Detecting AlcoholRelated Problems in Trauma Center Patients

A impairment has REASONS FOR SCREENING tient’s alcohol use pattern is a been linked to an array of routine part of medical care (p. 3). serious and fatal injuries result­ Two trauma center studies highlight the ing from various mechanisms need to identify and treat trauma patients of injury, including traffic crashes, falls, who suffer from alcoholism. A Detroit EFFECT OF ALCOHOL ON domestic violence, suicide, and assault. study (Sims et al. 1989) of victims of RECOVERY FROM TRAUMA Most victims of trauma are treated in a violence noted that those patients with hospital emergency department (ED) and evidence of alcohol abuse were almost Excessive use of alcohol can cause several released. More seriously injured victims, twice as likely (48 percent vs. 28 percent) bodily changes that might increase illness however, may be treated at 1 of the more to sustain a second injury within 5 years and death rates among trauma patients than 400 trauma centers nationwide. Here, that required either ED treatment or re­ (Soderstrom 1989; Albin 1987; Gentilello clinicians not only treat physical injuries admission to a trauma center than were et al. 1993). Alcohol abuse could exacerbate but also have the opportunity to detect patients without evidence of alcohol abuse. conditions such as brain, spinal cord, and alcohol­related problems1 that might A Seattle study (Rivara et al. 1993a), heart injuries; shock resulting from blood otherwise go unrecognized. with an average followup time of more than loss; impaired clotting of the blood; and As demonstrated by Gentilello and 2 years, assessed the relative risks of trau­ infectious diseases that may follow trauma. colleagues (1988), alcoholic trauma pa­ ma patients sustaining a second traumatic Large studies of trauma patients in tients are amenable to entering treatment episode requiring readmission. Among which outcome was assessed relative to programs; however, current practices in those who were intoxicated at the time living or dying have suggested that alco­ trauma centers do not facilitate that proc­ of the first admission, those judged possi­ hol use immediately prior to trauma either ess. Fewer than 25 percent of trauma bly alcoholic based on a screening inter­ has no effect on survival (Soderstrom and centers routinely test for alcohol and other view, and those who had elevated gamma­ Eastham 1987) or appears to be associated drugs of abuse, obtain patients’ histories glutamyl transferase (GGT) levels (see with increased chances of survival (Ward of alcohol abuse, and employ full­time below), the relative risks of readmission et al. 1982). As stated by Waller (1988), drug dependence counselors (Soderstrom for injury compared with the risks among and Cowley 1987). subjects without those characteristics were the methodologies that were used to This article discusses the need for 2.5, 2.2, and 3.5 times higher, respectively. assess alcohol’s effect on mortality in alcohol use assessment as a routine part Commenting in part on the problem of studies such as those cited above may be of trauma center care and evaluates some alcohol­related repeat trauma episodes, screening tests for usefulness for this Gordis (1991) noted CARL A. SODERSTROM, M.D., is an assistant purpose. professor of surgery at the University of Although some progress has been Maryland School of Medicine and the made to improve early identifica­ director of physician education in the 1Throughout this article, terms such as “alcohol tion and referral of alcohol abusers Department of Surgical Traumatology, abuse,” “alcoholism,” and “heavy drinking” are used. There is overlap among these terms in the alcoholism by physicians and other health care R Adams Cowley Shock Trauma Center, literature; therefore, the wording in each case is personnel, we still have not reached University of Maryland Medical Center, based on the terms used in the reference cited. the point where attention to a pa­ Baltimore, Maryland.