부산대학교 도서관

BACKGROUND: Alcohol-related trauma, which including drunk driving, fighting or a fall after drinking alcohol, is the main reason for sustaining trauma injury. Because the drunken patient has a poor control and may tend to be involved in an accident and sustain a lower or, in contrast, a higher injury severity, it is not yet determined in the relationship between alcohol use and the severity of trauma. Furthermore, it is interesting to clarify whether there is higher medical expense associated with alcohol-related trauma injury. To provide objective evidences and more complete therapeutic algorithm, this study was designed to investigate the relationship of alcohol-related trauma and the injury severity as well as medical expenses in adults. MATERIALS AND METHODS: A retrospective study of the medical records and registered data in Trauma Registry System from 2009 to 2014 was performed at a medical center in southern Taiwan. The inclusion criteria included all patients aged from 20 to 65 years and admitted via emergency department. Those who had incomplete registered data and those who were suspected drunken but refused an alcohol test were excluded. The patients whose blood alcohol concentration (BAC) level≧50mg/dl was considered as alcohol intoxication group while those whose BAC level less than 50mg/dl and those who were not required for an alcohol test were deemed as patients without alcohol intoxication group. SPSS statistical method and propensity score matching were used to compare these two groups. RESULTS: Of the total 11,033 adult patients, 929 patients with BAC (+) and 10,104 patients with BAC (–) were enrolled in this study. Patients with alcohol intoxication were predominantly men, of younger age, and had lower incidence of pre-existing comorbidities and chronic diseases such as hypertension, diabetes, and end-stage renal disease. In addition, more patients with alcohol intoxication were injured in motorcycle and motor vehicle accidents than those without alcohol intoxication. In contrast, a smaller number of patients with alcohol intoxication were injured in strike by/against objects and fall accidents. Patients with alcohol intoxication had significantly higher rates of head/neck injury, face injury, thoracic injury, and abdomen injury, lower Glasgow coma scale (GCS) score (12.6±3.7 vs. 14.5±1.9, p＜0.001), higher injury severity score (30.8±17.8 vs. 7.7±6.5, p＜0.001), higher short-term mortality (3.6% vs. 1.2%, p＜0.001), longer hospital stay (11.4 days vs. 9.1 days, p＜0.001), and higher proportion of admission to the intensive care unit (ICU) (35.4% vs. 15.0%, p＜0.001) than those without alcohol intoxication. On comparison with patients without alcohol intoxication, those who had alcohol intoxication spent a significantly higher total expenditure (28.3% higher), cost of operation (51.8% higher), cost of examination (71.7% higher), and cost of pharmaceuticals (63.8% higher). On comparing the selected well-balanced pairs of patients with and those without alcohol intoxication, who had similar personal characteristics regarding sex, age, and co-morbidities, those who had alcohol intoxication still had significantly higher total expenditure (17.4% higher), cost of operation (40.3% higher), cost of examination (52.8% higher), and cost of pharmaceuticals (38.3% higher). CONCLUSION: Alcohol-related trauma is associated to a higher injury severity and increase the cost of medical expenses. Therefore, how to lower and avoid alcohol-related trauma, particular the drunk driving, to decrease the associated complication and medical expenses would be an important key role in trauma prevention.