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

创伤患者群体中的酒精参与：趋势和未来死亡率

• 批准号: 8058760
• 负责人: Gordon Stephen Smith
• 金额: $ 39.24万
• 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: 2010-04-10 至 2015-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8058760
• 关键词: Admission activity; Age; Alcohol abuse; Alcohol consumption; Alcohols; Area; Blood alcohol level measurement; Caring; Cause of Death; Cessation of life; Clinical; Cohort Studies; Consumption; Data; Databases; Demographic Factors; Diabetes Mellitus; Disease; Drunk driving; Effectiveness; Environment; Etiology; Future; Gender; Goals; Health; Heavy Drinking; Hospitals; Hypertension; Incidence; Information Systems; Injury; Knowledge; Lead; Legal patent; Length; Link; Measures; Methods; Monitor; Multiple Trauma; Outcome; Patients; Persons; Pharmaceutical Preparations; Play; Population; Prevention; Prevention strategy; Questionnaires; Race; Recurrence; Registries; Relative (related person); Research; Resources; Risk; Risk Factors; Role; Sample Size; Screening procedure; Services; Subgroup; Suicide; Survival Analysis; Test Result; Testing; Time; Toxicology; Trauma; Triage; United States; Vehicle crash; Woman; Work; adverse outcome; alcohol abuse therapy; alcohol involvement; alcohol prevention; alcohol risk; assault; base; brief intervention; cohort; design; drinking; falls; follow-up; improved; indexing; injured; innovation; men; mortality; public health relevance; reduced alcohol use; trafficking; trauma centers; treatment program; trend; underage drinker

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.

描述（由申请人提供）：在过去的25年中，醉酒驾驶死亡人数大幅下降；但是，越来越多的受害者正在幸免于难，并且在幸存的创伤患者中，尤其是对于非行为损伤而在酒精参与中的同样下降在很大程度上尚不清楚。入院时血液酒精浓度（BAC）的程度也不是随后的不良后果的标志。拟议的研究的长期目标是提高对酒精在损伤因果关系中的作用的理解，并使用此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与酒精相关疾病的死亡人数。该应用的目的是开发一个关于1983年非致命损伤的酒精参与的全面毒理学数据库，使用这些数据来评估非致命性损伤的趋势，随着时间的推移，非致命性损伤的趋势，并确定升高的BAC在入院中升高与随后的死亡率风险有关（尤其是BAC级别的风险）。扩展的毒理学数据库将用于进行回顾性队列研究，该研究将把已排出的病例与国家死亡指数联系起来，以确定美国以前的创伤中心患者是否以及如何在美国任何地方死亡。生存分析将用于评估入院时BAC升高的程度，预测随后因损伤或酒精相关疾病而死亡的程度。基本的假设是：1）交通事故的酒精参与下降在很大程度上是针对减少醉酒驾驶的预防努力的结果，而与其他伤害相关的酒精参与变化较小； 2）与较低或阴性BAC的患者相比，BAC水平非常高的人（> 150 mg/dL）随后死亡和与酒精有关的疾病的死亡风险要大得多。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年的综合毒理学数据系统，该数据系统将用于记录所有受伤的患者的酒精参与，该患者被接受到美国最繁忙的1级创伤中心； 2）评估随着时间的流逝，非致命损伤涉及非致命损伤的趋势，并确定醉酒驾驶死亡人数的描述趋势在多大程度上发生了非致命损伤的趋势，包括运动车坠毁的入院和其他伤害模式，包括无意义的（e.g.，falls）和故意（例如，Assault和Sueault和Suiice）; 3）为了确定从医院活着出院的人中，BAC+入院状态的程度可预测随后因受伤和酒精相关疾病而死亡的死亡率。拟议的工作具有创新性，因为它将与全国死亡记录的创伤中心患者有关饮酒的独特纵向数据，以识别出院后死亡的患者。拟议的研究非常重要，因为它将改善针对酒精相关损伤或疾病风险的群体设计的酒精预防和治疗计划的监测和靶向。 公共卫生相关性：实现该研究的目标将导致了解醉酒驾驶死亡策略对非致命伤害发病率的有效性，即是否可以预计该领域的努力增加是否可以减少其他与酒精相关的伤害的数量，以及是否会适当地受到教育努力的适当影响。死亡率风险信息将用于优先考虑针对受创伤中心的患者设计和呈现的酒精治疗服务的强度。通过将治疗服务的靶向和匹配提高到最反复受伤风险的人，这项研究的结果预计将对从创伤中心出院后减少饮酒量产生重要的积极影响，从长远来看，诸如重复受伤和与酒精相关的健康问题等重饮酒后的后遗症。