THE EFFECTS OF ALCOHOL-ABUSE ON READMISSION FOR TRAUMA

Objective.-To determine the effect of admission for trauma with concurrent acute alcohol intoxication or chronic alcohol abuse on the risk of subsequent recurrence of trauma. Design.-Prospective cohort study. Setting.-Level I regional trauma center. Patients.-A total of 2578 patients 18 years or older admitted with blunt or penetrating trauma within 24 hours of injury and surviving to discharge. All patients had a blood alcohol concentration (BAC) test, a gamma-glutamyltransferase (GGT) test, and the short Michigan Alcohol Screening Test (SMAST) performed on admission. Main Outcome Measurement.-Readmission to the trauma center for new trauma. Average follow-up was 28 months (range, 16 to 40 months). Results.-The overall rate of readmission for new injuries was 1.3 per 1000 patient-months of follow-up. Patients who were intoxicated on the initial admission (BAC >22 mmol/L [100 mg/dL]) were 2.5-fold as likely to be readmitted than those not intoxicated (95% confidence limits, 1.6, 3.9). The relative risks for patients with positive SMAST scores and abnormal GGT values were 2.2 (95% confidence limits, 1.4, 3.5) and 3.5 (95% confidence limits, 2.2, 5.5), respectively. The increased risks remained significant for intoxication and abnormal GGT values after adjustment for gender, race, Medicaid status, and mechanism of injury. Conclusion.-Alcohol abuse is associated with an increased risk of readmission for new trauma. Trauma patients should be screened for alcohol problems; referral of problem drinkers for appropriate care may decrease their risk of admission for subsequent trauma.