toxicological screening, with benzodiazepines (51.2%) and alcohol (26.6%) being the most commonly abused substances. The mortality rate was 5.8% and 12.1% of the patients had unfavorable neurological outcomes upon discharge. On multivariate logistic regression, predictors of mortality among high-speed MVA victims were report of a death at the scene (adjusted odds ratio (aOR): 2.529; 95% confidence interval (CI): 1.026-6.232; p = 0.044), severe TBI, the presence of dilated pupils (aOR: 11.074; 95% CI: 1.293-94.812; p = 0.028), hypotension (aOR: 0.456; 95% CI: 0.227-0.916; p = 0.027), and hypoxia (aOR: 2.95; 95% CI: 1.46-5.95; p = 0.003). Predictors of unfavorable neurological outcomes were report of a death at the scene (aOR: 3.133; 95% CI: 1.445-6.791; p = 0.004), positive toxicology screening (aOR: 3.30; 95% CI:1.68-10.204; p = 0.038), severe TBI, the presence of hypoxia (aOR: 2.96; 95% CI:1.645-5.319; p = 0.000), hypotension (aOR: 0.437; 95% CI: 0.252-0.758; p = 0.003), and bleeding (aOR: 0.287; 95% CI: 0.164-0.501; p < 0.001).
A concerning proportion of high-speed MVA victims had a positive toxicology screening. Although intoxication did not increase mortality of high-speed MVAs, it was a significant predictor of unfavorable neurological outcomes of survivors.
多项研究表明精神活性物质与机动车事故（MVA）之间存在因果关系。本研究旨在评估药物滥用和酒精中毒对高速MVA受害者预后的影响。
这是一项单中心回顾性横断面研究，纳入因高速MVA而入住急诊科并接受毒理学筛查的成年多发伤患者。该队列研究基于两个主要结局进行；生存状态和神经学结局。
共研究了894例患者，平均年龄为27.8±9.24岁（范围：18 - 37岁），男性占97.9%。最常见的严重程度指标是车辆翻滚和被抛出车外。296例患者患有重度创伤性脑损伤（TBI）。622例患者毒理学筛查呈阳性，其中苯二氮䓬类药物（51.2%）和酒精（26.6%）是最常滥用的物质。死亡率为5.8%，12.1%的患者出院时神经学结局不佳。在多因素逻辑回归分析中，高速MVA受害者的死亡预测因素包括现场死亡报告（调整优势比（aOR）：2.529；95%置信区间（CI）：1.026 - 6.232；p = 0.044）、重度TBI、瞳孔散大（aOR：11.074；95%CI：1.293 - 94.812；p = 0.028）、低血压（aOR：0.456；95%CI：0.227 - 0.916；p = 0.027）和缺氧（aOR：2.95；95%CI：1.46 - 5.95；p = 0.003）。神经学结局不佳的预测因素包括现场死亡报告（aOR：3.133；95%CI：1.445 - 6.791；p = 0.004）、毒理学筛查阳性（aOR：3.30；95%CI：1.68 - 10.204；p = 0.038）、重度TBI、缺氧（aOR：2.96；95%CI：1.645 - 5.319；p = 0.000）、低血压（aOR：0.437；95%CI：0.252 - 0.758；p = 0.003）和出血（aOR：0.287；95%CI：0.164 - 0.501；p < 0.001）。
相当一部分高速MVA受害者毒理学筛查呈阳性。虽然中毒并未增加高速MVA的死亡率，但它是幸存者神经学结局不佳的重要预测因素。
