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Evidence summaries

Injuries in Problem Drinkers

Alcohol consumption appears to be associated with the risk of injuries. Interventions like brief counseling for problem drinking might possibly be effective for reducing injuries. Level of evidence: "B"

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 HASH(0x2fcfe80) 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.

    References

    • Dinh-Zarr T, Goss C, Heitman E, Roberts I, DiGuiseppi C. Interventions for preventing injuries in problem drinkers. Cochrane Database Syst Rev 2004;(3):CD001857. [PubMed]
    • Taylor B, Irving HM, Kanteres F et al. The more you drink, the harder you fall: a systematic review and meta-analysis of how acute alcohol consumption and injury or collision risk increase together. Drug Alcohol Depend 2010;110(1-2):108-16. [PubMed]
    • McKee J, Widder SL, Paton-Gay JD et al. A ten year review of alcohol use and major trauma in a Canadian province: still a major problem. J Trauma Manag Outcomes 2016;10:2. [PubMed]

Primary/Secondary Keywords