Alcohol and injury in adolescents

To determine the frequency of alcohol ingestion in adolescent victims of major trauma and determine whether alcohol ingestion is associated with increased injury severity or death.

Subjects were all patients between 12-25 years of age treated at Pennsylvania trauma centers in 1996 who were reported to the state trauma database. Data on age, mechanism of injury (E-code), blood alcohol concentration (BAC), Injury Severity Score (ISS), and survival were obtained from the state database. BAC positive and negative patients within three groups: ages 12-17, 18-20, and 21-25, were compared to determine any difference in death rate, injury severity or type of injury.

4309 patients aged 12-25 were reported to the state in 1996. 2724 (63.2%) underwent testing for BAC, with 884 (32.5%) of those tested being positive. Testing positive were: 93/726 (12.8%) between 12-17 years old, 249/844 (29.5%) between 18-20 years old, and 542/1154 (47.0%) between 21-25 years old. 567/884 (64.1%) of those testing positive had BAC > or = 100 mg/dl. There were no statistically significant differences in mean ISS or death rate between BAC negative and BAC positive patients in either of the age groups. Regression analysis also showed no relationship between mortality and either the presence of alcohol or the actual level of BAC. Other regression analysis demonstrated a slight downward trend for ISS with increasing intoxication, which was statistically significant at P < 0.01.

Alcohol ingestion is found even in early adolescent trauma patients and is seen to increase throughout the teenage years, occurring in over one-quarter of patients 18 to 20 years of age. Suspicion must be high that ingestion of alcohol has occurred in adolescent trauma. Further efforts should be made to improve the rate of testing in late adolescents, to ensure adequate identification of all alcohol-exposed patients and enable educational interventions. No significant differences in mortality were seen between alcohol positive and negative patients, but there was a trend to decreased injury severity with the presence of alcohol.