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Dose–response relationship between in-hospital mortality and alcohol following acute injury

Although the relationship between alcohol and injury incidence is well researched, there continues to be dispute about the relationship between alcohol and mortality following an injury. A study by Lee Friedman state that findings from past studies have varied primarily because of methodological issues and have failed to characterize the dose–response relationship.

The main objective of the study was to evaluate the dose response relationship of in-hospital mortality and blood alcohol concentration (BAC). The study was a retrospective analysis of traumatic injuries occurring between 1995 and 2009 as reported by all level 1 and 2 trauma units in the State of Illinois. It included all patients with blood alcohol toxicological examination levels ranging from zero to 500 mg/dl (N = 190,612). The Illinois trauma registry includes all patients sustaining traumatic injuries and admitted to a trauma center for ≥12 h. A total of 6733 patients meeting the inclusion criteria died following admission. In the adjusted multivariable model, a decrease in in-hospital mortality was strongly associated with an increase in blood alcohol concentration (adjusted OR = 0.83 per 100 mg/dl units change in BAC; CI 95%: 0.80, 0.85; p < 0.001). The direction of the dose response relationship was consistent across the stratified models, with the exception of patients suffering burns. The largest reduction of in-hospital case fatality rates by blood alcohol concentration was observed among patients suffering penetrating or severe injuries (Injury Severity Score ≥ 16). The authors conclude that in the clinical setting, it is important to understand not only how to recognise intoxicated patients, but also how alcohol may affect the course of treatment.

The consistency of the findings across the multivariable models indicates that blood alcohol concentration is strongly associated with lower in-hospital mortality among those that survive long enough to receive treatment in specialised trauma units.

Source: Dose–response relationship between in-hospital mortality and alcohol following acute injury, Lee S. Friedman. Alcoholism: Clinical and Experimental Research published online 22 October 2012.

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