[Ethyl alcohol and psychoactive drugs in patients with head and trunk injuries treated at the Department of General Surgery, Provincial Hospital in Siedlce].

INTRODUCTION Drug abuse is a social, moral, and penal problem in Poland since many years. Ethyl alcohol remains the prime cause of concern. The effect of narcotics (including alcohol) on trauma has been the object of investigations for years. STUDY OBJECTIVES 1) To determine the reliability of subjective assessment of sobriety of the patient by the physician. 2) To determine correlations between inebriety, duration of hospital stay, type and extent of surgical intervention, and death. 3) To compare blood alcohol content measured with an immunoenzyme assay and the reference gas chromatographic method (GC-headspace). 4) To assess correlations between GCS score, type of trauma, and blood alcohol content. MATERIAL The study was done in 207 patients referred between 1.07.2008 and 30.06.2009 to the hospital's emergency department due to trauma of the head and/or trunk. RESULTS The significant role of ethyl alcohol in trauma of the head and trunk has been corroborated, in particular in young males admitted from Friday to Monday between 8:00 pm and 8:00 am. Ethyl alcohol in serum was detected in 34% of patients (40.1% of males and 12.5% of females) qualified to the test. The presence of alcohol in blood correlated with pedestrian or cyclist road accidents or violence (assault). Fractures of the skull and surgical treatment of wounds were significantly more frequent in inebriated patients. Inebriated patients were more inclined to leave the hospital on demand. According to the GCS score, 55.8% of patients with less than 15 points were inebriated. Disorders of speech were observed by the physician in only 47.9% of inebriated patients. The smell of alcohol on the breath was noted in 81.69% of inebriated patients and 60.42% of them admitted drinking alcohol. Subjective assessment of sobriety/inebriety by the physician was correct in 81.7% of patients. The involvement of drugs acting like alcohol in trauma is marginal in Siedlce and its region. Xenobiotics were found in just three of 207 patients qualified to the test. The immunoenzyme assay used at the hospital for the measurement of blood alcohol content cannot serve for medicolegal purposes because its results are 1.2 times above true values. This fact is particularly important for values between 0.2 and 0.5 when legal responsibility is to be decided. CONCLUSIONS 1) The accuracy of subjective assessment of sobriety of patients by the surgeon ranges from 48% to 82%. 2) Sobriety/inebriety correlated with circumstances of trauma, type of trauma, lower GCS score, and extent of surgical intervention. 3) Inebriety at admission did not correlate with the duration of hospital stay. 4) The immunoenzyme assay is sufficiently sensitive and accurate for diagnostic and clinical purposes. For medicolegal purposes, however, results provided by this method should be verified by gas chromatography.