Hangovers and Traffic Injuries: Is Alcohol's Influence Greater Than Expected?

宿醉和交通伤害：酒精的影响是否比预期更大？

• 批准号: 7891070
• 负责人: Gordon Stephen Smith
• 金额: $ 57.53万
• 依托单位: UNIVERSITY OF MARYLAND BALTIMORE
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-05-01 至 2015-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7891070
• 关键词: Acute; Admission activity; Alcohol abuse; Alcohol consumption; Alcoholic Intoxication; Alcoholism; Alcohols; Beverages; Biological Assay; Biological Markers; Blood; Blood alcohol level measurement; Cessation of life; Clinical assessments; Critical Care; Cross-Over Studies; Data Analyses; Data Sources; Death Records; Development; Disease; Documentation; Elderly; General Population; Glucuronides; Goals; Heavy Drinking; High Prevalence; Hospitals; Impairment; Individual; Injury; Interview; Intoxication; Knowledge; Lead; Link; Maryland; Medical Examiners; Methods; Monitor; Motor Vehicles; Patient Self-Report; Patients; Pattern; Performance; Pharmaceutical Preparations; Police; Policies; Population Attributable Risks; Positioning Attribute; Prevalence; Prevention; Preventive Intervention; Procedures; Regulation; Reporting; Research; Residual state; Risk; Risk Factors; Role; Safety; Screening procedure; Shock; Stratification; Symptoms; Systems Analysis; Technology Assessment; Testing; Time; Transportation; Trauma; Universities; Urine; Variant; Vehicle crash; Work; Workplace; alcohol effect; alcohol involvement; alcohol related problem; alcohol screening; case control; clinical practice; college; diethyl sulfate; drinking; drinking behavior; experience; hangover; hazardous drinking; high risk; improved; injured; injury prevention; innovation; instrument; intervention program; medical schools; new technology; novel; patient population; prevent; programs; public health relevance; research study; sobriety; substance abuse prevention; substance abuse treatment; tool; trafficking; trauma centers

DESCRIPTION (provided by applicant): Hangover symptoms and other residual effects of intoxication (hence-forth called residual effects) may be an important but poorly recognized risk factor in many injuries. The long term goal of this study is to reduce alcohol-related injuries through expanding the understanding of alcohol's role in injury risk to also include residual effects of intoxication. We intend to use this information for preventing further injuries and/or hazardous drinking by including recent intoxication assessments as part of routine screening programs for alcohol problems in critical care. We will identify and quantify the role of residual effects in traffic injuries by assessing biomarkers of recent alcohol consumption in urine among Motor Vehicle Crash (MVC) drivers admitted to the University of Maryland R. Adams Cowley Shock Trauma Center (STC) as well as all driver deaths from the medical examiner for the entire state of Maryland for 4 years. This study is an innovative use of two alcohol consumption biomarkers, ethyl glucuronide (EtG) and ethyl sulfate (EtS) in urine as indicators of residual effects even when blood alcohol is zero. The specific hypotheses behind the proposed research are: 1) impairment from residual effects of intoxication increases the risk of traffic injuries; and 2) the prevalence of residual effects of intoxication is elevated among those injured drivers with a zero BAC who were responsible for causing their crash compared to those determined not responsible. Aim 1 defines the quantitative relationship between biomarkers for residual effects, self-reported recent drinking behavior and alcohol problems, time of last drink, and symptom scores from the validated "Hangover Scale" among drivers able to be interviewed in hospital. Interviews will include information on current drinking patterns, CAGE, and hangover symptoms and linked to biomarker results to cross-validate the EtG/EtS estimates of residual effects. Drinking patterns including the place of last drink will also be conducted. Aim 2 quantifies risk factors for injury associated with residual effects using a case-crossover study among interviewed patients. This case-control variant compares drinking during the day immediately prior to the injury (case period) with drinking on the same day the preceding week (control) and can estimate injury risks associated with residual effects. Testing for other drugs allows stratification of results by presence or absence of drugs causing impairment. Aim 3 identifies the extent to which injured zero BAC drivers with biomarker evidence of residual effects are likely to be responsible for causing their crash, compared with zero-BAC drivers without biomarker evidence. This risk factor study involves linkage with police crash reports. Aim 4 determines the prevalence of elevated biomarkers for recent alcohol consumption among BAC zero MVC admissions and deaths. Aim 5 establishes the contribution of residual effects to all alcohol-involved serious MVC injuries and deaths and seeks to improve estimates of the alcohol-attributable fraction for traffic injuries. This novel use of biomarkers provides an unparalleled opportunity to advance understanding of the expanded role of alcohol in traffic injuries. PUBLIC HEALTH RELEVANCE: Accomplishing the study aims will increase our understanding of the full extent of alcohol's role in traffic injuries and expand the spectrum of alcohol-related problems to include the period of time after BAC is no longer elevated. Transportation and workplace regulations regarding alcohol use have largely ignored risks associated with residual effects of intoxication, and documentation of these risks could lead to improved regulations to protect public safety. The ability to objectively identify patients with evidence of residual effects post-intoxication will also enhance current clinical practice as they can be targeted for prevention efforts to either reduce or eliminate hazardous drinking, and reduce the risk of serious injury or death to both the driver impaired from residual effects and the general public.

描述（由申请人提供）：宿醉症状和中毒的其他残留影响（因此称为残留效应）可能是许多受伤的重要但知名的危险因素。这项研究的长期目标是通过扩展对酒精在损伤风险中的作用的理解，以减少与酒精相关的伤害，以还包括中毒的残留影响。我们打算使用这些信息来防止进一步的伤害和/或危险饮酒，包括最近的中毒评估，这是针对重症监护中酒精问题的常规筛查计划的一部分。我们将通过评估马里兰州R. Adams Cowley Shock Treauma Center（STC）的机动车撞车司机（MVC）驾驶员（MVC）驾驶员中最近尿液饮酒的生物标志物，以及整个马里兰州医学检查官的所有驾驶员死亡，并量化剩余影响在交通损伤中的作用。这项研究是对两种饮酒生物标志物，葡萄糖醛酸乙酯（ETG）和硫酸乙酯（ETS）的创新使用，即使血液酒精为零，也是残留作用的指标。拟议的研究背后的具体假设是：1）毒化的残余影响受到损害，增加了交通损伤的风险； 2）与确定的不承担任何责任的人相比，在零BAC的受伤驾驶员中，残留的残留效应的患病率升高。 AIM 1定义了生物标志物的残留效果，自我报告的近期饮酒行为和酒精问题，最后饮料的时间以及在医院接受医院接受采访的驾驶员中经过验证的“宿醉量表”的症状评分之间的定量关系。访谈将包括有关当前饮酒模式，笼子和宿醉症状的信息，并与生物标志物结果相关，以跨越估算残余效应的ETG/ETS估计。还将进行包括最后一杯饮料在内的饮酒方式。 AIM 2使用访谈的患者中的病例分解研究量化了与残留效应相关的损伤的危险因素。这种病例对照变体在受伤（病例周期）的第二天与前一周（对照）的饮酒进行了比较，并可以估计与残留效应有关的损伤风险。对其他药物进行测试可以通过存在或不存在导致损害的药物来分层结果。 AIM 3标识了与没有生物标志物证据的零-BAC驱动器相比，与零-BAC驱动器相比，具有生物标志物的零BAC驱动器具有生物标志物证据可能导致其崩溃的程度。此危险因素研究涉及与警察坠机报告联系。 AIM 4决定了BAC零MVC入院和死亡中最近饮酒的生物标志物升高的流行率。 AIM 5确定了残留效应对所有涉及酒精的严重MVC伤害和死亡的贡献，并试图改善对交通损伤的酒精饮料分数的估计。这种新型生物标志物的使用提供了一个无与伦比的机会，可以促进对酒精在交通损伤中扩展的作用的理解。 公共卫生相关性：实现这项研究的目标将提高我们对酒精在交通损伤中的全部作用的理解，并扩大与酒精有关的问题的范围，以包括BAC之后的时间不再升高。有关酒精使用的运输和工作场所法规在很大程度上忽略了与中毒的残留影响相关的风险，并且这些风险的记录可能会导致改善法规保护公共安全。在发生后毒性后具有残留影响的患者客观地识别患者的能力也将增强当前的临床实践，因为它们可以针对预防努力减少或消除危险饮酒的努力，并减少对残留效应和普通公众造成严重伤害或死亡的风险。