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，酒后驾车的死亡人数显着下降;然而，更多的受害者在受伤后幸存下来，而且在很大程度上不知道幸存的创伤患者中是否发生了类似的酒精参与下降，特别是对于非车辆伤害。也不知道入院时血液酒精浓度（BAC）升高的程度是随后不良后果的标志。拟议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。本申请的目的是开发一个关于酒精参与非致命性损伤的综合毒理学数据库，涵盖1983年至今，使用该数据评估酒精参与非致命性损伤随时间的趋势，并确定入院时BAC升高与随后死亡风险的关系（特别是该风险如何随BAC水平变化）。扩展的毒理学数据库将用于进行回顾性队列研究，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升高预测随后因损伤或酒精相关疾病死亡的程度。潜在的假设是：1）交通事故中酒精参与的下降主要是针对减少酒后驾驶的预防措施的结果，并且与其他伤害相关的酒精参与变化较小;和2）具有非常高的BAC水平的人（>150 mg/dL）的患者因重复损伤和酒精相关疾病而随后死亡的风险比BAC较低或阴性的患者高得多。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进行测试：1）开发一个跨越25年的全面毒理学数据系统，用于记录美国最繁忙的1级创伤中心收治的所有受伤患者的酒精参与; 2）评估随着时间的推移酒精参与非致命伤害的趋势，并确定在何种程度上酒后驾车死亡的良好描述的趋势发生了非-致命伤害，包括机动车碰撞入院和其他伤害模式，无论是无意的（例如，福尔斯）和故意（例如，袭击和自杀）;以及3）确定在那些从医院活着出院的患者中，入院时BAC+状态在多大程度上预测随后因损伤和酒精相关疾病而死亡。这项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。这项拟议中的研究意义重大，因为它将改善酒精预防和治疗计划的监测和针对性，这些计划是为酒精相关伤害或疾病风险最高的群体设计的。 公共卫生相关性：完成这项研究的目的将导致了解酒后驾驶死亡预防策略对非致命伤害发生率的有效性，是否可以预期在这方面的努力增加，以减少其他酒精相关伤害的数量，以及某些群体，如未成年饮酒者是否受到教育工作的适当影响。死亡风险信息将用于优先考虑为创伤中心收治的患者设计和提供的酒精治疗服务的强度。通过改善治疗服务的针对性和匹配性，以那些最有可能复发的伤害，这项研究的结果预计将有一个重要的积极影响，减少从创伤中心出院后的酒精消费，并在长期内，大量饮酒的后遗症，如重复伤害和酒精相关的健康问题。

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.