1 Department of Emergency Medicine, University of Michigan Medical School,
2 University of Michigan Injury Research Center,
3 Department of Psychiatry, University of Michigan Medical School,
4 The Serious Mental Illness Treatment Research and Evaluation Center, Division of Veterans Affairs Health Services Research and Development and
5 University of Michigan Transportation Research Institute, MI, USA
Received 6 November 2001; accepted 19 March 2002
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ABSTRACT |
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INTRODUCTION |
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SUBJECTS AND METHODS |
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A more detailed description of the methods utilized in this study has been previously reported by Waller et al. (1997). In brief, injured patients were approached by ED physicians or trained research assistants for enrolment into the study. If study criteria were met, the study was explained by the project interviewer, and consent was obtained. Blood for study purposes was provided only after obtaining informed consent. If the patients injury severity prohibited obtaining informed consent, blood was drawn and stored until the patient was sufficiently recovered, and consent was obtained. Consent was requested from a family member of those subjects who died or were too disabled to participate in the study. In these cases, guardian interviews substituted for the subject interviews. No analyses were obtained without consent. This study was approved by the Institutional Review Boards of both institutions.
Three types of data were included for analysis: (1) demographic information, obtained from both patients and hospital records; (2) alcohol and drug data, obtained from laboratory analyses of blood samples; (3) information on previous alcohol and drug use, obtained from a structured interview [Diagnostic Interview Survey (DIS; DSM III-R), Robins et al., 1989].
Demographic data
Demographic information included basic information on age, race, marital status, education, number of children, and occupation.
Alcohol and drug data
All laboratory analyses were performed by Labcorps Inc., Research Triangle Park, NC, USA. Alcohol testing was conducted by whole blood analysis using gas chromatography or breath analysis. Drug testing was also performed on whole blood. Using radioimmunoassay, initial screening was performed for cocaine metabolites (benzoylecgonine), cannabanoid metabolites [THCA (11-nor-delta-8-tetrahydrocannabinol-9-carboxylic acid)], opiates (morphine); cut-offs were 50, 10 and 50 ng/ml respectively. Samples testing positive for radioimmunoassay were then analysed using gas chromatography and mass spectroscopy (GC/MS analysis) for quantitative results.
Alcohol and drug history
A diagnosis of AA/AD or DA/DD was determined using the alcohol and drug section of the DIS (Robins et al., 1989). The DIS is a validated standardized diagnostic instrument based on DSM III-R criteria, and contains 30 stem questions administered in a standardized format. Diagnosis was considered current if any symptoms had occurred during the past year. The DIS also identifies the number of lifetime symptoms related to alcohol and drug use.
Statistical analysis
Data were analysed using the SAS 6.12 (Cary, NC, USA) database for analysis. Due to limited sample size, substance-positive groups were pooled for analysis, as were data regarding pedestrians and bicyclists. Bivariate analyses were performed using 2-tests and Wilcoxon rank sum scores, where appropriate, for variable distributions. P < 0.05 was considered statistically significant, and P < 0.1 was considered a statistical trend. No correction for multiple comparisons was made, because the tests were a priori hypotheses, based on previous research.
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RESULTS |
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Eleven per cent of NOMVC victims tested positive for alcohol alone, 7% for drugs alone, and 3% for both. Table 1 shows a comparison of demographics, as well as current or lifetime substance abuse diagnosis. Victims with a current substance abuse diagnosis were more likely to have tested positive for alcohol or drugs (AA/AD, P = 0.003; DA/DD, P = 0.028). Sixty-one (66%) subjects were treated and released from the ED.
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DISCUSSION |
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Second, 16% of injured bicyclists and/or pedestrians had either a lifetime or current diagnosis of AA/AD, more than twice that of previously reported estimates of the prevalence of current AA/AD in the general US population (Kessler et al., 1994). These findings support the importance of screening and intervention for AA/AD among NOMVC victims.
The following study limitations are noteworthy: (1) Our data are largely descriptive due to the small number of victims meeting enrolment criteria. (2) Because only the evening shift was covered throughout the entire study, with sampling of other shifts at the community hospital, the study population cannot be considered to be characteristic of all bicycle and pedestrian crashes presenting to the participating hospitals. However, the sample is valid for determining how descriptive characteristics differ among those testing positive for AOD versus those who tested negative. (3) Because of the small sample size, we were unable to make valid comparisons of injury severity among AOD (+) and AOD (-) patients. Studies involving alcohol and motor vehicle crashes, and those on bicycle and pedestrian injuries, have not adequately addressed variations of injury severity based on impact forces. Recently, a population-based study that considered the force of impact among injured pedestrians reported a 45-fold increase in the odds of dying when alcohol was present (Miles-Doan, 1996). However, no clinical study involving injured non-occupants has adequately controlled for forces of impact. (4) We cannot exclude the possibility of bias when considering the analyses of drinking history information, since victims who were BAC (+) were less likely to consent to an interview. In addition, the sample of victims who consented to be interviewed and to provide blood samples for analysis may underestimate the frequency of past history of dependence and of substance abuse other than alcohol.
In conclusion, a considerable number of NOMVC victims who presented to the ED tested AOD (+). When compared to AOD (-) NOMVC victims, those testing AOD (+) were significantly more likely to have a current or lifetime substance abuse diagnosis and a greater severity of injury. This information is useful for the development of injury prevention strategies to decrease the incidence and severity of adult NOMVC injuries.
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ACKNOWLEDGEMENTS |
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FOOTNOTES |
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REFERENCES |
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Brainard, B. J., Slauterbeck, J., Benjamin, J. B. et al. (1989). Injury profiles in pedestrian motor vehicle trauma. Annals of Emergency Medicine 18, 881883.[ISI][Medline]
Cimbura, G., Lucas, D. M., Bennett, R. C. et al. (1982) Incidence and toxicological aspects of drugs detected in 484 fatally injured drivers and pedestrians in Ontario. Journal of Forensic Science 27, 855867.[ISI]
Frank, E., Frankel, P., Mullins, R. J. and Taylor, N. (1995) Injuries resulting from bicycle collisions. Academic Emergency Medicine 2, 200203.[Abstract]
Haddon, W. Jr, Valien, P., McCarroll, J. R. et al. (1961) A controlled investigation of the characteristics of adult pedestrians fatally injured by motor vehicles in Manhattan. Journal of Chronic Diseases 14, 655678.[ISI]
Holubowycz, O. T. (1995) Age, sex, and blood alcohol concentration of killed and injured pedestrians. Accident and Analysis Prevention 27, 417422.
Honkanen, R. and Smith, G. (1990) Impact of acute alcohol intoxication on the severity of injury: a cause specific analysis of non-fatal trauma. Injury 21, 353357.[ISI][Medline]
Honkanen, R., Liisa, E., Linnoila, M., Alha, A. et al. (1980) Role of drugs in traffic accidents. British Medical Journal 281, 13091312.[ISI][Medline]
Irwin, S. T., Patterson, C. C. and Rutherford, W. H. (1986) Association between alcohol consumption and adult pedestrians who sustain injuries in road traffic accidents. British Medical Journal 286, 522.
Jehle, D. and Cottington, E. (1988) Effect of alcohol consumption on outcome of pedestrian victims. Annals of Emergency Medicine 17, 953956.[ISI][Medline]
Kessler, R. C., McGonagle, K. A., Zhao, S. et al. (1994) Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Archives of General Psychiatry 51, 819.[Abstract]
Lane, P. L., McClafferty, K. J. and Nowak, E. S. (1994) Pedestrians in real world conditions. Journal of Trauma 36, 231236.[ISI][Medline]
Li, G. and Baker, S. P. (1994) Alcohol in fatally injured bicyclists. Accident and Analysis Prevention 26, 543548.
Li, G., Baker, S. P., Sterling, S. et al. (1996) A comparative analysis of alcohol in fatal and nonfatal bicycling injuries. Alcoholism: Clinical and Experimental Research 20, 15531559.[ISI][Medline]
Maio, R. F., Waller, P. F., Blow, F. C., Hill, E. M. et al. (1997) Alcohol abuse/dependence in motor vehicle crash victims presenting to the emergency department. Academic Emergency Medicine 4, 256262.[Abstract]
Miles-Doan, R. (1996) Alcohol use among pedestrians and the odds of surviving an injury: evidence from Florida law enforcement data. Accident and Analysis Prevention 28, 2331.
National Center for Health Statistics (1993) Health, United States 1992 and Healthy People 2000 review. Hyattsville, MD: Public Health Service. DHHS publication no. (PHS) 931232.
Richter, E., Meltzer, U., Bloch, B. et al. (1986) Alcohol levels in drivers and pedestrians killed in road accidents in Israel. International Journal of Epidemiology 15, 272273.[Abstract]
Rivara, F. P., Mueller, B. A., Fligner, C. L., Luna, G. et al. (1989) Drug use in trauma victims. Journal of Trauma 29, 462470.[ISI][Medline]
Rivara, F. P., Thompson, D. C. and Thompson, R. S. (1997) Epidemiology of bicycle injuries and risk factors for serious injury. Injury Prevention 3, 110114.[Abstract]
Roberts, I., Norton, R., Jackson, R. et al. (1995) Effect of environmental factors on risk of injury of child pedestrians by motor vehicles: a casecontrol study. British Medical Journal 310, 9194.
Robins, L., Helzer, J., Cottler, L. et al. (1989) NIMH Diagnostic Interview Schedule: Version III Revised. Washington University, St Louis, MO.
Rogers, G. B. (1995) Bicyclist deaths and fatality and risk patterns. Accident and Analysis Prevention 27, 215223.
Spaite, D. W., Criss, E. A., Weist, D. J., Valenzuela, T. D. et al. (1995) A prospective investigation of the impact of alcohol on helmet use, injury severity, medical resource utilization, and health care costs in bicycle related trauma. Journal of Trauma 38, 287290.[ISI][Medline]
Stevenson, M. R., Jamrozik, K. D. and Spittle, J. (1995) A casecontrol study of traffic risk factors and child pedestrian injury. International Journal of Epidemiology 24, 957964.[Abstract]
Struik, M. and Rogerson, P. (1988) Pedestrian Accident Project. Report no. 5. Methodology and General Results. Road Safety Division, Road Traffic Authority, Hawthorn, Victoria, Australia.
Substance Abuse and Mental Health Services Administration (1996) Preliminary Estimates from the 1995 National Household Survey on Drug Abuse. US Department of Health and Human Services, Rockville, MD.
Vestrup, J. A. and Reid, J. D. S. (1989) A profile of urban adult pedestrian trauma. Journal of Trauma 17, 741745.
Waller, P. F., Stewart, R. J., Hansen, A. R. et al. (1986) The potentiating effects of alcohol on injury. Journal of the American Medical Association 256, 14611466.[Abstract]
Waller, P. F., Blow, F. C., Maio, R. F. et al. (1997) Crash characteristics and injuries of victims impaired by alcohol versus illicit drugs. Accident and Analysis Prevention 29, 817827.
Yelon, J. A., Harrigan, N. and Evans, J. T. (1995) Bicycle trauma: a five-year experience. American Surgeon 61, 202205.[ISI][Medline]