Fp. Rivara et al., THE EFFECTS OF ALCOHOL-ABUSE ON READMISSION FOR TRAUMA, JAMA, the journal of the American Medical Association, 270(16), 1993, pp. 1962-1964
Objective.-To determine the effect of admission for trauma with concur
rent acute alcohol intoxication or chronic alcohol abuse on the risk o
f subsequent recurrence of trauma. Design.-Prospective cohort study. S
etting.-Level I regional trauma center. Patients.-A total of 2578 pati
ents 18 years or older admitted with blunt or penetrating trauma withi
n 24 hours of injury and surviving to discharge. All patients had a bl
ood alcohol concentration (BAC) test, a gamma-glutamyltransferase (GGT
) test, and the short Michigan Alcohol Screening Test (SMAST) performe
d on admission. Main Outcome Measurement.-Readmission to the trauma ce
nter for new trauma. Average follow-up was 28 months (range, 16 to 40
months). Results.-The overall rate of readmission for new injuries was
1.3 per 1000 patient-months of follow-up. Patients who were intoxicat
ed on the initial admission (BAC >22 mmol/L [100 mg/dL]) were 2.5-fold
as likely to be readmitted than those not intoxicated (95% confidence
limits, 1.6, 3.9). The relative risks for patients with positive SMAS
T scores and abnormal GGT values were 2.2 (95% confidence limits, 1.4,
3.5) and 3.5 (95% confidence limits, 2.2, 5.5), respectively. The inc
reased risks remained significant for intoxication and abnormal GGT va
lues after adjustment for gender, race, Medicaid status, and mechanism
of injury. Conclusion.-Alcohol abuse is associated with an increased
risk of readmission for new trauma. Trauma patients should be screened
for alcohol problems; referral of problem drinkers for appropriate ca
re may decrease their risk of admission for subsequent trauma.