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BLOOD ALCOHOL IN HOSPITALIZED TRAFFIC CRASH VICTIMS
R. A. Rockerbie, G. R. Martin, H.E. Parkin
Drinking Driving CounterAttack, Ministry of the AttorneyGeneral, Policy Planning & Research, 4th Floor (Bridge),
800 Hornby Street, VANCOUVER, B.C. V6Z 2C5, Canada.
Research on the effect of alcoholic influence on severity
of injury in traffic crashes is hampered by the necessity
to give priority to medical care over research and police
investigations. Consequently, such studies are few in num­
ber. Blood alcohol was determined in 1S2 consecutive adult
crash victims at a hospital in Finland in 1974.
In 30
per cent of them, alcohol was found in the blood. In a
study in South Africa in 1976, 36 per cent of a group of
115 traffic crash victims exceeded the legal limit of .05
2
per cent.
In a roadside survey in B.C. in 1974, 1,157
drivers were breath-tested between the hours of 10 p.m.
and 3 a.m. Evidence of drinking was found in 23.7 per cent,
and 6.6 per cent exceeded the legal limit of .08 per cent
3
in the blood.
The B.C. Medical Association, in June, 1978, endorsed a
proposal by the M i n i s t r y of Attorney-General to study
blood alcohol in traffic crash victims admitted to the
Royal Columbian Hospital in New Westminster. The purpose
of the study was to determine the proportion of injuries
which were alcohol-related; to explore the relationship
between blood alcohol concentrations and severity of in­
jury; and to assess the feasibility of routine blood al­
cohol testing in all hospitalized traffic crash victims.
The study has been completed and this report summarizes
165
soae of the findings.
Data collection covered a six month period from I-Jovember
20, 1978 to liay 12, 1979. All patients admitted to the
emergency ward of the Royal Columbian Hospital, as the re­
sult of a motor vehicle accident, were included in the
study. Ilinors were omitted. Basic information concerning
the accident was collected including: age, sex, time and
date, patient crash role, seatbelt usage, duration of
stay, and police action. The degree of injury was assessed
using the abbreviated injury scale (AIS) of the American
Association for Automotive Medicine.
Venous blood speci­
mens, upon signed consent, were collected for quantitation
of alcohol. Patients were guaranteed individual confiden­
tiality of information.
In total, 776 crash victims were examined. Of these, 422
(54 per cent) were drivers, 270 (35 per cent) were passen­
gers, 43 (6 per cent) were pedestrians, and 41 (5 per cent)
were cyclists. Hales comprised 58 per cent and females com­
prised 42 per cent of the group.
The incidence and degree of alcohol usage is shown in
Table 1. Forty-eight patients were not tested due to lack
of informed consent, communication barriers, patient's
critical condition, inadequate specimen, or other techni­
calities. Of those tested, 30 per cent of the drivers, 38
per cent of the passengers, 26 per cent of the cyclists,
and 3 3 per cent of the total had been drinking. Of the 410
drivers tested, 25.8 per cent exceeded the legal limit of
.00 per cent blood alcohol and an additional 3.9 per cent
had been drinking but were below the limit. Forty-one per
cent of tested male patients and 21.1 per cent of the fe­
male patients had been drinking. Female passengers and
female drivers did not differ significantly in blood alco­
hol concentration. Of the male patients, 57.3 per cent of
the passengers had been drinking as contrasted to 35.2 per
166
cent of the drivers. In an age vs alcohol correlation, a
number of peculiarities became apparent (Table 2). Wher­
eas those over age 40 made up 24 per cent of non-drinking
male patients, this age group made up only 32 per cent of
the female casualty victims. Similarly, of those who had
been drinking, the over 40 group made up only 9 per cent
of the males as compared to 17 per cent of the females.
Other correlations are shown in Table 2 with the under 25
age group conforming to the expected pattern.
Consistent with established social and drinking habits
which follow cyclic weekly patterns, 50 per cent of the
injuries occurred between 4 p.m. Friday and 4 a.m. Sunday.
This period accounted for a disproportionate 64 per cent
of the blood alcohol findings over .08 per cent. The time
of day at which accidents occurred was found to be age-re­
lated. Persons under 16 and those aged 16-19 were found to
have 62.5 and 52.7 per cent of their accidents respective­
ly between 3 p.m. and 4 a.m. Accidents involving the 20-40
age group occurred between 4 p.m. and 4 a.m. in 6 5 per
cent of the instances. Sixty-one per cent of the injury
accidents involving persons over 40 occurred between 12
noon and 8 p.m.
2
A weak correlation (R =0.40) was found between the severi­
ty of injury and BAC (Table 3).
however,
A significant difference,
(P<.01), was found in the degree of injury sus­
tained by drinking crash victims as compared to the sober
group. Only 2 9 per cent of the sober persons had an AIS
greater than one, as contrasted to 40 per cent of those
who had been drinking. No significant difference in AIS
between drivers and passengers was found.
The duration of hospital stay was not related to the BAC
at admission, but quite expectedly correlated well with
the AIS (R“=0.7S). Seventy-eight per cent of the patients
were discharged from Emergency. Thirteen per cent remained
167
in hospital for more than 7 days.
Compliance with the seat-belt law was 58 per cent. This
corroborates a previous finding of 60 per cent by Parkin
and Constance (5). Of the non-drinking persons 68 per cent
wore seatbelts as contrasted to 33 per cent of those drink­
ing. A marked relationship was found between age and seat­
belt usage. Compliance increased gradually from 12.5 per
cent at age 16 and under to 73.1 per cent in subjects over
40. Sixty-eight per cent of the drivers complied as com­
pared to 44.4 per cent of passengers. The degree of injury
was significantly less (PC.01) in the belted vehicle occu­
pants as compared to those that were not. The difference
in AIS appeared to be about 23 per cent, thus making a
clear case for seatbelt usage without even taking into ac­
count vehicle occupants who may have completely escaped
injury wearing seatbelts.
Police recognition of alcoholic influence and possible pro­
secution was hampered and complicated by the presence of
injury, shock, and the need to bring the injured person to
medical aid prior to collection of evidence and breath
testing. A search of police files revealed that of 106
drivers exceeding the legal limit of .08, only 18 were
charged for drinking driving. Legal provision for mandato­
ry blood testing for alcohol in hospital, as compatible
with medical care, can provide the evidence needed for law
enforcement, and is recommended as a result of this study.
A question may arise as to whether all crash victims should
be tested, or only drivers and on the basis of clinical ob­
servations which suggest the presence of alcohol. Selective
blood sampling has a shortcoming in that clinical observ­
ations for impairment are unreliable.
Secondly, testing
of drivers alone wouldplace an onus on medical staff to
identify patient crash role, the legal implications of
which are unattractive.
168
Blood testing for alcohol in an injured person oresents ad
vantages to patient management. Patients with alcohol in
their blood have their senses dulled to the extent that se
rious injuries are obscured. Knowledge of the patient's
level of impairment significantly reminds the physician to
place less reliability on the patient's self-assessment.
Testing for alcohol may also minimize confusion between
effects of trauma and the effects' of alcohol on level of
consciousness. Similarly the hazard of synergism between
alcohol and anesthetics, sedatives, tranquilizers and anal
gesics is decreased.
The 196 9 amendments to the Criminal Code of Canada, which
make breath-testing mandatory and of which blood testing
may be an extension for those injured, precludes most of
the arguments related to infringement of civil rights and
liberties. The legal ramifications as they affect the prac
tice of medicine, however, will need to be carefully stu­
died and resolved for such a lav/ to be workable.
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TABLE 2
INCIDENCE OF DRINKING AS RELATED TO SEX
AND AGE
Hale Patients
Female Patients
Age
(years)
Drinking
%
124
109
(62)
118
(47)
36
(56)
97
(41)
25 - 40
50
(29)
73
(29)
17
(27)
66
(27)
>40
16
(9)
59
(24)
11
(17)
76
(32)
TOTAL
175 (100)
Not Drinking
Q.
O
250 (100)
Drinking
Not Drinking
9*
1
5
64 (100)
9
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239 (100)
171
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REFERENCES
1.
Honkanen, R . , Ottelin, J., 31ood Alcohol Levels in
Injury Victims at the Emergency Station of a Rural
Central Hospital, Ann. chir. Gynne. Fenn., 65 (1976)
232-236.
2.
livers, R.A.il. et al, Alcohol and Road Traffic Injury,
S.A. lied. J., Aug. 13 (1977)
328-330.
3.
Smith, G.A. et al, A National Roadside Survey of the
Blood Alcohol Concentrations in llighttime Canadian
Drivers, Road and Motor Vehicle Traffic Safety Branch,
Transport Canada, Ottawa, 1976.
4.
The Abbreviated Injury Scale, American Association for
Automotive Iledicine, liorton Grove, 111., U.S.A., 1976 .
5.
Parkin, H., Constance, P. I1V injuries reduced since
seatbelt law. B.C. lied. J. 21 :5 186-187, 1979.
173