Alcohol-related hospitalisations of trauma patients in Southern Taiwan: a cross-sectional study based on a trauma registry system

Rau, Cheng-Shyuan; Liu, Hang-Tsung; Hsu, Shiun-Yuan; Cho, Tzu-Yu; Hsieh, Ching-Hua

doi:10.1136/bmjopen-2014-005947

Cited by 15 publications

(14 citation statements)

References 25 publications

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“…Moreover, because of different riding speeds, the impact energy may differ between collisions involving motorcyclists and those involving bicyclists. There is scarce information on the protective effect of helmet use in Taiwan, where motorcycle and bicycle accidents occur on relatively crowded streets [ 19 ]. Therefore, in this study we aimed to investigate the protective effect of helmet use during motorcycle and bicycle accidents by using a propensity score–matched study based on trauma registry system data over a seven-year period.…”

Section: Introductionmentioning

confidence: 99%

The protective effect of helmet use in motorcycle and bicycle accidents: a propensity score–matched study based on a trauma registry system

Kuo

Rau

et al. 2017

BMC Public Health

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BackgroundTransportation by motorcycle and bicycle has become popular in Taiwan, this study was designed to investigate the protective effect of helmet use during motorcycle and bicycle accidents by using a propensity score–matched study based on trauma registry system data.MethodsData of adult patients hospitalized for motorcycle or bicycle accidents between January 1, 2009 and December 31, 2015 were retrieved from the Trauma Registry System. These included 7735 motorcyclists with helmet use, 863 motorcyclists without helmet use, 76 bicyclists with helmet use, and 647 bicyclists without helmet use. The primary outcome measurement was in-hospital mortality. Secondary outcomes were the hospital length of stay (LOS), intensive care unit (ICU) admission rate, and ICU LOS. Normally distributed continuous data were analyzed by the unpaired Student t-test, and non-normally distributed data were compared using the Mann–Whitney U-test. Two-sided Fisher exact or Pearson chi-square tests were used to compare categorical data. Propensity score matching (1:1 ratio using optimal method with a 0.2 caliper width) was performed using NCSS software, adjusting for the following covariates: sex, age, and comorbidities. Further logistic regression was used to evaluate the effect of helmet use on mortality rates of motorcyclists and bicyclists, respectively.ResultsThe mortality rate for motorcyclists with helmet use (1.1%) was significantly lower than for motorcyclists without helmet use (4.2%; odds ratio [OR] 0.2; 95% confidence interval [CI]: 0.17–0.37; p < 0.001). Among bicyclists, there was no significant difference in mortality rates between the patients with helmet use (5.3%) and those without helmet use (3.7%; OR 1.4; 95% CI: 0.49–4.27; p = 0.524). After propensity-score matching for covariates, including sex, age, and comorbidities, 856 well-balanced pairs of motorcyclists and 76 pairs of bicyclists were identified for outcome comparison, showing that helmet use among motorcyclists was associated with lower mortality rates (OR 0.2; 95% CI: 0.09–0.44; p < 0.001). In contrast, helmet use among bicyclists was not associated with a decrease in mortality (OR 1.3; 95% CI: 0.30–5.96; p = 0.706). The hospital LOS was also significantly shorter for motorcyclists with helmet use than for those without (9.5 days vs. 12.0 days, respectively, p < 0.001) although for bicyclists, helmet use was not associated with hospital LOS. Fewer motorcyclists with helmet use were admitted to the ICU, regardless of the severity of injury; however, no significant difference of ICU admission rates was found between bicyclists with and without helmets.ConclusionsMotorcycle helmets provide protection to adult motorcyclists involved in traffic accidents and their use is associated with a decrease in mortality rates and the risk of head injuries. However, no such protective effect of helmet use was observed for bicyclists involved in collisions.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-017-4649-1) contains supplem...

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Section: Introductionmentioning

confidence: 99%

The protective effect of helmet use in motorcycle and bicycle accidents: a propensity score–matched study based on a trauma registry system

Kuo

Rau

et al. 2017

BMC Public Health

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“…21 In alcohol-intoxicated patients with less-severe injuries, brain CT was overused, with a higher proportion of negative findings for intracranial haemorrhage. 22 In an analysis of the sample of ED patient visits, representing ∼13 million ED visits nationwide, BAC-positive patients underwent more diagnostic tests and had longer ED stays. 28 Previous studies have reported alcohol use to be associated with higher hospital mortality and expenditure.…”

Section: Introductionmentioning

confidence: 99%

Influence of alcohol use on mortality and expenditure during hospital admission: a cross-sectional study

et al. 2016

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ObjectivesThis study was designed to investigate the effect of alcohol intoxication on clinical presentation of hospitalised adult trauma patients at a Level I trauma centre using propensity score matching.DesignCross-sectional study.SettingTaiwan.ParticipantsDetailed data of 929 hospitalised adult trauma patients with alcohol intoxication, aged 20–65 years, and 10 104 corresponding patients without alcohol intoxication were retrieved from the Trauma Registry System between 1 January 2009 and 31 December 2014. Alcohol intoxication was defined as a blood alcohol concentration (BAC) ≥50 mg/dL.Main outcome measuresIn-hospital mortality and expenditure.ResultsPatients with alcohol intoxication presented with significantly higher short-term mortality (OR: 3.0, 95% CI 2.0 to 4.4; p<0.001) than patients without alcohol intoxication. However, on comparison with propensity score-matched patients with respect to sex, age, comorbidity, Glasgow Coma Scale (GCS), injury region based on Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS), alcohol intoxication did not significantly influence mortality (OR: 0.8, 95% CI 0.5 to 1.4; p=0.563). This implied that the higher mortality of alcohol-intoxicated patients was attributable to patient characteristics such as a higher injury severity rather than alcohol intoxication. Even on comparison with sex-matched, age-matched and comorbidity-matched patients without alcohol intoxication, patients with alcohol intoxication still had significantly higher total expenditure (17.4% higher), cost of operation (40.3% higher), cost of examination (52.8% higher) and cost of pharmaceuticals (38.3% higher).ConclusionsThe associated higher mortality of adult trauma patients with alcohol intoxication was completely attributable to other patient characteristics and associated injury severity rather than the effects of alcohol. However, patients with alcohol intoxication incurred significantly higher expenditure than patients without alcohol intoxication, even on comparison with sex-matched, age-matched and comorbidity-matched patients without alcohol intoxication.

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“…Variations in ndings between this study and others that examine the effect of alcohol on injury severity may result from local variations among study populations and the utilization of our tertiary care center versus community hospitals. Relevant studies looked at diverse demographic and geographic communities, from our own study in the suburbs of New York City, to LA county 5 and even Taiwan 7,22 . Meta-analysis of these studies should be performed to normalize the demographic and geographical differences to more accurately determine alcohol's effect on injury.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have examined the effects of alcohol on injury type and severity, but results have varied between study cohorts. [4][5][6][7] Some studies suggest that intoxicated patients have worse injuries. For example, one group found that pedestrians who had consumed alcohol were more injured (as determined by their Injury Severity Score (ISS)) and had longer hospital length of stay (LOS).…”

Section: Introductionmentioning

confidence: 99%

Higher Blood Alcohol Concentration is Related to Less Severe Injury Amongst Intoxicated Trauma Patients

Kumar

Prabhakaran

McIntyre

et al. 2020

Preprint

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Background Previous studies show varied results regarding the protective effects of alcohol intoxication upon injury and mortality in the setting of trauma. Our study aimed to determine the effects of blood alcohol content (BAC) amongst trauma patients with alcohol ingestion, upon injury type and severity, as well as outcomes. Methods This 4-year retrospective study (2013–2017) used an institutional trauma database to capture all Level 1 and 2 trauma patients (≥14 years old) with BAC > 10 mg/dL presenting to the emergency department at a Level 1 trauma center. Demographic variables including mechanism of injury (MOI) were collected. Patients’ BAC was compared to their calculated injury severity scores (ISS) and abbreviated injury scale (AIS) scores. Analysis included linear regression, T-tests and ANOVAs with Tukey’s post-hoc analysis for continuous variables and Fisher’s exact test for binary variables. Multivariate regression analysis was performed to determine independent predictors of injury severity. Results 332 intoxicated patients were identified (mean BAC: 210.2±87.14 mg/dL, range 12.7–460.0; 74.1% male; median age 35; range: 16–90). The median ISS was 6 (range: 1–48). Patients in motor vehicle collisions had lower BACs (186.0±5.59 mg/dL) than those who fell (233.8±10.42 mg/dL, p = 0.0002), were assaulted (230.4±14.04 mg/dL, p = 0.0261), or were pedestrians struck (259.4±14.17 mg/dL, p = 0.004). Overall, patients with higher BAC had lower GCS, lower ISS, and shorter intensive care unit (ICU) length of stay, but no differences in hospital stay, or ventilator days. Conclusions Trauma patients with higher BAC have lower ISS, less severe chest injury, and shorter ICU stays. These findings suggest that higher levels of alcohol ingestion may portend a protective effect in the setting of trauma with respect to severity of injury that does not mitigate the importance of education and injury prevention but warrants further study into the physiology of alcohol and trauma.

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Alcohol-related hospitalisations of trauma patients in Southern Taiwan: a cross-sectional study based on a trauma registry system

Cited by 15 publications

References 25 publications

The protective effect of helmet use in motorcycle and bicycle accidents: a propensity score–matched study based on a trauma registry system

The protective effect of helmet use in motorcycle and bicycle accidents: a propensity score–matched study based on a trauma registry system

Influence of alcohol use on mortality and expenditure during hospital admission: a cross-sectional study

Higher Blood Alcohol Concentration is Related to Less Severe Injury Amongst Intoxicated Trauma Patients

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