Alcohol Exposure, Injury, and Death in Trauma Patients Majid Afshar, M.D., M.S.C.R. 1 , Giora Netzer, M.D., M.S.C.E. 2 , Sarah Murthi, M.D. 3 , and Gordon S. Smith, MB.ChB., M.P.H. 4 Giora Netzer: gnetzer@medicine.umaryland.edu; Sarah Murthi: smurthi@umm.edu; Gordon S. Smith: gssmith@som.umaryland.edu 1 Division of Pulmonary and Critical Care Medicine, Loyola University, Chicago, IL 2 Division of Pulmonary and Critical Care Medicine, University of Maryland, Baltimore, MD 3 Program in Trauma, R. Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD 4 Shock Trauma and Anesthesiology Research (STAR) – Organized Research Center, University of Maryland, Baltimore, MD Abstract Background—The association of alcohol use with in-hospital trauma deaths remains unclear. This study identifies the association of blood alcohol content with in-hospital death accounting for injury severity and mechanism. Methods—Historical cohort of 46,222 admissions to a statewide trauma center between January 1, 2002 and October 31, 2011. Blood alcohol was evaluated as an ordinal variable: 1–100 mg/dL as moderate blood alcohol, 101–230 mg/dL as high blood alcohol, and >230 mg/dL as very high blood alcohol. Results—Blood alcohol was recorded in 44,502 (96.3%) of patients. Moderate blood alcohol was associated with an increased odds for both penetrating mechanism (Odds Ratio 2.22; 95% CI 2.04–2.42) and severe injury (Odds Ratio 1.25; 95% CI 1.16–1.35). Very high blood alcohol had a decreased odds for penetrating mechanism (Odds Ratio 0.75; 95% CI 0.67–0.85) compared to the undetectable blood alcohol group. An inverse U-shaped association was shown for severe injury and penetrating mechanism by alcohol group (p<0.001). Moderate blood alcohol had an increased odds for in-hospital death (Odds Ratio 1.50; 95% CI 1.25–1.79), and the odds decreased for very high blood alcohol (Odds Ratio 0.69; 95% CI 0.54–0.87). An inverse U-shaped association was Corresponding Author and Reprints Contact Information: Majid Afshar, MD, MSCR 2160 South First Avenue, Building 54 Maywood, IL 60153, majid_afshar@luhs.org Phone: 708-216-0461 Fax: 708-216-6839. Conflicts of Interest: No conflicts of interest to disclose amongst the authors. This work was presented as an abstract at the Research Society on Alcoholism Conference 2014 AUTHOR CONRIBUTION Study concept and design: Giora Netzer, Sarah Murthi, Gordon Smith, and Majid Afshar Acquisition of Data: Giora Netzer, Gordon Smith, Majid Afshar Analysis and Interpretation of Data: Majid Afshar, Gordon Smith, Sarah Murthi, and Giora Netzer Drafting of the manuscript: Majid Afshar, Gordon Smith, Sarah Murthi, and Giora Netzer Administrative, technical, or material support: Betsy Kramer, Project Manager for Clinical Information Systems contributed to the manuscript by providing the dataset from the Shock Trauma Registry. HHS Public Access Author manuscript J Trauma Acute Care Surg. Author manuscript; available in PMC 2016 October 01. Published in final edited form as: J Trauma Acute Care Surg. 2015 October ; 79(4): 643–648. doi:10.1097/TA.0000000000000825. Author Manuscript Author Manuscript Author Manuscript Author Manuscript