血液酒精水平对创伤复发风险及严重程度的作用。
Role of blood alcohol level on the risk and severity of trauma recurrence.
作者信息
Char Steven, Sharma Bharti, Arnold Monique, Agriantonis George, Whittington Jennifer, Bhatia Navin
机构信息
Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Surgery, NYC Health and Hospitals Elmhurst, Elmhurst, New York, USA.
出版信息
Trauma Surg Acute Care Open. 2025 Aug 17;10(3):e001743. doi: 10.1136/tsaco-2024-001743. eCollection 2025.
BACKGROUND
Alcohol intoxication at the time of index trauma is associated with an increased risk of recurrent traumatic injury. It is unclear, however, whether the degree of intoxication impacts the risk of recurrence or its severity. This study aimed to analyze the relationship between alcohol level at index trauma and risk of recurrent trauma. We hypothesized that increasing levels of alcohol would be associated with an increased risk of trauma recurrence and severity.
METHODS
We conducted a retrospective cohort study of adults who presented to our Level 1 trauma center between January 2020 and December 2022 with traumatic injury and a positive alcohol level (blood alcohol content (BAC)). The primary outcome of interest was recurrent trauma within 12 months. Secondary outcomes included injury severity score, hospital length of stay, and discharge location. We performed univariable and multivariable logistic regression with class balancing sensitivities controlling for baseline patient characteristics to analyze the association between risk factors and trauma recurrence.
RESULTS
Of the 1,653 trauma encounters across 1,585 patients included in this study, 63 patients (3.8%) experienced re-injury within 12 months. Mean BAC at index trauma was higher among the recurrently injured compared with non-recurrently injured patients (270.0 mg/dL vs 221.0 mg/dL, p<0.001). Multivariate analysis revealed that for all-comers increasing BAC was weakly associated with an increased risk of trauma recurrence (OR 1.004, 95% CI: 1.001 to 1.007, p=0.013), but that among the highest tertile of intoxicated patients, increasing BAC was strongly associated with recurrence (OR 2.607, 95% CI: 1.166 to 6.448, p=0.026). Recurrently injured patients were more likely to have at least one medical comorbidity.
CONCLUSIONS
We found a differential effect of alcohol intoxication on the risk of trauma recurrence whereby increasing BAC was strongly associated with an increased risk of recurrence only among the most intoxicated patients.
LEVEL OF EVIDENCE
III, Prognostic and epidemiological.
背景
初次创伤时酒精中毒与再次发生创伤性损伤的风险增加相关。然而，中毒程度是否会影响复发风险或其严重程度尚不清楚。本研究旨在分析初次创伤时酒精水平与再次创伤风险之间的关系。我们假设酒精水平升高会与创伤复发风险及严重程度增加相关。
方法
我们对2020年1月至2022年12月期间前往我们的一级创伤中心就诊、有创伤性损伤且酒精水平呈阳性（血液酒精含量（BAC））的成年人进行了一项回顾性队列研究。感兴趣的主要结局是12个月内再次创伤。次要结局包括损伤严重程度评分、住院时间和出院地点。我们进行了单变量和多变量逻辑回归分析，并通过控制基线患者特征的类平衡敏感性来分析危险因素与创伤复发之间的关联。
结果
本研究纳入的1585例患者共发生1653次创伤事件，其中63例患者（3.8%）在12个月内再次受伤。与未再次受伤的患者相比，再次受伤患者初次创伤时的平均BAC更高（270.0mg/dL对221.0mg/dL，p<0.001）。多变量分析显示，对于所有患者，BAC升高与创伤复发风险增加呈弱相关（比值比1.004，95%置信区间：1.001至1.007，p=0.013），但在中毒程度最高的三分位数患者中，BAC升高与复发密切相关（比值比2.607，95%置信区间：1.166至6.448，p=0.026）。再次受伤的患者更有可能至少有一种合并症。
结论
我们发现酒精中毒对创伤复发风险有不同影响，即仅在中毒程度最高的患者中，BAC升高与复发风险增加密切相关。
证据水平
III，预后和流行病学。
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