Behavioral Correlates and Staff Recognition of Alcohol Use in a University Hospital Trauma Service A. SILVER. M.D. LAWRENCE D. SPORTY. M.D. BARBARA
Hospital course alld admissioll hlood alco/wlle'I'els were comlJUred ill ].+2 cOlISeclllil'e adult trauma admissiolls. A 33Ck (II'erall illloxiC(/fiOIl raIl' 1I·(/sfiJ/llld. IlIloxicated paliellts were more likely lO IJe youllg. male. alld Hispallic or hlack ami to he illl'oll'ed infights. slahhillgs. alld aUlOl/while a('cidellls ill lI'hich they were prcsumed to he at.lilllit. These patiellls lI'ere also more likely lO malli!I'.H disruptil'e hehm'ior ill the emergellc.\' mom. Disruptin' hehm'ior 011 the ward was 1I0t conl'!ated wilh a!cohol illloxicalioll al admissioll. hUlwas corrl'!(/fed wilh Ihe hislory olhead illjury. Slatrrecogllilioll oj'illloxicatioll 11'(/.1' high. hill ollly aholll 7Ck o(lhe paliellls who In'I'l' illloxicaled al admissioll were re.li·rret! 10 a!coholtrealmelll programs. Morcfi'e(/uelll re.li'nals.lill' such tre(/Imelll mig/I! decrease Irauma celller admissiolls am/lhe high cosIoi' associaled wilh Ihem.
iscussions of alcohol use by emergency room and trauma patients are primarily published in medical. surgical. and public health journals. I 'I but far fewer studies have been published in the psychiatric literature. In addition. very little is known about the hospital and posthospitalization course of such patients. For example. the relationship between severity of injury and admission blood alcohol level has been a point of contention. I" I.' and issues such as inpatient behavioral complications. compliance with surgical aftercare appointments. staff recognition of alcohol abuse. and post-hospitalization referral of these patients to alcohol treatment centers
D
R~n:i\'\:d
Augu,t X. IlIXlI: r~\'i,~d No\'~mhcr I. IlIXlI: 20. IlIXlI. From th~ D~panm~nt of Con· suhation·Liaison Psy,hiatry. L;ni\'~rsity of Califomia Ir\'in~ M~dkal C~tll~r. Addrt'" r~print r~4u~s" to Dr. Sporty. De· partm~nt of Psy,hiatry. L:CI M~di,al C~nt~r. 101 Tht' City Dri\'~. South. Rout~ XX. Orange. CA lI2hhX. Copyright CD IlIlIO Th~ Acad~my of Psychosomatic
remain largely unaddressed. Our work as consultation-liaison psychiatrists has made us aware of the need for further study of such issues. We have. therefore. undertaken a retrospective chan review of 272 consecutive university hospital trauma admissions. aged 16 and older. At our university hospital. which serves as a regional trauma center. blood is routinely drawn for determination of blood alcohol level (BALl immediately upon arrival of patients. who are rapidly transported to us by the emergency medical services network. We have collected admission BALs. as well as information on hospital and post-hospitalization course. of these patients in an effort to address these issues.
an:~pt~d No\'~mhcr
M~dil'in~.
METHODS Of the 272 adult trauma admissions that occurred between June 5. Il)XX. and September 7. 19XX. medical records were available for 269 or l)l)ck. PSYCHOS():\1ATlCS
Silver and Sporty
TARLE I.
Demographic characteristics of trauma patients, by admission blood alcohol level (RA L) RAL=Omg/dl
.
RAL 1-99 mg/dl
BAL~100 mg/dl
Variable
n
n
%
n
%
Sex Male Female
186 56
89 49
48 88
23 2
12 4
74 5
40 9
Race " Hispanic Black Caucasian Other" Asian
91 14 116 8 13
37 5 79 7 10
41 36 68 88 77
10
II
4 9 0 2
29 8 0 15
44 5 28 I I
48 36 24 13 X
10 25 42 15 13 14 33 8 64 18
3 7 19 8 2 6 21 6 50 16
30 28 45 53 15 43 64 75 7X X9
0 7 6 I 6 3 I 0 I 0
0 2X 14 7 46 21 3 0 2 0
7 II 17 6 5 5 II 2 13 2
70 44 41 40 39 36 33 25 20
242
138
57
25
10
79
33
".
Trauma type Fight Stabbing Single auto accident Other' Shooting Pedestrian Motorcycle Bicycle Auto/auto Fall Total
.
n
%
II
1'=
Hospital course alld admissioll hlood alco/wlle'I'els were comlJUred ill ].+2 cOlISeclllil'e adult trauma admissiolls. A 33Ck (II'erall illloxiC(/fiOIl raIl' 1I·(/sfiJ/llld. IlIloxicated paliellts were more likely lO IJe youllg. male. alld Hispallic or hlack ami to he illl'oll'ed infights. slahhillgs. alld aUlOl/while a('cidellls ill lI'hich they were prcsumed to he at.lilllit. These patiellls lI'ere also more likely lO malli!I'.H disruptil'e hehm'ior ill the emergellc.\' mom. Disruptin' hehm'ior 011 the ward was 1I0t conl'!ated wilh a!cohol illloxicalioll al admissioll. hUlwas corrl'!(/fed wilh Ihe hislory olhead illjury. Slatrrecogllilioll oj'illloxicatioll 11'(/.1' high. hill ollly aholll 7Ck o(lhe paliellls who In'I'l' illloxicaled al admissioll were re.li·rret! 10 a!coholtrealmelll programs. Morcfi'e(/uelll re.li'nals.lill' such tre(/Imelll mig/I! decrease Irauma celller admissiolls am/lhe high cosIoi' associaled wilh Ihem.
iscussions of alcohol use by emergency room and trauma patients are primarily published in medical. surgical. and public health journals. I 'I but far fewer studies have been published in the psychiatric literature. In addition. very little is known about the hospital and posthospitalization course of such patients. For example. the relationship between severity of injury and admission blood alcohol level has been a point of contention. I" I.' and issues such as inpatient behavioral complications. compliance with surgical aftercare appointments. staff recognition of alcohol abuse. and post-hospitalization referral of these patients to alcohol treatment centers
D
R~n:i\'\:d
Augu,t X. IlIXlI: r~\'i,~d No\'~mhcr I. IlIXlI: 20. IlIXlI. From th~ D~panm~nt of Con· suhation·Liaison Psy,hiatry. L;ni\'~rsity of Califomia Ir\'in~ M~dkal C~tll~r. Addrt'" r~print r~4u~s" to Dr. Sporty. De· partm~nt of Psy,hiatry. L:CI M~di,al C~nt~r. 101 Tht' City Dri\'~. South. Rout~ XX. Orange. CA lI2hhX. Copyright CD IlIlIO Th~ Acad~my of Psychosomatic
remain largely unaddressed. Our work as consultation-liaison psychiatrists has made us aware of the need for further study of such issues. We have. therefore. undertaken a retrospective chan review of 272 consecutive university hospital trauma admissions. aged 16 and older. At our university hospital. which serves as a regional trauma center. blood is routinely drawn for determination of blood alcohol level (BALl immediately upon arrival of patients. who are rapidly transported to us by the emergency medical services network. We have collected admission BALs. as well as information on hospital and post-hospitalization course. of these patients in an effort to address these issues.
an:~pt~d No\'~mhcr
M~dil'in~.
METHODS Of the 272 adult trauma admissions that occurred between June 5. Il)XX. and September 7. 19XX. medical records were available for 269 or l)l)ck. PSYCHOS():\1ATlCS
Silver and Sporty
TARLE I.
Demographic characteristics of trauma patients, by admission blood alcohol level (RA L) RAL=Omg/dl
.
RAL 1-99 mg/dl
BAL~100 mg/dl
Variable
n
n
%
n
%
Sex Male Female
186 56
89 49
48 88
23 2
12 4
74 5
40 9
Race " Hispanic Black Caucasian Other" Asian
91 14 116 8 13
37 5 79 7 10
41 36 68 88 77
10
II
4 9 0 2
29 8 0 15
44 5 28 I I
48 36 24 13 X
10 25 42 15 13 14 33 8 64 18
3 7 19 8 2 6 21 6 50 16
30 28 45 53 15 43 64 75 7X X9
0 7 6 I 6 3 I 0 I 0
0 2X 14 7 46 21 3 0 2 0
7 II 17 6 5 5 II 2 13 2
70 44 41 40 39 36 33 25 20
242
138
57
25
10
79
33
".
Trauma type Fight Stabbing Single auto accident Other' Shooting Pedestrian Motorcycle Bicycle Auto/auto Fall Total
.
n
%
II
1'=
