Alcohol interventions in a trauma center as a means of reducing the risk of injury recurrence
Alcohol interventions in a trauma center as a means of reducing the risk of injury recurrence
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DOI：
10.1097/00000658-199910000-00003
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发表时间：
1999-10-01
影响因子：
9
通讯作者：
Ries, RR
中科院分区：
文献类型：
--
作者：
Gentilello, LM;Rivara, FP;Ries, RR
目的酒精中毒是创伤的主要危险因素，作者假设在创伤护理中提供短暂的酒精干预可以显著减少酒精摄入量，降低创伤再发率。使用血液酒精浓度、谷氨酰转肽酶水平和短密歇根酒精中毒筛查试验(SMAST)对患者进行筛查。那些有阳性结果的人被随机分成短暂的干预组或对照组。通过计算机搜索急诊科酸性全州出院记录来发现再损伤，并进行6个月和12个月的访谈以评估酒精使用情况。结果共筛查了2524名患者，1153名筛查阳性(46%)。366人被随机分到干预组，396人被分到对照组。12个月后，干预组每周饮酒量减少21.8+/-3.7杯；对照组减少6.7+/-5.8(p=0.03)。这种减少在轻度到中度酒精问题(SMAST评分为3到8)的患者中最为明显；他们每周饮酒量减少21.8+/-4.2杯，而对照组每周增加2.3+/-8.3杯(p<；0.01)。需要急诊科或创伤中心入院的伤害减少了47%(风险比0.53，95%可信区间0.26至1.07，p=0.07)，需要住院的伤害减少了48%(3年随访)。结论酒精干预与减少酒精摄入量和降低创伤再发风险有关。鉴于酒精问题在创伤中心的普遍存在，酒精问题的筛查、干预和咨询应该是例行公事。
Objective Alcoholism is the leading risk factor for injury, The authors hypothesized that providing brief alcohol interventions as a routine component of trauma care would significantly reduce alcohol consumption and would decrease the rate of trauma recidivism.Methods This study was a randomized, prospective controlled trial in a level 1 trauma center. Patients were screened using a blood alcohol concentration, gamma glutamyl transpeptidase level, and short Michigan Alcoholism Screening Test (SMAST). Those with positive results were randomized to a brief intervention or control group. Reinjury was detected by a computerized search of emergency department acid statewide hospital discharge records, and 6- and 12-month interviews were conducted to assess alcohol use.Results A total of 2524 patients were screened; 1153 screened positive (46%). Three hundred sixty-six were randomized to the intervention group, and 396 to controls. At 12 months, the intervention group decreased alcohol consumption by 21.8 +/- 3.7 drinks per week; in the control group, the decrease was 6.7 +/- 5.8 (p = 0.03). The reduction was most apparent in patients with mild to moderate alcohol problems (SMAST score 3 to 8); they had 21.8 +/- 4.2 fewer drinks per week, compared to an increase of 2.3 +/- 8.3 drinks per week in controls (p < 0.01). There was a 47% reduction in injuries requiring either emergency department or trauma center admission (hazard ratio 0.53, 95% confidence interval 0.26 to 1.07, p = 0.07) and a 48% reduction in injuries requiring hospital admission (3 years follow-up). Conclusion Alcohol interventions are associated with a reduction in alcohol intake and a reduced risk of trauma recidivism. Given the prevalence of alcohol problems in trauma centers, screening, intervention, and counseling for alcohol problems should be routine.