Background: The effects of blood alcohol on injury after crash are controve
rsial, and safe limits are not settled. We examined if a positive blood alc
ohol concentration, even in a nontoxic range, affects management and outcom
e of injured patients after road crashes.
Methods: In this prospective cohort study, we recruited all adult subjects
admitted to an emergency department within 4 hours after a road crash. Outc
omes were mortality or expected permanent disability, and data related to p
atients' management.
Results: Alcohol-positive trauma patients were more frequently critical at
admission (odds ratio [OR], 1.89; 95% confidence interval [CT], 1.18-3.02),
and had an increased risk of combined mortality or expected permanent disa
bility (OR, 1.67; 95% CI, 1.08-2.58), need for intensive care (OR, 1.87; 95
% CI, 1.01-3.46), surgery (OR, 1.91; 95% CI, 1.37-2.66) and blood transfusi
ons (OR, 2.09; 95% CI, 1.20-3.64), and acute medical complications (OR, 1.9
4; 95% CI, 1.33-2.85). All these events were explained by higher trauma sev
erity. Only the risk of unsuspected injuries, diagnosed only at final evalu
ation, was independently associated with a positive blood alcohol concentra
tion (OR, 4.98; 95% CI, 3.62-6.87), in addition to trauma severity and pree
xisting chronic conditions. Blood alcohol measurement significantly improve
d the accuracy in predicting unsuspected injuries, from 81.3% to 86.2%.
Conclusion: In injured patients after a road crash, a positive blood alcoho
l concentration increases the chance that the final diagnosis will include
more injuries than initially documented. More careful monitoring is needed
in alcohol-positive trauma patients, independent of clinical status, injury
severity, and overt symptoms of alcohol intoxication.