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The alcohol-intoxicated trauma patient: impact on imaging and radiation exposure

  • Christian David Weber
  • Jana Kristina Schmitz
  • Christina Garving
  • Klemens Horst
  • Hans-Christoph Pape
  • Frank Hildebrand
  • Philipp Kobbe
Original Article

Abstract

Introduction

The purpose of this study was to investigate the effects of alcohol intoxication in trauma patients in regard to its impact on application of computed tomography (CT) and associated radiation exposure.

Methods

We conducted a retrospective study from a continuous patient cohort. Inclusion criteria: admission to the emergency room of an urban Level 1 trauma center with trauma team activation during a 12-month period (Jan 1st–Dec 31st 2012). Patients with incomplete data, age ≤ 12 years and with neurological diseases were excluded. Demographics, mechanisms, severity and patterns of injury (Abbreviated Injury Scale, Injury Severity Score, Glasgow Coma Scale), blood alcohol concentration (BAC, in permille, ‰), imaging studies (head/whole body CT), radiation exposure, and hospital length of stay, surgical procedures and mortality were evaluated with SPSS statistics (Version 25, IBM Inc., Armonk, New York).

Results

A positive BAC (mean 1.80 ± 0.767) was reported in 19.2% (n = 41/214) of the cohort. Alcohol intoxication was associated with higher utilization of head CT (65.9 vs. 46.8%, p = 0.017) and radiation exposure (231.75 vs. 151.25 mAS, p = 0.045; dose-length product, 583.03 vs. 391.04, p = 0.006). In general, the presence of alcohol was associated with over-triage (p = 0.001), despite minor injury severity (ISS < 9) and a comparable rate of head injuries (p = 0.275). Head injury (AIS ≥ 3) and positive BAC (OR 2.34, 95% CI 1.096–5.001) were identified as strongest independent predictors for head CT.

Conclusion

Alcohol intoxication is a common finding in trauma patients, and the rate of moderate and serious head injuries seems to be comparable to a more severely injured control group. Furthermore, head CT utilization in intoxicated patients is associated with significant radiation exposure, despite poor image quality, due to motion artifacts (27%). Future strategies are required to exclude head injuries safely, while reducing the rate of head CT and associated radiation exposure in intoxicated patients.

Keywords

Alcohol intoxication Trauma patient Head CT Radiation Mortality 

Abbreviations

AIS

Abbreviated Injury Scale

BAC

Blood alcohol concentration/content

CCT

Cranial computed tomography

CT

Computed tomography

CI

Confidence interval

DLP

Dose length product

ER

Emergency room

GCS

Glasgow Coma Score

ICU

Intensive care unit

ISS

Injury severity score

LOS

Length of stay

mAS

Milliampere second

MCA

Motorcycle accident

MVA

Motor vehicle accident

NISS

New injury severity score

OR

Odds ratio

SBP

Systolic blood pressure

SD

Standard deviation

TBI

Traumatic brain injury

WBCT

Whole body computed tomography

Notes

Acknowledgements

This paper has been presented at the 16th European Congress of Trauma and Emergency Surgery in Amsterdam, The Netherlands, and was nominated for the Best Oral Paper Presentation.

Funding

No financial support was received for this study.

Compliance with ethical standards

Conflict of interest

Christian David Weber, Jana Kristina Schmitz, Christina Garving, Klemens Horst, Hans-Christoph Pape, Frank Hildebrand and Philipp Kobbe have no conflicts of interest to disclose.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Christian David Weber
    • 1
  • Jana Kristina Schmitz
    • 1
  • Christina Garving
    • 2
  • Klemens Horst
    • 1
  • Hans-Christoph Pape
    • 3
  • Frank Hildebrand
    • 1
  • Philipp Kobbe
    • 1
  1. 1.Department of Trauma and Reconstructive SurgeryRWTH Aachen University Medical CenterAachenGermany
  2. 2.Department of Trauma SurgeryKrankenhaus AgathariedHaushamGermany
  3. 3.Department of Trauma SurgeryUniversity of ZurichZurichSwitzerland

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