PRAXIS
O rig in a l A rtic le
Praxis 2015; 104 (8): 3 9 7 - 4 0 1
397
Department of Trauma Surgery, University Hospital of Zurich Ladislav M ic a , Linda O e s te rle , C le m e n t M . L. W e rn e r, H a n s -P e te r S im m en
A g e a n d G e n d e r as In d e p e n d e n t P re d ic to rs o f V io le n c e u n d e r t h e In flu e n c e o f A lc o h o l in Z u ric h , S w itz e r la n d A lte r und G eschlecht als u n a b h ä n g ig e P rä d ik to re n von G e w a lt u n te r d em Einfluss von A lk o h o l in Zürich
Abstract Violent behaviour associated with alco hol consumption is frequently report ed by different media. Clinical data an alysing the correlation between alcohol intoxication, age, gender and violence are scarce. The aim of this study was to evaluate the influence of age, gender and blood alcohol content on violent behaviour under the influence of alco hol under central European conditions. Three hundred patients admitted to the emergency department were included into this study in the time period from January 01. to December 31. 2009. The inclusion criteria were a blood alco hol content (BAC) of >10mmol/l, any traumatic injury and an age >16 years. Violence was defined as an evitable act committed by others leading to pa tient's hospitalisation. The data were compared with Wilcoxon and y2-test for proportions. The data were consid ered as significant if p10 mmol/1 (approximately 0,5%o) were included into this study. The
O rig in a l A rtic le
differenciation between violence before, after or during drinking was not made. Oligo-substantial intoxications were only evaluated annamnesticaly and not tested by the laboratory of the University Hospital of Zurich, these intoxications were tested by the laboratory of Legal Medicine and are not accessible. No pol ytrauma (Injury Severity Score >16) pa tients admitted into the trauma bay were included into this study. To analyse the independent predictors of violence the patients were grouped in male, female and violence or no violence. The study was approved by the local Institutional Review Board approval according to the University of Zurich IRB guidelines IRB and was conducted according to the guidelines of good clinical practice. According to the Swiss ethical law and guidance of the ethical committee nei ther a verbal nor a written consent had to be obtained due to the retrospective and anonymous character of the study. The ethics committee of the University Hospital of Zürich fully approved the study design and investigation proce dure (Nr. StV 01-2008).
M e a s u r e m e n t o f b lo o d a lc o h o l c o n c e n tra tio n
After drying of the disinfection media (Kodan, Schulke & Meyer GmbH, Zu rich, Switzerland), 10 ml of whole blood were taken from the cubital vein into a Vacutainer tube (Becton & Dickinson, Allschwil, Switzerland) with no addi tives. The blood was send to central laboratory for BAC measurements. The
Praxis 2015; 104 (8): 3 9 7 - 4 0 1
398
BAC in patient's blood samples was measured by the Alcohol dehydrogenase (ADH)-method as described previously [9]. Measurements of blood alcohol con centration (BAC) were not performed routinely, only when the patient men tioned alcohol consumption or if there was somatic suspicion for alcoholisation.
D e fin itio n o f v io le n c e
Violence was defined as an evitable and unnecessary act of aggression leading to hospitalisation of the patient. The pa tients might have been offenders or vic tims. All patients involved in such an act were included into this study. The infor mation about violence was obtained in the first line from the rescue team, from the patients themselves or the city police.
S ta tis tic a l a n a ly s is
Continuous data are presented as mean ± standard deviation (SD) and are com pared between groups using the Wilcoxon test. For proportions the x2~test was used. All analyses were done using R (R Development Core Team, 2010), the generalized additive model (GAM) us ing a cyclical cubic spline was computed with the MGCV package [10], Results were considered significant at p10mmol/l, une atteinte traumatique de n'importe quelle nature et un äge >16 ans. La violence etait definie comme un acte evitable commis par d'autres et ayant conduit ä l'hospitalisation du malade. Les resultats ont ete compares par un test de Wilcoxon et de chi-carre. Une difference a ete consideree comme significative ä partir d'un p
O rig in a l A rtic le
Praxis 2015; 104 (8): 3 9 7 - 4 0 1
397
Department of Trauma Surgery, University Hospital of Zurich Ladislav M ic a , Linda O e s te rle , C le m e n t M . L. W e rn e r, H a n s -P e te r S im m en
A g e a n d G e n d e r as In d e p e n d e n t P re d ic to rs o f V io le n c e u n d e r t h e In flu e n c e o f A lc o h o l in Z u ric h , S w itz e r la n d A lte r und G eschlecht als u n a b h ä n g ig e P rä d ik to re n von G e w a lt u n te r d em Einfluss von A lk o h o l in Zürich
Abstract Violent behaviour associated with alco hol consumption is frequently report ed by different media. Clinical data an alysing the correlation between alcohol intoxication, age, gender and violence are scarce. The aim of this study was to evaluate the influence of age, gender and blood alcohol content on violent behaviour under the influence of alco hol under central European conditions. Three hundred patients admitted to the emergency department were included into this study in the time period from January 01. to December 31. 2009. The inclusion criteria were a blood alco hol content (BAC) of >10mmol/l, any traumatic injury and an age >16 years. Violence was defined as an evitable act committed by others leading to pa tient's hospitalisation. The data were compared with Wilcoxon and y2-test for proportions. The data were consid ered as significant if p10 mmol/1 (approximately 0,5%o) were included into this study. The
O rig in a l A rtic le
differenciation between violence before, after or during drinking was not made. Oligo-substantial intoxications were only evaluated annamnesticaly and not tested by the laboratory of the University Hospital of Zurich, these intoxications were tested by the laboratory of Legal Medicine and are not accessible. No pol ytrauma (Injury Severity Score >16) pa tients admitted into the trauma bay were included into this study. To analyse the independent predictors of violence the patients were grouped in male, female and violence or no violence. The study was approved by the local Institutional Review Board approval according to the University of Zurich IRB guidelines IRB and was conducted according to the guidelines of good clinical practice. According to the Swiss ethical law and guidance of the ethical committee nei ther a verbal nor a written consent had to be obtained due to the retrospective and anonymous character of the study. The ethics committee of the University Hospital of Zürich fully approved the study design and investigation proce dure (Nr. StV 01-2008).
M e a s u r e m e n t o f b lo o d a lc o h o l c o n c e n tra tio n
After drying of the disinfection media (Kodan, Schulke & Meyer GmbH, Zu rich, Switzerland), 10 ml of whole blood were taken from the cubital vein into a Vacutainer tube (Becton & Dickinson, Allschwil, Switzerland) with no addi tives. The blood was send to central laboratory for BAC measurements. The
Praxis 2015; 104 (8): 3 9 7 - 4 0 1
398
BAC in patient's blood samples was measured by the Alcohol dehydrogenase (ADH)-method as described previously [9]. Measurements of blood alcohol con centration (BAC) were not performed routinely, only when the patient men tioned alcohol consumption or if there was somatic suspicion for alcoholisation.
D e fin itio n o f v io le n c e
Violence was defined as an evitable and unnecessary act of aggression leading to hospitalisation of the patient. The pa tients might have been offenders or vic tims. All patients involved in such an act were included into this study. The infor mation about violence was obtained in the first line from the rescue team, from the patients themselves or the city police.
S ta tis tic a l a n a ly s is
Continuous data are presented as mean ± standard deviation (SD) and are com pared between groups using the Wilcoxon test. For proportions the x2~test was used. All analyses were done using R (R Development Core Team, 2010), the generalized additive model (GAM) us ing a cyclical cubic spline was computed with the MGCV package [10], Results were considered significant at p10mmol/l, une atteinte traumatique de n'importe quelle nature et un äge >16 ans. La violence etait definie comme un acte evitable commis par d'autres et ayant conduit ä l'hospitalisation du malade. Les resultats ont ete compares par un test de Wilcoxon et de chi-carre. Une difference a ete consideree comme significative ä partir d'un p
