Alcohol interventions in a trauma center as a means of reducing the risk of injury recurrence

Larry M. Gentilello, Frederick P. Rivara, Dennis M. Donovan, Gregory Jurkovich, Elizabeth Daranciang, Christopher W. Dunn, Andres Villaveces, Michael Copass, Richard R. Ries

Research output: Contribution to journalArticle

603 Citations (Scopus)

Abstract

Objective: Alcoholism is the leading risk factor for injury. The authors hypothesized that providing brief alcohol interventions as a routine component of trauma care would significantly reduce alcohol consumption and would decrease the rate of trauma recidivism. Methods: This study was a randomized, prospective controlled trial in a level 1 trauma center. Patients were screened using a blood alcohol concentration, gamma glutamyl transpeptidase level, and short Michigan Alcoholism Screening Test (SMAST). Those with positive results were randomized to a brief intervention or control group. Reinjury was detected by a computerized search of emergency department and statewide hospital discharge records, and 6- and 12-month interviews were conducted to assess alcohol use. Results: A total of 2524 patients were screened; 1153 screened positive (46%). Three hundred sixty-six were randomized to the intervention group, and 396 to controls. At 12 months, the intervention group decreased alcohol consumption by 21.8 ± 3.7 drinks per week; in the control group, the decrease was 6.7 ± 5.8 (p = 0.03). The reduction was most apparent in patients with mild to moderate alcohol problems (SMAST score 3 to 8); they had 21.6 ± 4.2 fewer drinks per week, compared to an increase of 2.3 ± 8.3 drinks per week in controls (p < 0.01). There was a 47% reduction in injuries requiring either emergency department or trauma center admission (hazard ratio 0.53, 95% confidence interval 0.26 to 1.07, p = 0.07) and a 48% reduction in injuries requiring hospital admission (3 years follow-up). Conclusion: Alcohol interventions are associated with a reduction in alcohol intake and a reduced risk of trauma recidivism. Given the prevalence of alcohol problems in trauma centers, screening, intervention and counseling for alcohol problems should be routine.

Original languageEnglish (US)
Pages (from-to)473-483
Number of pages11
JournalAnnals of Surgery
Volume230
Issue number4
DOIs
StatePublished - Oct 1 1999
Externally publishedYes

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Trauma Centers
Alcohols
Recurrence
Wounds and Injuries
Alcoholism
Alcohol Drinking
Hospital Emergency Service
Control Groups
gamma-Glutamyltransferase
Hospital Records
Counseling
Randomized Controlled Trials
Confidence Intervals
Interviews

ASJC Scopus subject areas

  • Surgery

Cite this

Gentilello, L. M., Rivara, F. P., Donovan, D. M., Jurkovich, G., Daranciang, E., Dunn, C. W., ... Ries, R. R. (1999). Alcohol interventions in a trauma center as a means of reducing the risk of injury recurrence. Annals of Surgery, 230(4), 473-483. https://doi.org/10.1097/00000658-199910000-00003

Alcohol interventions in a trauma center as a means of reducing the risk of injury recurrence. / Gentilello, Larry M.; Rivara, Frederick P.; Donovan, Dennis M.; Jurkovich, Gregory; Daranciang, Elizabeth; Dunn, Christopher W.; Villaveces, Andres; Copass, Michael; Ries, Richard R.

In: Annals of Surgery, Vol. 230, No. 4, 01.10.1999, p. 473-483.

Research output: Contribution to journalArticle

Gentilello, LM, Rivara, FP, Donovan, DM, Jurkovich, G, Daranciang, E, Dunn, CW, Villaveces, A, Copass, M & Ries, RR 1999, 'Alcohol interventions in a trauma center as a means of reducing the risk of injury recurrence', Annals of Surgery, vol. 230, no. 4, pp. 473-483. https://doi.org/10.1097/00000658-199910000-00003
Gentilello, Larry M. ; Rivara, Frederick P. ; Donovan, Dennis M. ; Jurkovich, Gregory ; Daranciang, Elizabeth ; Dunn, Christopher W. ; Villaveces, Andres ; Copass, Michael ; Ries, Richard R. / Alcohol interventions in a trauma center as a means of reducing the risk of injury recurrence. In: Annals of Surgery. 1999 ; Vol. 230, No. 4. pp. 473-483.
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abstract = "Objective: Alcoholism is the leading risk factor for injury. The authors hypothesized that providing brief alcohol interventions as a routine component of trauma care would significantly reduce alcohol consumption and would decrease the rate of trauma recidivism. Methods: This study was a randomized, prospective controlled trial in a level 1 trauma center. Patients were screened using a blood alcohol concentration, gamma glutamyl transpeptidase level, and short Michigan Alcoholism Screening Test (SMAST). Those with positive results were randomized to a brief intervention or control group. Reinjury was detected by a computerized search of emergency department and statewide hospital discharge records, and 6- and 12-month interviews were conducted to assess alcohol use. Results: A total of 2524 patients were screened; 1153 screened positive (46{\%}). Three hundred sixty-six were randomized to the intervention group, and 396 to controls. At 12 months, the intervention group decreased alcohol consumption by 21.8 ± 3.7 drinks per week; in the control group, the decrease was 6.7 ± 5.8 (p = 0.03). The reduction was most apparent in patients with mild to moderate alcohol problems (SMAST score 3 to 8); they had 21.6 ± 4.2 fewer drinks per week, compared to an increase of 2.3 ± 8.3 drinks per week in controls (p < 0.01). There was a 47{\%} reduction in injuries requiring either emergency department or trauma center admission (hazard ratio 0.53, 95{\%} confidence interval 0.26 to 1.07, p = 0.07) and a 48{\%} reduction in injuries requiring hospital admission (3 years follow-up). Conclusion: Alcohol interventions are associated with a reduction in alcohol intake and a reduced risk of trauma recidivism. Given the prevalence of alcohol problems in trauma centers, screening, intervention and counseling for alcohol problems should be routine.",
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AU - Daranciang, Elizabeth

AU - Dunn, Christopher W.

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