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

描述(申请人提供)：酒后驾车死亡人数在过去25年中显著下降；然而，更多的受害者在他们的伤害中幸存下来，而且在很大程度上还不清楚，在幸存的创伤患者中，酒精参与的情况是否也出现了类似的下降，特别是非车祸伤害。入院时升高的血液酒精浓度(BAC)在多大程度上是后续不良后果的标志也不清楚。这项拟议研究的长期目标是提高对酒精在伤害原因中的作用的理解，并利用这些信息更好地针对创伤中心的酒精治疗服务，以减少因反复创伤和酒精相关疾病而死亡的人数。本应用程序的目的是开发一个从1983年到现在的关于酒精与非致命伤害有关的综合毒理学数据库，使用该数据来评估酒精与非致命伤害随时间的变化趋势，并确定入院时BAC升高与随后的死亡风险之间的关系(特别是这种风险如何随BAC水平的变化而变化)。扩展的毒理学数据库将被用于进行一项回溯性队列研究，将出院病例与国家死亡指数联系起来，以确定前创伤中心患者是否以及如何在美国任何地方死亡。生存分析将被用来评估入院时BAC升高在多大程度上预测随后因损伤或酒精相关疾病而死亡。基本的假设是：1)交通事故中与酒精有关的下降在很大程度上是旨在减少酒后驾驶的预防努力的结果，而与其他伤害相关的酒精影响的变化较小；以及2)BAC水平非常高的人(&gt；150 mg/dL)与BAC水平较低或阴性的患者相比，后续死于重复伤害和与酒精有关的疾病的风险要大得多。在强大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检验：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一级创伤中心收治的所有受伤患者中涉及酒精的情况；2)评估非致命伤害中涉及酒精的趋势，并确定在非致命伤害中发生的已描述的死亡趋势的程度，包括机动车碰撞入院和其他形式的伤害，包括无意(如跌倒)和故意(如袭击和自杀)；3)在那些活着出院的人中，确定入院时的BAC状态在多大程度上预测随后因伤害和酒精相关疾病而死亡。这项拟议的工作具有创新性，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联系起来，以识别出院后死亡的患者。这项拟议的研究具有重要意义，因为它将改善针对与酒精相关的伤害或疾病风险最高的群体设计的酒精预防和治疗计划的监测和目标。 公共卫生相关性：实现这项研究的目标将有助于理解预防酒后驾车死亡的战略对非致命伤害发生率的有效性，这一领域的更多努力是否有望减少其他与酒精有关的伤害的数量，以及某些群体，如未成年饮酒者是否受到教育努力的适当影响。死亡风险信息将被用来确定为住进创伤中心的患者设计并提供的酒精治疗服务的优先程度。通过改进针对最有可能再次受伤的人的治疗服务的针对性和匹配性，这项研究的结果预计将对减少创伤中心出院后的酒精消费以及长期大量饮酒的后遗症，如重复伤害和与酒精相关的健康问题产生重要的积极影响。

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.