Skip to main content

Advertisement

SpringerLink
Log in

The influence of alcohol on the outcome of trauma patients: a matched-pair analysis of the TraumaRegister DGU®

  • Original Article
  • Published:
European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Background and purpose

In the diagnosis and treatment of trauma patients, numerous individual and trauma-related factors must be considered, all of which may influence the outcome. Although alcohol exposure is a major risk factor for an accident, its influence on the outcome is unclear. This matched-pair analysis investigates the hypothesis that alcohol has no negative impact on the outcome of trauma patients.

Materials and methods

In a retrospective matched-pair analysis of the multi-centre database of the TraumaRegister DGU® patients with a maximum Abbreviated Injury Scale (MAIS) of 3 or greater from the years 2015 and 2016 with an alcohol level ≥ 0.5‰ were compared to patients with a measured alcohol level of 0.0‰. The patients were matched according to age, gender, AIS body regions (head, thorax, abdomen, pelvis/extremities) and survival presumption (Revised Injury Severity Classification Score (RISC) II the TraumaRegister ervals).

Results

After matching, a total of 834 patients were enrolled, with 417 patients in group with positive blood alcohol levels (BAL +) with a median alcohol level of 1.82‰ and 417 patients in the negative-alcohol group (BAL −). As a mechanism of injury, the BAL + group showed more often penetrating injuries, pedestrian accidents and low energy falls compared to car and motorcycle accidents in the BAL − group. BAL + patients were significantly less sedated (BAL −: 66.7% vs. BAL + : 56.2%, p = 0.002), less frequently transported by rescue helicopter, were more frequently hypotensive (BAL −: 42 patients (10.3%) vs. BAL + : 61 patients (15.2%), p = 0.045, Table 2) and exhibited lower base excess levels associated with an acidotic metabolic status compared to sober patients (acidosis: BAL −: 24 patients (6.1%) vs. BAL + : 61 patients (17.2%), p < 0.001). There was no difference regarding in-hospital complications, length of stay or mortality rate.

Conclusions and implications

Our data demonstrate that alcohol exposure in trauma patients has no impact on complication or mortality rates. On the other hand, there are initially clear differences in the mechanism of injury, sedation, mode of transport and the acid–base balance.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Greenspan L, McLellan BA, Greig H. Abbreviated injury scale and injury severity score: a scoring chart. J Trauma. 1985;25:60–4.

    Article  CAS  PubMed  Google Scholar 

  2. Sektion Notfall- & Intensivmedizin, Schwerverletztenversorgung (NIS) der Deutschen und AUC - Akademie der Unfallchirurgie GmbH. TR-DGU-Jahresbericht_2017.

  3. Berry C, Ley EJ, Margulies DR, Mirocha J, Bukur M, Malinoski D, Salim A. Correlating the blood alcohol concentration with outcome after traumatic brain injury: too much is not a bad thing. Am Surg. 2011;77:1416–9.

    PubMed  Google Scholar 

  4. Lin H-L, Lin T-Y, Soo K-M, Chen C-W, Kuo L-C, Lin Y-K, et al. The effect of alcohol intoxication on mortality of blunt head injury. Biomed Res Int. 2014;2014:619231. https://doi.org/10.1155/2014/619231.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Raj R, Skrifvars MB, Kivisaari R, Hernesniemi J, Lappalainen J, Siironen J. Acute alcohol intoxication and long-term outcome in patients with traumatic brain injury. J Neurotrauma. 2015;32:95–100. https://doi.org/10.1089/neu.2014.3488.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Albrecht JS, Afshar M, Stein DM, Smith GS. Alcohol is not protective against mortality following traumatic brain injury. Am J Epidemiol. 2017. https://doi.org/10.1093/aje/kwx254.

    Article  PubMed Central  Google Scholar 

  7. Wagner N, Akbarpour A, Mors K, Voth M, Stormann P, Auner B, et al. Alcohol intoxication reduces systemic interleukin-6 levels and leukocyte counts after severe TBI compared with not intoxicated TBI patients. Shock. 2016;46:261–9. https://doi.org/10.1097/SHK.0000000000000620.

    Article  CAS  PubMed  Google Scholar 

  8. Wagner N, Franz N, Dieteren S, Perl M, Mörs K, Marzi I, Relja B. Acute alcohol binge deteriorates metabolic and respiratory compensation capability after blunt chest trauma followed by hemorrhagic shock-A new research model. Alcohol Clin Exp Res. 2017;41:1559–67. https://doi.org/10.1111/acer.13446.

    Article  CAS  PubMed  Google Scholar 

  9. Relja B, Wilhelm K, Wang M, Henrich D, Marzi I, Lehnert M. Acute ethanol gavage attenuates hemorrhage/resuscitation-induced hepatic oxidative stress in rats. Oxid Med Cell Longev. 2012;2012:983427. https://doi.org/10.1155/2012/983427.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Relja B, Menke J, Wagner N, Auner B, Voth M, Nau C, Marzi I. Effects of positive blood alcohol concentration on outcome and systemic interleukin-6 in major trauma patients. Injury. 2016;47:640–5. https://doi.org/10.1016/j.injury.2016.01.016.

    Article  CAS  PubMed  Google Scholar 

  11. Mörs K, Hörauf J-A, Kany S, Wagner N, Sturm R, Woschek M, et al. Ethanol decreases inflammatory response in human lung epithelial cells by inhibiting the canonical NF-kB-pathway. Cell Physiol Biochem. 2017;43:17–30. https://doi.org/10.1159/000480313.

    Article  CAS  PubMed  Google Scholar 

  12. Nau C, Wutzler S, Dörr H, Lehnert M, Lefering R, Laurer H, et al. Liver cirrhosis but not alcohol abuse is associated with impaired outcome in trauma patients: a retrospective, multicentre study. Injury. 2013;44:661–6. https://doi.org/10.1016/j.injury.2012.06.013.

    Article  PubMed  Google Scholar 

  13. Pandit V, Patel N, Rhee P, Kulvatunyou N, Aziz H, Green DJ, et al. Effect of alcohol in traumatic brain injury: is it really protective? J Surg Res. 2014;190:634–9. https://doi.org/10.1016/j.jss.2014.04.039.

    Article  CAS  PubMed  Google Scholar 

  14. Teng SX, Katz PS, Maxi JK, Mayeux JP, Gilpin NW, Molina PE. Alcohol exposure after mild focal traumatic brain injury impairs neurological recovery and exacerbates localized neuroinflammation. Brain Behav Immun. 2015;45:145–56. https://doi.org/10.1016/j.bbi.2014.11.006.

    Article  CAS  PubMed  Google Scholar 

  15. Relja B, Hohn C, Bormann F, Seyboth K, Henrich D, Marzi I, Lehnert M. Acute alcohol intoxication reduces mortality, inflammatory responses and hepatic injury after haemorrhage and resuscitation in vivo. Br J Pharmacol. 2012;165:1188–99. https://doi.org/10.1111/j.1476-5381.2011.01595.x.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Lustenberger T, Inaba K, Barmparas G, Talving P, Plurad D, Lam L, et al. Ethanol intoxication is associated with a lower incidence of admission coagulopathy in severe traumatic brain injury patients. J Neurotrauma. 2011;28:1699–706. https://doi.org/10.1089/neu.2011.1866.

    Article  PubMed  Google Scholar 

  17. Akademie der Unfallchirurgie GmbH. Manuskript—AUC. http://www.traumaregister-dgu.de/de/forschung/manuskript.html. Accessed 23 Mar 2018.

  18. Vincent JL, Moreno R, Takala J, Willatts S, Mendonça A de, Bruining H, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996;22:707–10. https://doi.org/10.1007/bf01709751.

  19. § 24a StVG - Einzelnorm. 15.03.2018. https://www.gesetze-im-internet.de/stvg/__24a.html. Accessed 21 Mar 2018.

  20. Calandra T, Cohen J. The international sepsis forum consensus conference on definitions of infection in the intensive care unit. Crit Care Med. 2005;33:1538–48. https://doi.org/10.1097/01.ccm.0000168253.91200.83.

    Article  PubMed  Google Scholar 

  21. Akademie der Unfallchirurgie GmbH. Teilnahme - AUC. http://www.traumaregister-dgu.de/de/registerstruktur/teilnahme.html. Accessed 23 Mar 2018.

  22. Lefering R. Ein neuer Prognose-Score im TraumaRegister DGU® (RISC II). Orthopädie und Unfallchirurgie - Mitteilungen und Nachrichten. 2015;04:80–1. https://doi.org/10.1055/s-0041-100418.

    Article  Google Scholar 

  23. Pape H-C, Lefering R, Butcher N, Peitzman A, Leenen L, Marzi I, et al. The definition of polytrauma revisited: an international consensus process and proposal of the new ‘Berlin definition’. J Trauma Acute Care Surg. 2014;77:780–6. https://doi.org/10.1097/TA.0000000000000453.

    Article  PubMed  Google Scholar 

  24. Afshar M, Netzer G, Murthi S, Smith GS. Alcohol exposure, injury, and death in trauma patients. J Trauma Acute Care Surg. 2015;79:643–8. https://doi.org/10.1097/TA.0000000000000825.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Afshar M, Netzer G, Salisbury-Afshar E, Murthi S, Smith GS. Injured patients with very high blood alcohol concentrations. Injury. 2016;47:83–8. https://doi.org/10.1016/j.injury.2015.10.063.

    Article  PubMed  Google Scholar 

  26. Molina PE, Zambell KL, Norenberg K, Eason J, Phelan H, Zhang P, et al. Consequences of alcohol-induced early dysregulation of responses to trauma/hemorrhage. Alcohol. 2004;33:217–27. https://doi.org/10.1016/j.alcohol.2004.07.002.

    Article  CAS  PubMed  Google Scholar 

  27. Bilello J, McCray V, Davis J, Jackson L, Danos LA. Acute ethanol intoxication and the trauma patient: hemodynamic pitfalls. World J Surg. 2011;35:2149–53. https://doi.org/10.1007/s00268-011-1191-7.

    Article  PubMed  Google Scholar 

  28. Yoonhee C, Jung K, Eo E, Lee D, Kim J, Shin D, et al. The relationship between alcohol consumption and injury in ED trauma patients. Am J Emerg Med. 2009;27:956–60. https://doi.org/10.1016/j.ajem.2008.07.035.

  29. Halperin ML, Hammeke M, Josse RG, Jungas RL. Metabolic acidosis in the alcoholic: a pathophysiologic approach. Metab Clin Exp. 1983;32:308–15.

    Article  CAS  PubMed  Google Scholar 

  30. Lamminpaa A, Vilska J. Acid-base balance in alcohol users seen in an emergency room. Vet Hum Toxicol. 1991;33:482–5.

    CAS  PubMed  Google Scholar 

  31. Sahn SA, Lakshminarayan S, Pierson DJ, Weil JV. Effect of ethanol on the ventilatory responses to oxygen and carbon dioxide in man. Clin Sci Mol Med. 1975;49:33–8.

    CAS  PubMed  Google Scholar 

  32. Dunham CM, Watson LA, Cooper C. Base deficit level indicating major injury is increased with ethanol. J Emerg Med. 2000;18:165–71.

    Article  CAS  PubMed  Google Scholar 

  33. Davis JW, Kaups KL, Parks SN. Effect of alcohol on the utility of base deficit in trauma. J Trauma. 1997;43:507–10.

    Article  CAS  PubMed  Google Scholar 

  34. Abt R, Lustenberger T, Stover JF, Benninger E, Lenzlinger PM, Stocker R, Keel M. Base excess determined within one hour of admission predicts mortality in patients with severe pelvic fractures and severe hemorrhagic shock. Eur J Trauma Emerg Surg. 2009;35:429. https://doi.org/10.1007/s00068-009-8245-7.

    Article  PubMed  Google Scholar 

  35. Mutschler M, Nienaber U, Brockamp T, Wafaisade A, Fabian T, Paffrath T, et al. Renaissance of base deficit for the initial assessment of trauma patients: a base deficit-based classification for hypovolemic shock developed on data from 16,305 patients derived from the TraumaRegister DGU®. Crit Care. 2013;17:R42. https://doi.org/10.1186/cc12555.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Rixen D, Raum M, Bouillon B, Lefering R, Neugebauer E. Base deficit development and its prognostic significance in posttrauma critical illness: an analysis by the trauma registry of the Deutsche Gesellschaft für unfallchirurgie. Shock. 2001;15:83–9.

    Article  CAS  PubMed  Google Scholar 

  37. Davis JW, Shackford SR, Mackersie RC, Hoyt DB. Base deficit as a guide to volume resuscitation. J Trauma. 1988;28:1464–7.

    Article  CAS  PubMed  Google Scholar 

  38. Ibrahim I, Chor WP, Chue KM, Tan CS, Tan HL, Siddiqui FJ, Hartman M. Is arterial base deficit still a useful prognostic marker in trauma? A systematic review. Am J Emerg Med. 2016;34:626–35. https://doi.org/10.1016/j.ajem.2015.12.012.

    Article  CAS  PubMed  Google Scholar 

  39. Gustafson ML, Hollosi S, Chumbe JT, Samanta D, Modak A, Bethea A. The effect of ethanol on lactate and base deficit as predictors of morbidity and mortality in trauma. Am J Emerg Med. 2015;33:607–13. https://doi.org/10.1016/j.ajem.2015.01.030.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Zehtabchi S, Baron BJ, Sinert R, Yadav K, Lucchesi M. Ethanol and illicit drugs do not affect the diagnostic utility of base deficit and lactate in differentiating minor from major injury in trauma patients. Acad Emerg Med. 2004;11:1014–20. https://doi.org/10.1197/j.aem.2004.06.008.

    Article  PubMed  Google Scholar 

  41. Dunne JR, Tracy JK, Scalea TM, Napolitano LM. Lactate and base deficit in trauma: does alcohol or drug use impair their predictive accuracy? J Trauma. 2005;58:959–66.

    Article  CAS  PubMed  Google Scholar 

  42. Zeckey C, Dannecker S, Hildebrand F, Mommsen P, Scherer R, Probst C, et al. Alcohol and multiple trauma: is there an influence on the outcome? Alcohol. 2011;45:245–51. https://doi.org/10.1016/j.alcohol.2010.08.004.

    Article  PubMed  Google Scholar 

  43. Friedman LS. Complications associated with blood alcohol concentration following injury. Alcohol. 2014;48:391–400. https://doi.org/10.1016/j.alcohol.2014.01.008.

    Article  CAS  PubMed  Google Scholar 

  44. Hadjizacharia P, O’Keeffe T, Plurad DS, Green DJ, Brown CVR, Chan LS, et al. Alcohol exposure and outcomes in trauma patients. Eur J Trauma Emerg Surg. 2011;37:169–75. https://doi.org/10.1007/s00068-010-0038-5.

    Article  CAS  PubMed  Google Scholar 

  45. Stübig T, Petri M, Zeckey C, Brand S, Müller C, Otte D, et al. Alcohol intoxication in road traffic accidents leads to higher impact speed difference, higher ISS and MAIS, and higher preclinical mortality. Alcohol. 2012;46:681–6. https://doi.org/10.1016/j.alcohol.2012.07.002.

    Article  PubMed  Google Scholar 

  46. Opreanu RC, Kuhn D, Basson MD. Influence of alcohol on mortality in traumatic brain injury. J Am Coll Surg. 2010;210:997–1007. https://doi.org/10.1016/j.jamcollsurg.2010.01.036.

    Article  PubMed  Google Scholar 

  47. Woolf PD, Cox C, McDonald JV, Kelly M, Nichols D, Hamill RW, Feliciano DV. Effects of intoxication on the catecholamine response to multisystem injury. J Trauma. 1991;31:1271–5. https://doi.org/10.1097/00005373-199109000-00012 (discussion 1275-6).

    Article  CAS  PubMed  Google Scholar 

  48. Woolf PD, Cox C, Kelly M, McDonald JV, Hamill RW. Alcohol intoxication blunts sympatho-adrenal activation following brain injury. Alcohol Clin Exp Res. 1990;14:205–9. https://doi.org/10.1111/j.1530-0277.1990.tb00473.x.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Goethe-University, Frankfurt, Germany

    Nils Wagner, Borna Relja, Thomas Lustenberger, Max Leiblein & Ingo Marzi

  2. Department of Trauma, Hand and Orthopaedic Surgery, Helios Dr. Horst Schmidt Hospital, Wiesbaden, Germany

    Sebastian Wutzler

  3. IFOM, Institute for Research in Operative Medicine, Faculty of Health, University Witten/Herdecke, Ostmerheimer Straße 200, 51109, Cologne, Germany

    Rolf Lefering

Authors
  1. Nils Wagner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Borna Relja
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Thomas Lustenberger
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Max Leiblein
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sebastian Wutzler
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Rolf Lefering
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ingo Marzi
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

the TraumaRegister DGU3

Corresponding author

Correspondence to Nils Wagner.

Ethics declarations

Conflict of interest

Prof. Lefering is a member and advisor of Emergency Medicine, Intensive Care and Trauma Management (Sektion NIS) of the German Trauma Society (DGU). His institute receives financial support from the AUC—Academy of Trauma Surgery GmbH, the operator of the TR-DGU, as part of a cooperation agreement which also includes the statistical support of scientific publications. The other authors declare that there is no conflict of interest.

Additional information

TraumaRegister DGU: Committee on Emergency Medicine, Intensive Care and Trauma Management (Sektion NIS) of the German Trauma Society (DGU).

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wagner, N., Relja, B., Lustenberger, T. et al. The influence of alcohol on the outcome of trauma patients: a matched-pair analysis of the TraumaRegister DGU®. Eur J Trauma Emerg Surg 46, 463–472 (2020). https://doi.org/10.1007/s00068-019-01231-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00068-019-01231-0

Keywords

Search

Navigation