A Cochrane review [Abstract] 1 included 17 trials providing results for relevant outcomes. These compared diverse interventions to no intervention reporting reduced motor-vehicle crashes and related injuries, falls, suicide attempts, domestic violence, assaults and child abuse, alcohol-related injuries and injury emergency visits, hospitalizations and deaths. Reductions ranged from 27% to 65%, but they were statistically nonsignificant in most studies. Brief counseling in the clinical setting was studied in seven trials, in which injury-related deaths seemed to be reduced (RR 0.65; 95% CI 0.21-2.00, 3 trials, n=1 555), but the reduction was not statistically significant. The majority of trials of brief counseling also showed beneficial effects on diverse non-fatal injury outcomes.
A systematic review and meta-analysis 2 studied how acute alcohol consumption and injury or collision risk increase together. 28 case-control and case-crossover studies were included. The risk of injury increases non-linearly with increasing alcohol consumption. For motor vehicle accidents (MVA), the odds ratio increased by 1.24 (95% CI 1.18 to 1.31) per 10-g in pure alcohol increase to 52.0 (95% CI 34.50 to 78.28) at 120 g. For non-motor vehicle injury, the OR increased by 1.30 (95% CI 1.26 to 1.34) to an OR of 24.2 at 140 g (95% CI 16.2 to 36.2). Case-crossover studies of non-MVA injury result in overall higher risks than case-control studies and the per-drink increase in odds of injury was highest for intentional injury, at 1.38 (95% CI 1.22 to 1.55). Increase in odds of injury per 10-gram increase in consumption were follows: Intentional Injury 1.38 (95% CI 1.22 to 1.55; 5 studies), falls 1.25 (95% CI 1.14 to 1.36; 5 studies), MVA 1.24 (95% CI 1.18 to 1.31; 8 studies), and other unintentional 1.32 (95% CI:1.27 to 1.36; 13 studies).
A review 3 assessed alcohol use and major trauma in a Canadian province via a 10 year retrospective examination of Alberta Trauma Registry (ATR) data on all major trauma patients ( age ≥ 9) from 2001-2010. Of 22 457 patients included, only 60 % (n=13 552) were screened for alcohol use. Of those screened, 38 % (n=5 170) tested positive for alcohol with a mean blood alcohol concentration (BAC) of 39.4 ± 21.1 mmol/L. Of the positive screening tests, 82.3 % had BAC levels greater than the common legal driving limit of 17.4 mmol/L (0.08 %). Testing positive was associated with male gender (p < 0.001) and younger age (p < 0.001). The rate of positive alcohol use in major trauma increased from 20.3 % in 2001 to 24.3 % in 2010, corresponding with a screening rate increase from 51.3 % to 61.2 % over the same period. Railway incidents have the highest rate of alcohol involvement (65 %), followed by undetermined-if-accidental/self-inflicted (53.5 %) and assault (49 %); motor vehicle traffic (MVT) incidents had a frequency of 25.4 %.
Comment: The quality of evidence is downgraded by limitations in study quality (case-control studies) and by inconsistency (heterogeneity in interventions and outcomes) and upgraded by a clear dose-response gradient.
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