ALCHL AND DRUGS AMNG MVA AND NN-MVA ADMISSINS T A REGINAL TRAUMA UNIT B.M. Kapur, E. Vingilis, B. McLellan, W. Nelsn and W-J Sheu; (Addictin Research Fundatin, Trnt and Sunnybrk Medical Centre, Trnt, Canada.) Summary: Demgraphic data, drug analysis including BAC were cllected in a prspective study n 738 cnsecutive, seriusly injured mtr vehicle accidents (MVA) and nn-mva admissins t a reginal trauma unit. This study spanned ver a 3 year perid. Majrity f the admissins were male casualties (72%). Bdy fluids f almst 2/3rd f the admissins had ne r mre drugs in them. Alchl was fund in almst l/3rd f the ppulatin. Intrductin Alchl has shwn t be a majr factr in MVA fatalities in the industrialized cuntries. In Canada abut 50% f all drivers killed in MVA had been drinking. Cimbura et.al in a study dne in the early 1980's fund nt nly alchl but ther drugs such as marijuana in the bdy fluids f MVAs. Ccaine and marijuana use has, since the mid 1980's, increased dramatically and nw many industries have intrduced drug testing f their wrkfrce. Gd cmparative data n nn-fatal injuries are nt available fr alchl and ther drugs. ne aim f this study was t investigate the incidence f alchl and drugs in the ppulatin mst likely t get invlved in a serius injury resulting in admissins t the trauma unit. Methd The Reginal Trauma Unit (RTU) at Sunnybrk Medical Centre is a tertiary care referral center specializing in the care f the plytraumatized patient. The study sample was drawn frm the cmbined grup f direct and referred patients; the RTU currently assesses ver 500 blunt plytraumatized patients annualy. Data was cllected prspectively n all trauma admissins and included crash r accident infrmatin, demgraphic infrmatin, injury related infrmatin and utcme measures. Bld and urine was rutinely cllected fr alchl and drug screening. Bld and urine samples f all patients admitted t the trauma unit were analyzed fr varius drugs including alchl, ccaine, cannabinids and benzdiazepines using bth immunassay and thin layer chrmatgraphy. Urine samples were analysed fr drugs using the Syva EMIT prcedures n the ETS analyser and the Abbtt's TDx analyser. Acidic and basic extracts f urine samples were further analysed using thin layer chrmatgraphy. Bld samples were analysed using gas liquid chrmatgraphy (GLC) fr barbiturates, sedative and hypntics. Vlatile screens were als dne with GLC n bld samples. The turn-arund time fr bld (GLC) and immunassay (urine) screens averaged abut 2 hurs frm the receipt f the bdy fluids. ur turn-arund, time fr patient results, imprved cnsiderably after the intrductin f the Syva's ETS drugs f abuse analyser. 866
BAC measurments were started in the first year f this study. Drug screening was dne during the year tw and three f the study. Althugh a large variety f data and infrmatin was cllected n all these patients, this paper presents sme f the preliminary findings n the incidence f alchl and ther drugs in a 24 mnth sample. Ppulatin characteristics: (Fig. 1) ver a perid f abut 24 mnths 738 patients were screened. 450 were MVA accidents, 288 were nn MVA accident victims. The MVA ppulatin was further divided int drivers (277), passengers (125) and mtrcyclists (48). Nn MVA ppulatin cnsisted f pedestrians (90), industrial accidents (48), falls (39), assault and stabbing (35), bike (20), recreatinal vehicle (24), and thers (28). Males dminated all catgries (Fig. 2) Mtr cyclist which was mstly made up f males was the yungest (mean age =22.7, range 15-38), whereas the pedestrian were the ldest (mean age =49.9, range 16-90) (Fig. 3) Results: 66% f the MVA drivers had 1 r mre drugs in their bdy fluids as cmpared t 58% f the nn-mva admissins (Fig 4). 34% f the MVA drivers had alchl in their bld with a mean BAC at the time f hspital admissin f 138 mg/100 ml (Fig. 5). Estimated mean BAC at time f accident was calculated t be 180 mg/100ml (Extrplatin backwards at 15 mg/100 ml/hr) In the nn-mva alchl was present in 24% f the cases with mean BAC f 160 mg/100 ml. at time f admissin, (mean estimated BAC at time f accident was 194 mg/100 ml). 60% f the ttal ppulatin had 1 r mre drugs while 29% f the ttal ppulatin had mre than 2 drugs in their bdy fluids. Alchl fllwed by cannabinids and benzdiazepines were the mst cmmn drugs (Fig. 6). Ccaine, barbiturates, cdeine, and diphenhydramine were amng the ther drugs that were fund in the serum and urine f these trauma admissins. Highest mean BAC at time f accident was fund t be in Fall (204 mg/100ml) fllwed by Pedestrians (186 mg/100ml) victims. There was nly ne accident victim in the Industrial accident grup f 48 and had BAC f 50mg/100ml. In the victims f vilent actins (assault and stabbing categry) alchl was present in 43% f the admissins t the RTU. This was als the largest percentage psitives f the varius grups. Alchl (43%) fllwed by cannabinids (31.4%) and benzdiazepines (17%) were the three mst frequently fund drugs in the admissins in the assault and stabbing categry. This grup als had the largest prprtinal psitives f ccaine (11.4%) in the whle study. Multiple drugs was a cmmn finding in ur study. 216(29%) f the ttal 738 admissins had 2 r mre drugs in their bdy fluids. (Fig. 7). Antihistamines were als a cmmn findings in ur study. Sme f ur preliminary data (nt presented here) suggests that there were patients wh had these class f drugs in additin t alchl a cmbinatin knwn t cause drwsiness. The preliminary findings f ur study raise many questins. We had nt anticipated this large percentage f psitives cases. Fr many f the drugs fund in these RTU admissins a cause and effect (accident) relatins may r may nt exist. It wuld be interesting t carry ut this study where all drugs levels were btained rather than the qualitative results that we btained n mst f the urine samples. 867
Trauma Admissins Ppulatin Characteristics 200 400 600 800 1000 Number f Patients fs H C/5, T3 «03 & Q- n3 LL CD CQ a) cc +- C/) x 1_ 05 CD -C TD C 2 4- C/3 01 H 868
-c 0 ww'-c/3' töj3 c- 3 w *- CC 5 CD 3 C X CD C CC f - Li. nj------ - CL D"D s Q_ nj w cn - 2 ' Q - ~ w CD(/) - 2 m - Z 5 CN Fig. 869
w ( / ) - ~. C - * - n J j Q C T 3 3 in- - er s x CQ.X D TRAUMA LU ü LL 03---- S- 0.0*0 q. (öw tn 2 1Q 1-5 z 2 Fig. 870
Trauma Admissins % psitives fr drugs c c 03 Q_ Ö Z "05 h- 100 80 60 40 20 0 200 400 600 800 1000 % Psitives fr 1 Drug Ttal N. f Patients CD 5 S 03 cc c x ZJ n3 CD x : T3 C C C Di H 871
j= w «'-t*' C - 3 / *- tr u 5 CD TRAUMA BAC nj------ D. T3 2, BAC-Admissin Q. nj w w 2E 1Q 2 in CM CM y. s l l i i i l k in ^ x w ä ; H - h H C J in in Di Hfn 872
TRAUMA ADMISSINS MVA and NN-MVA % psitive f Ttal Ppulatin cn-l Q LLIh-z CLLUZ 1-N ^CL=ELI LLIh- DCLC CD= -_J Q_m liz 2 0 CG cz ID Z CLX LIz C CLCL LICLI LIQ LICLLIC =5cT- Q CDcrCQ Q CLI LIz cccl 12 CDLIZN Z Z _J Q LIH n: F ig. 873
Trauma Admissins Number f Psitive Patients Cn *H 874