Ethanol Abuse and the Trauma Patient

Abstract

Background: Alcohol intoxication has long been associated with an increased risk of injury from a number of mechanisms and with trauma recidivism. It is less certain whether alcohol abuse is associated with worse outcomes for a given degree of injury. Methods: Review of the pertinent English-language literature. Results: The vasodilator effects of alcohol may hamper fluid resuscitation, especially in head-injured patients. Acute and chronic alcohol intoxication both have substantial effects on the cellular and molecular responses necessary to fight infection. High alcohol concentrations exert an immunosuppressive effect on production of proinflammatory cytokines such as tumor necrosis factor and interleukin-1. However, the clinical effects of the immunosuppression are variable and difficult to discern in heterogeneous trauma patient populations with variable degrees of intoxication. Conclusion: Alcohol has a profound impact on the epidemiology of injury, but the physiology and biochemical effects in an individual patient may be difficult to predict. Identification of intoxicated persons is essential, despite economic disincentives to do so, because even brief targeted intervention programs can decrease substantially the patient's risk of subsequent injury.