背景:饮酒是几种类型的伤害和创伤累犯的重要危险因素,并且仍然是全球重要的公共卫生问题。我们旨在描述在部分禁止饮酒的国家/地区进入1级创伤中心的创伤患者中强制性酒精筛查和AUDIT工具的实施情况。
方法:这是一项对2014年至2019年间需要入院并接受血液酒精浓度(BAC)筛查的创伤患者(>12岁)的回顾性分析。这是通过使用醇脱氢酶进行血浆和血清样品中的乙醇检测的酶方法实现的。BAC<2.2mmol/L的创伤患者被称为“阴性”,\"和BAC>2.2mmol/L被称为\"BAC阳性。“在两个BAC组之间进行了比较分析。酒精筛查,简短干预,转诊治疗[ASBIRT]计划,并应用了审计。
结果:在研究期间,共对7,284名患者进行了7,326次BAC筛查测试。多年来略有变化,达标率为77%(70.4%-85.3%),检测阳性率为10%(8.6%-12.5%)。有42人重复入院,其中7例患者每次入院时BAC呈阳性。年轻和非阿拉伯患者更有可能检测出阳性,损伤的主要机制为道路交通损伤(P<0.05)。BAC阳性患者的攻击和自我伤害明显高于BAC阴性患者(18%vs4%和2.7%vs1.3%,分别为;p=0.001)。研究组之间的损伤严重程度评分(ISS)和死亡率具有可比性。BAC阳性的患者在急诊科接受pan-CT扫描的可能性更大,插管,与BAC阴性的剖腹探查术相比。在因袭击而受伤的患者中,全地形车,或者摩托车撞车,BAC试验阳性与患者ISS之间存在显著关联.
结论:尽管多年来BAC筛查在创伤入院方面有所改善,近20%的病例漏诊。尽管死亡率相当,酒精消费在过度成像方面增加了资源负担,插管,开腹手术,可能的残疾。需要进一步的研究来了解在创伤环境中实现最佳筛查依从性的关键障碍和挑战。
BACKGROUND: Alcohol consumption is a significant risk factor for several types of injuries and trauma recidivism and remains an important public health concern worldwide. We aimed to describe the implementation of mandatory alcohol screening and the AUDIT tool among trauma patients admitted to a level 1 trauma center in a country with a partial ban on alcohol consumption.
METHODS: This was a retrospective analysis of trauma patients (>12 years old) who required hospital admission and underwent blood alcohol concentration (BAC) screening between 2014 and 2019. This was achieved via an enzymatic method using alcohol dehydrogenase for ethanol detection in the plasma and serum samples. Trauma patients with a BAC <2.2 mmol/L were referred to as \"negative\", and BAC >2.2 mmol/L was referred to as \"BAC positive\". A comparative analysis was performed between the two BAC groups. Alcohol Screening, Brief Intervention, Referral for Treatment [ASBIRT] program, and AUDIT were applied.
RESULTS: A total of 7326 BAC screening tests were performed on 7284 patients during the
study period. With slight variation over the years, the compliance rate was 77% (70.4%-85.3%), and the test positivity rate was 10% (8.6%-12.5%). There were 42 repeated admissions, of which seven patients were BAC positive at every admission. Young age and non-Arab patients were more likely to test positive, and the main mechanism of injury (MOI) was road traffic-related trauma (p < 0.05). Assault and self-inflicted injuries were significantly higher in BAC-positive patients than in BAC-negative patients (18% vs. 4% and 2.7% vs. 1.3%, respectively; p = 0.001). The injury severity score (ISS) and mortality rate were comparable between the
study groups. Patients with a positive BAC were significantly more likely to undergo pan-CT scan in the emergency department, intubation, and exploratory laparotomy than those with a negative BAC. In patients who sustained injuries due to assault, all-terrain vehicles, or motorcycle crashes, there was a significant association between the positivity of BAC tests and the patient\'s ISS.
CONCLUSIONS: Despite improvements in BAC screening in trauma admissions over the years, almost 20% of cases were missed. Although the mortality rates were comparable, alcohol consumption burdens resources in terms of excess imaging, intubation, open abdominal surgery, and possible disability. Further studies are needed to understand the key obstacles and challenges to achieving optimum compliance for screening in trauma settings.