Alcohol and psychoactive drugs increased the pre-hospital mortality in 655 fall-related fatalities in Greece: A call for management protocols

Abstract

Introduction: The frequency of alcohol and psychoactive drugs in fall-related fatalities and their effect on type, severity of injury and location of death constitute the subjects of this study. Methods: A retrospective analysis based on autopsy and toxicology compared demographics, location of injury; intention for the injury, height of fall, Abbreviated Injury Scale - 90 (AIS-90), post-mortem Injury Severity Score (ISS), and location of death. Results: Amongst 655 fall-related fatalities screened for alcohol and psychoactive drugs 123 (18.8%) were classified in the positive toxicology group (PTG) and the remaining in the negative toxicology group (NTG). The median ages were 48 (16-94) years for the PTG and 62 (12-96) years for the NTG. The screened represent 31% of the national toll. The median height of fall was 7 m and the median blood alcohol concentration was 53 (1.5-630) mg/dl. Males were more likely to be included in the PTG than females (21.6 versus 13.6%; p = 0.014) as were the aged between 11 and 60 years. The odds of severe (AIS ≥ 3) head, thoracic, abdominal, extremity, and spine injuries were not influenced by toxicology status. Fatalities of the PTG were as likely to have severe trauma (ISS ≥ 16) as were fatalities of the NTG (93.5 versus 90.8%; p = 0.34). There was no significant difference of ISS between PTG (median ISS 43, range: 6-75) and NTG (median ISS 35, range: 3-75). Nevertheless, 76.4% of the subjects of the PTG died during the pre-hospital stage of care compared to 60.5% of the subjects of the NTG, which was highly significant (or = 2.80, p = 0.001) after controlling for confounders as age, gender, intention for injury, height of fall, and ISS. Conclusions: In fall related trauma, alcohol and psychoactive drugs increased the risk of death during the pre-hospital stage by 2.80 times. This is strong evidence that specific protocols for their early management should be instituted. © 2010 Elsevier Ltd. All rights reserved.