Hangovers and Traffic Injuries: Is Alcohol's Influence Greater Than Expected?

宿醉和交通伤害：酒精的影响是否比预期更大？

• 批准号: 8068909
• 负责人: Gordon Stephen Smith
• 金额: $ 57.32万
• 依托单位: UNIVERSITY OF MARYLAND BALTIMORE
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-05-01 至 2015-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8068909
• 关键词: Acute; Admission activity; Alcohol abuse; Alcohol consumption; Alcoholic Intoxication; Alcoholism; Alcohols; Beverages; Biological Assay; Biological Markers; Blood; Blood alcohol level measurement; Cessation of life; Clinical assessments; Critical Care; Cross-Over Studies; Data Analyses; Data Sources; Death Records; Development; Disease; Documentation; Elderly; General Population; Glucuronides; Goals; Heavy Drinking; High Prevalence; Hospitals; Impairment; Individual; Injury; Interview; Intoxication; Lead; Link; Maryland; Medical Examiners; Methods; Monitor; Motor Vehicles; Patient Self-Report; Patients; Pattern; Performance; Pharmaceutical Preparations; Police; Policies; Population Attributable Risks; Positioning Attribute; Prevalence; Prevention; Preventive Intervention; Procedures; Regulation; Reporting; Research; Residual state; Risk; Risk Factors; Role; Safety; Screening procedure; Shock; Stratification; Symptoms; Systems Analysis; Technology Assessment; Testing; Time; Transportation; Trauma; Universities; Urine; Variant; Vehicle crash; Work; Workplace; alcohol effect; alcohol involvement; alcohol related problem; alcohol screening; case control; clinical practice; college; diethyl sulfate; drinking; drinking behavior; experience; hangover; hazardous drinking; high risk; improved; injured; injury prevention; innovation; instrument; intervention program; medical schools; new technology; novel; patient population; prevent; programs; public health relevance; research study; sobriety; substance abuse prevention; substance abuse treatment; tool; trafficking; trauma centers

DESCRIPTION (provided by applicant): Hangover symptoms and other residual effects of intoxication (hence-forth called residual effects) may be an important but poorly recognized risk factor in many injuries. The long term goal of this study is to reduce alcohol-related injuries through expanding the understanding of alcohol's role in injury risk to also include residual effects of intoxication. We intend to use this information for preventing further injuries and/or hazardous drinking by including recent intoxication assessments as part of routine screening programs for alcohol problems in critical care. We will identify and quantify the role of residual effects in traffic injuries by assessing biomarkers of recent alcohol consumption in urine among Motor Vehicle Crash (MVC) drivers admitted to the University of Maryland R. Adams Cowley Shock Trauma Center (STC) as well as all driver deaths from the medical examiner for the entire state of Maryland for 4 years. This study is an innovative use of two alcohol consumption biomarkers, ethyl glucuronide (EtG) and ethyl sulfate (EtS) in urine as indicators of residual effects even when blood alcohol is zero. The specific hypotheses behind the proposed research are: 1) impairment from residual effects of intoxication increases the risk of traffic injuries; and 2) the prevalence of residual effects of intoxication is elevated among those injured drivers with a zero BAC who were responsible for causing their crash compared to those determined not responsible. Aim 1 defines the quantitative relationship between biomarkers for residual effects, self-reported recent drinking behavior and alcohol problems, time of last drink, and symptom scores from the validated "Hangover Scale" among drivers able to be interviewed in hospital. Interviews will include information on current drinking patterns, CAGE, and hangover symptoms and linked to biomarker results to cross-validate the EtG/EtS estimates of residual effects. Drinking patterns including the place of last drink will also be conducted. Aim 2 quantifies risk factors for injury associated with residual effects using a case-crossover study among interviewed patients. This case-control variant compares drinking during the day immediately prior to the injury (case period) with drinking on the same day the preceding week (control) and can estimate injury risks associated with residual effects. Testing for other drugs allows stratification of results by presence or absence of drugs causing impairment. Aim 3 identifies the extent to which injured zero BAC drivers with biomarker evidence of residual effects are likely to be responsible for causing their crash, compared with zero-BAC drivers without biomarker evidence. This risk factor study involves linkage with police crash reports. Aim 4 determines the prevalence of elevated biomarkers for recent alcohol consumption among BAC zero MVC admissions and deaths. Aim 5 establishes the contribution of residual effects to all alcohol-involved serious MVC injuries and deaths and seeks to improve estimates of the alcohol-attributable fraction for traffic injuries. This novel use of biomarkers provides an unparalleled opportunity to advance understanding of the expanded role of alcohol in traffic injuries. PUBLIC HEALTH RELEVANCE: Accomplishing the study aims will increase our understanding of the full extent of alcohol's role in traffic injuries and expand the spectrum of alcohol-related problems to include the period of time after BAC is no longer elevated. Transportation and workplace regulations regarding alcohol use have largely ignored risks associated with residual effects of intoxication, and documentation of these risks could lead to improved regulations to protect public safety. The ability to objectively identify patients with evidence of residual effects post-intoxication will also enhance current clinical practice as they can be targeted for prevention efforts to either reduce or eliminate hazardous drinking, and reduce the risk of serious injury or death to both the driver impaired from residual effects and the general public.

描述（由申请人提供）：宿醉症状和其他中毒残留效应（以下称为残留效应）可能是许多伤害的重要但认识不足的风险因素。这项研究的长期目标是通过扩大对酒精在伤害风险中的作用的理解来减少酒精相关的伤害，包括醉酒的残余影响。我们打算使用这些信息，通过将最近的中毒评估作为重症监护中酒精问题的常规筛查计划的一部分，来预防进一步的伤害和/或危险饮酒。我们将通过评估马里兰州R大学承认的机动车碰撞（MVC）驾驶员近期尿中酒精消耗的生物标志物，确定和量化交通伤害中残留效应的作用。亚当斯考利休克创伤中心（STC）以及所有司机死亡的法医为整个马里兰州为4年。这项研究创新性地使用了两种酒精消耗生物标志物，即尿液中的乙基葡萄糖醛酸苷（EtG）和硫酸乙酯（EtS），即使血液中的酒精含量为零，也可以作为残留效应的指标。拟议研究背后的具体假设是：1）醉酒残余影响的损害增加了交通伤害的风险; 2）与那些确定不负责的人相比，那些BAC为零的受伤司机中醉酒残余影响的患病率升高。目的1定义了残留效应的生物标志物之间的定量关系，自我报告最近的饮酒行为和酒精问题，最后一次饮酒的时间，以及能够在医院接受采访的驾驶员中验证的“宿醉量表”的症状评分。访谈将包括有关当前饮酒模式、CAGE和宿醉症状的信息，并与生物标志物结果相关联，以交叉验证EtG/EtS对残留效应的估计。还将进行饮酒模式，包括最后一次饮酒的地点。目的2：通过在受访患者中进行病例交叉研究，量化与残留效应相关的损伤风险因素。这个病例对照变量比较了受伤前一天（病例期）和前一周同一天（对照组）的饮酒情况，可以估计与残留效应相关的受伤风险。其他药物的检测允许通过存在或不存在导致损害的药物对结果进行分层。目标3确定了与没有生物标志物证据的零BAC驾驶员相比，具有残留效应生物标志物证据的受伤零BAC驾驶员可能对导致其撞车负责的程度。这项风险因素研究涉及与警方事故报告的联系。目的4确定BAC零MVC入院和死亡中近期饮酒的生物标志物升高的患病率。目标5确定了残留效应对所有酒精相关严重MVC伤害和死亡的贡献，并寻求改善对交通伤害中酒精可归因比例的估计。生物标志物的这种新用途为进一步了解酒精在交通伤害中的扩大作用提供了无与伦比的机会。 公共卫生相关性：实现研究目标将增加我们对酒精在交通伤害中作用的全面理解，并扩大酒精相关问题的范围，包括BAC不再升高后的一段时间。关于酒精使用的交通和工作场所法规在很大程度上忽视了与中毒残余影响相关的风险，记录这些风险可能会导致改善法规以保护公共安全。客观识别具有中毒后残留效应证据的患者的能力也将增强当前的临床实践，因为他们可以成为预防工作的目标，以减少或消除危险饮酒，并降低因残留效应受损的驾驶员和公众的严重伤害或死亡风险。