Motor vehicle collision fatalities involving alcohol and illicit drugs in Greece: the need for management protocols and a reassessment of surveillance Iordanis N. Papadopoulos 1 , Stefanos Bonovas 2 , Nikolaos K. Kanakaris 1 , Ioanna Konstantiadou 1 , Georgios Nikolopoulos 2 , George Konstantoudakis 1 & Christos Leukidis 3 Fourth Surgery Department, University General Hospital ‘Attikon’, National and Kapodistrian University of Athens, Athens, Greece 1 , Centre for Disease Control and Prevention, Athens, Greece 2 and The Athens Forensic Medical Department, Ministry of Justice, Athens, Greece 3 ABSTRACT Aims The frequency and the effect of alcohol and illicit drugs on injury type, severity and location of death in motor vehicle collision (MVC) fatalities were investigated. Design Retrospective case–control study based on autopsy and toxicology. Settings Single faculty accepting referrals from Greater Athens and prefectures. Participants Consecu- tive pre-hospital and in hospital fatalities. Measurements Demographics, toxicology, abbreviated injury scale (AIS), injury severity score (ISS), and location of death. Findings Of the 1860 screened subjects, 612 (32.9%) constituted the positive toxicology group (PTG) for alcohol or illicit drugs or both and the 1248 (67.1%) the negative toxicology group (NTG). The median age was 34 (4–90) years for the PTG and 45 (3–97) years for the NTG. The PTG included significantly higher proportions of males and motorcyclists. The PTG had a 50% increased risk for a severe (AIS3) cervical spine and 85% for a severe upper extremity injury, compared to the NTG. A total of 29.2% of the PTG and 22.4% of the NTG deaths were non-preventable (ISS = 75). The frequency of severe trauma (ISS16) was comparable between PTG and NTG (P = 0.87). The PTG presented with a median ISS of 43 (6–75) versus 41 (2–75) of the NTG, hence without significant difference (P = 0.11). The pre-hospital death rate was 77.8% for the PTG versus 58% of the NTG (P < 0.001). The analysis confirmed that the odds of positive toxicology were considerably higher in the subjects who arrived dead at the hospital (OR 2.62, P < 0.001). Conclusions In the greater Athens region, almost a third of motor vehicle collision-related fatalities involved alcohol, illicit drugs or both. Individuals screened positive for alcohol or drugs were 2.6 times more likely to die before hospital admission than those with a negative toxicology screen, despite comparable injury severity. Specific evidence-based management protocols and reassessment of surveillance are required. Keywords Alcohol, audit, Greece, illicit drugs, trauma mortality. Correspondence to: Iordanis N. Papadopoulos, Fourth Surgery Department, University General Hospital ‘Attikon’, 1 Rimini Street, 124 62, Athens, Greece. E-mail: ipapado@med.uoa.gr Submitted 9 September 2009; initial review completed 18 November 2009; final version accepted 4 May 2010 INTRODUCTION Trauma related to alcohol and illicit drugs has a poten- tially avoidable, profound negative societal impact. Alcohol consumption caused 6.1% of all deaths in the World Health Organization European regions in 2002 [1]. An increase in per capital alcohol consumption of 1 litre in Canada during the second half of the 20th century was accompanied by an increase in accident mortality of 5.9 among males and 1.9 among females per 100 000 inhabitants [2]. Alcohol-attributable deaths from motor-vehicle/traffic crashes resulted in 579 501 years of potential life lost in the United States in 2001 [3]. The estimated per capital consumption of alcohol in Greece for 2002 was 9.1 litres [4]. However, the associa- tion of alcohol/illicit drugs with motor vehicle collision (MVC)-related trauma in Greece has not been well quan- tified.The frequency, types/anatomical regions and sever- ity of injuries, as well as the stage of care at which deaths occur and the efficacy of acute care for the subjects who RESEARCH REPORT doi:10.1111/j.1360-0443.2010.03072.x © 2010 The Authors, Addiction © 2010 Society for the Study of Addiction Addiction, 105, 1952–1961