Alcohol Involvement in a Cohort of Trauma Patients: Trends and Future Mortality

描述（由申请人提供）：在过去的25年里，酒后驾车死亡人数显著下降；然而，更多的受害者在他们的伤害中幸存下来，并且在很大程度上不知道是否在幸存的创伤患者中发生了类似的酒精参与的下降，特别是对于非车辆伤害。入院时血液酒精浓度升高（BAC）在多大程度上是随后不良后果的标志，目前也不清楚。该研究的长期目标是提高对酒精在伤害因果关系中的作用的理解，并利用这些信息更好地针对创伤中心的酒精治疗服务，以减少复发性创伤和酒精相关疾病的死亡人数。本申请的目的是建立一个1983年至今酒精与非致命性伤害相关的全面毒理学数据库，利用这些数据来评估随时间推移酒精与非致命性伤害相关的趋势，并确定入院时血液酒精浓度升高与随后死亡风险的关系（特别是这种风险如何随血液酒精浓度的变化而变化）。扩展毒理学数据库将用于进行一项回顾性队列研究，该研究将出院病例与国家死亡指数联系起来，以确定美国任何地方的前创伤中心患者是否以及如何死亡。生存分析将用于评估入院时bac升高对随后因损伤或酒精相关疾病死亡的预测程度。潜在的假设是：1)交通事故中涉及酒精的减少主要是针对减少酒后驾驶的预防工作的结果，并且酒精与其他伤害的关联变化较小；2) BAC水平非常高（bb0 ~ 150mg /dL）的人与BAC水平较低或阴性的患者相比，因重复损伤和酒精相关疾病而死亡的风险要大得多。在强有力的初步数据的指导下，这些假设将通过追求三个具体目标来验证：1)建立一个跨越25年的综合毒理学数据系统，用于记录美国最繁忙的一级创伤中心收治的所有受伤患者的酒精相关情况；2)评估一段时间以来酒精涉及非致命伤害的趋势，并确定非致命伤害（包括机动车碰撞入院和其他伤害模式，包括无意（如跌倒）和故意（如殴打和自杀））中酒驾死亡的良好趋势在多大程度上发生；3)确定在那些活着出院的患者中，入院时BAC+状态对随后因伤害和酒精相关疾病死亡的预测程度。拟议的工作是创新的，因为它将把创伤中心患者饮酒的独特纵向数据与国家死亡登记册联系起来，以确定出院后死亡的患者。这项提议的研究意义重大，因为它将改善针对酒精相关伤害或疾病风险最高的群体设计的酒精预防和治疗方案的监测和目标。

DESCRIPTION (provided by applicant): Drunk-driving fatalities have declined significantly over the past 25 years; however, many more victims are surviving their injuries, and it is largely unknown if similar declines in alcohol involvement have occurred among surviving trauma patients, especially for non-vehicular injuries. Nor is it known the extent to which elevated Blood Alcohol Concentration (BAC) on admission is a marker for subsequent adverse outcomes. The long-term goal of the proposed study is to improve the understanding of alcohol's role in injury causation and use this information to better target alcohol treatment services in trauma centers to reduce the number of deaths from recurrent trauma and alcohol-related disease. The objective of this application is to develop a comprehensive toxicology database on alcohol involvement in non-fatal injuries, spanning 1983 to the present, to use this data to evaluate trends in alcohol involvement in non-fatal injuries over time, and to determine how an elevated BAC on admission relates to subsequent mortality risk (especially how this risk varies by BAC level). The extended toxicology database will be used to conduct a retrospective cohort study that will link discharged cases to the National Death Index to determine if and how former trauma center patients die anywhere in the United States. Survival analysis will be used to evaluate the extent to which elevated BACs on admission predict subsequent mortality from injury or alcohol-related disease. The underlying hypotheses are that: 1) declines in alcohol involvement for traffic crashes have been largely the result of prevention efforts directed at reducing drunk driving, and that there has been less change in alcohol involvement in association with other injuries; and 2) persons with very high BAC levels (>150 mg/dL) are at much greater risk of subsequent death from repeat injuries and alcohol-related diseases than patients with lower or negative BACs. Guided by strong preliminary data, these hypotheses will be tested by pursuing three specific aims: 1) to develop a comprehensive toxicology data system spanning 25 years that will be used to document alcohol involvement among all injured patients admitted to the busiest Level 1 trauma center in the US; 2) to evaluate trends in alcohol involvement in non-fatal injuries over time and determine the extent to which the well-described trends in fatalities from drunk driving have occurred for non-fatal injuries, including motor-vehicle crash admissions and other modes of injury, both unintentional (e.g., falls) and intentional (e.g., assault and suicide); and 3) to determine, among those discharged alive from the hospital, the extent to which BAC+ status on admission predicts subsequent mortality from injuries and alcohol-related diseases. The proposed work is innovative because it will link unique longitudinal data on alcohol consumption by trauma center patients with a national death register to identify patients who die after discharge. The proposed research is significant because it will improve the monitoring and targeting of alcohol prevention and treatment programs designed for groups most at risk of alcohol-related injury or diseases. PUBLIC HEALTH RELEVANCE: Accomplishing the study's aims will lead to an understanding of the effectiveness of drunk-driving fatality prevention strategies on the incidence of non-fatal injuries, of whether increased efforts in this area can be expected to reduce the number of other alcohol-related injuries, and of whether certain groups such as underage drinkers are appropriately influenced by educational efforts. The mortality risk information will be used to prioritize the intensity of alcohol treatment services designed for and presented to patients admitted to trauma centers. By improving the targeting and matching of treatment services to those most at risk of recurrent injury, the results of this study are expected to have an important positive impact on reducing alcohol consumption after discharge from the trauma center and, in the long term, the sequelae of heavy drinking such as repeat injury and alcohol-related health problems.