Alcohol. Gordon Smith, MD (MB, ChB Otago), MPH Professor University of Maryland National Study Center for Trauma and EMS

Transcription

1 This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike License. Your use of this material constitutes acceptance of that license and the conditions of use of materials on this site. Copyright 2011, The Johns Hopkins University and Gordon Smith. All rights reserved. Use of these materials permitted only in accordance with license rights granted. Materials provided AS IS ; no representations or warranties provided. User assumes all responsibility for use, and all liability related thereto, and must independently review all materials for accuracy and efficacy. May contain materials owned by others. User is responsible for obtaining permissions for use from third parties as needed.

2 Alcohol Gordon Smith, MD (MB, ChB Otago), MPH Professor University of Maryland National Study Center for Trauma and EMS

3 Alcohol and Injuries What do we know? What can we do? 3

4 Lecture Topics Extent of alcohol involvement in injuries Measurement and assessment of risk Case studies and the need for local data Collecting alcohol data and planning interventions 4

5 Section A Extent of Alcohol Involvement in Injuries

6 How Much of a Problem Is Alcohol? 107,000 deaths attributed to alcohol abuse, 42% of which (44,940) were due to injuries 147,840 injury-related deaths, 40% (57,885) of which were attributed to alcohol Injury Prevention, 1989 Note: Information from more recent studies is available in the online library 6

7 What Is the Role of Alcohol? How do we assess risk? What is the evidence? 7

8 Anecdotal Evidence Make not thyself helpless drinking in the beer shop... falling down, thy limbs will be broken and no one will give thee a hand to help thee up. The Making of the Scribe Ani 1500 BCE papyrus N el Guebaly Int J of Addictions 81 8

9 Anecdotal Evidence The benefits arising from the moderate use of strong liquor have been experienced in all armies and are not to be disputed... Gen. George Washington August 15,

10 Descriptive Studies First descriptive article: Twenty-five fatal accidents occurring to automobile wagons Nineteen drivers used spirits Six moderate drinkers Source: (1904). Quart J Inebriety. 10

11 Impaired Driving Problem in the United States 11,000 12,000 killed by intoxicated drivers 300,000 people injured in drinking driving crashes $129.7 billion in annual costs to society 1,400,000 drivers arrested annually for DWI or DUI 11

12 US Alcohol-Related Crash Fatalities Non Alcohol-Related ,087 50% ,250 45% ,611 38% ,730 40% ,808 32% Source: NHTSA NASS. (2005). 12

13 Proportion of All Fatally Injured Intoxicated Drivers Proportion of all fatally injured drivers estimated to have been legally intoxicated (BAC=>.08) [-33%] 13

14 Drivers Involved in Fatal Crashes by BAC Level FARS 2007 (N = 55,681) 14

15 Proportion of Crashes that Are Alcohol- Related Proportion of crashes that are alcohol-related as a function of the number of vehicles and crash severity Source: NHTSA 15

16 Single- and Multiple-Vehicle Fatal Crashes Single- and multiple-vehicle fatal crashes by time of day and alcohol involvement (NHTSA) 16

17 Number of Drinks and BAC in Two Hours of Drinking 17

18 Metabolism of Alcohol 18

19 Alcohol Involvement by Cause of Injury Death BAC positive BAC 100 mg/dl Percent of Cases Source: Smith et al. (1999). 19

20 Alcohol Involvement for Unintentional Injuries by Cause Percent of Cases Source: Smith et al. (1999). 20

21 Alcohol Involvement Increases with Injury Severity Adult Pedestrians with BAC Levels 0.08 g/100 ml From MVAPED study, South Africa, 1993 (n = 196) In-hospital deaths Severe injuries admitted 70.0% 61.2% Lesser injuries discharged 50.9% Randomly sampled uninjured adult pedestrians 10 13% 21

22 Trauma Patients Admitted: Port Elizabeth, South Africa Substances abused by injured patients, Trauma patients Port Elizabeth, South Africa (n = 235) 13.2% 44.3% 40.4% Alcohol only Drugs only Alcohol and drugs No substances 2.1% 22

23 Substances Abused by Traffic Trauma Victims From data from South Africa, 1997 (n = 72) Pedestrians (n = 31) Drivers/riders (n = 22) Passengers (n = 19) All traffic (n = 72) Alcohol (acute) BAC positive (%) Mean BAC (g/100 ml) ± ± ± ± 0.1 Alcohol (chronic) Total cage 2 (%) Illicit drugs Cannabis positive (%) Cocaine positive (%) White pipe positive (%)