Citation

Afshar M, Smith GCS, Terrin ML, Barrett M, Lissauer ME, Mansoor S, Jeudy J, Netzer G. J. Trauma Acute Care Surg. 2014; 76(6): 1447-1455.

Affiliation

From the Division of Pulmonary and Critical Care Medicine (M.A., M.L.T., M.B., G.N.), Department of Epidemiology and Public Health (G.S.S., M.L.T., G.N.), Shock Trauma and Anesthesiology Research (STAR)-Organized Research Center (G.S.S.), Program in Trauma (M.E.L.), R. Adams Cowley Shock Trauma Center, Department of Medicine (S.M.), and Department of Diagnostic Radiology and Nuclear Medicine (J.J.), University of Maryland, Baltimore, Maryland.

Copyright

(Copyright © 2014, Lippincott Williams and Wilkins)

DOI

10.1097/TA.0000000000000238

PMID

24854314

Abstract

BACKGROUND: Elevated blood alcohol content (BAC) is a risk factor for injury. Associations of BAC with adult respiratory distress syndrome (ARDS) have not been conclusively established.We evaluated the association of a BAC greater than 0 mg/dL with the intermediate outcomes, Injury Severity Score (ISS) and Glasgow Coma Scale (GCS) score, and their association with ARDS development.

METHODS: This is an observational retrospective cohort study of 26,305 primary trauma admissions to a statewide referral trauma center from July 11, 2003, to October 31, 2011. Logistic regression was performed to assess the relationship between admission BAC, ISS, GCS score, and ARDS development within 5 days of admission.

RESULTS: The case rate for ARDS was 5.5% (1,447). BAC greater than 0 mg/dL was associated with ARDS development in adjusted analysis (odds ratio, 1.50; 95% confidence interval [CI], 1.33-1.71; p < 0.001). High ISS (≥16) had a stronger association with ARDS development (odds ratio, 17.99; 95% CI, 15.51-20.86), as did low GCS score (≤8) (odds ratio, 8.77; 95% CI, 7.64-10.07; p < 0.001). Patients with low GCS score and high ISS had the most frequent ARDS (33.6%) and the highest case-fatality rate without ARDS (24.7%).

CONCLUSION: Elevated BAC is associated with ARDS development. In the analysis of alcohol exposure, ISS and GCS score occur after alcohol ingestion, making them intermediate outcomes. ISS and GCS score were strong predictors of ARDS and may be useful to identify at-risk patients. Elevated BAC may increase the frequency of the ARDS through influence on injury severity or independent molecular mechanisms, which can be discriminated only in experimental models. LEVEL OF EVIDENCE: Epidemiologic study, level III.

Language: en