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



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.


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).


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.


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.


Alcohol intoxication Trauma patient Head CT Radiation Mortality 



Abbreviated Injury Scale


Blood alcohol concentration/content


Cranial computed tomography


Computed tomography


Confidence interval


Dose length product


Emergency room


Glasgow Coma Score


Intensive care unit


Injury severity score


Length of stay


Milliampere second


Motorcycle accident


Motor vehicle accident


New injury severity score


Odds ratio


Systolic blood pressure


Standard deviation


Traumatic brain injury


Whole body computed tomography



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.


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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