Alcohol and Traumatic Injury
By Rebecca Turpin, MA
Alcohol use in Wisconsin
It’s no secret alcohol use is a part of Wisconsin culture. In a 2014 survey, 63.1% of Wisconsinites reported having had a drink in the last 30 days compared to 53.1% of the U.S. as a whole. In the same survey, 22.1% of Wisconsinites reported binge drinking compared to 16% of the U.S. population1.
Alcohol contribution to trauma
The contribution of alcohol to traumatic injury has been well documented. We are often most familiar with injuries associated with drinking and driving, but alcohol plays a role in all types of injury from campfire burns and older adult falls to bicycle crashes, drowning, suicide, and assault. Estimates show that 26% to as high as 62% of traumatic injuries are alcohol related2. Further, those seeking treatment for an alcohol-related injury are three to six times more likely to be treated for another alcohol-related injury in the future3. The relationship between alcohol and injury is so common, Trauma Centers are required by the American College of Surgeons to identify and address problem drinking in all patients.
UW Health patients
At the Level I Trauma Center at UW Health, 69% of patients were tested for the presence of alcohol in 2015. Of those tested, 24% were positive for alcohol4. All UW Health patients are given the AUDIT-C alcohol screen to identify possible problem drinking. Recent conservative data estimates 7% of our trauma patients screen at high risk for alcohol related problems, while 17% screen at moderate risk. While these patients screening at moderate risk may not be alcohol dependent, they may have experienced problems or engage in drinking at levels that put them at increased risk for future injuries. Identification of these patients during treatment in the inpatient setting offers the opportunity to capitalize on a teachable moment.
Addressing risky drinking
While patients screening at high risk for alcohol use receive a consult from the Center for Addictive Disorders and may receive referral for additional treatment, those screening at moderate risk are prime candidates for an alcohol brief intervention. Brief interventions provided by trained hospital staff have shown to reduce the risk for future traumatic injuries by up to 50%5.
Anyone can be trained to provide brief intervention. Brief intervention contains three components and can take as few as 5 minutes to complete, depending on the patient.
Brief intervention components5:
Serving the Trauma Center at UW Health, Care Team Leaders on the trauma unit have been trained to provide brief intervention during busy weekend shifts. During the week the Learning Center, the patient education department, provides brief intervention to trauma patients as well as other units throughout the hospital.
As trauma patients transition out of the hospital and to their primary care provider for follow-up of their injuries, providers have an opportunity to reinforce patient plans for reducing risky drinking. Trauma discharge summaries will often note if alcohol contributed to the injury (in the problem list) and/or if the patient was provided counseling for risky drinking. Additionally, both Addiction Medicine notes and Alcohol Brief Intervention notes can be found in the patient’s record. These notes can signal a primary care provider to engage that patient further and support their behavior change efforts.
Of course, screening early and often could prevent many of these injuries in the first place. Many clinical guidelines recommend screening and brief intervention for alcohol use in primary care on an annual basis. For additional resources on SBIRT in your practice visit the Wisconsin Department of Health Services or the Substance Abuse and Mental Health Services Administration.
For more information
1 Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health. BRFSS Prevalence & Trends Data. 2015. [accessed May 31, 2016].
2 MacLeod, J.B.A and Hungerford, DW. Alcohol-related injury visits: Do we know the true prevalence in U.S. trauma centers?” Injury, Int. J. Care Injured 42 (2011) 922–926
3 Miller, T.R and Spicer, R.S. Hospital-Admitted Injury Attributable to Alcohol. Alcohol Clin Exp Res 36, No 1 (2012) 104–112
4 University of Wisconsin Hospital and Clinics (2016). Trauma Registry. 2015 Unpublished Raw Data.
5 American College of Surgeons, Committee on Trauma. Alcohol Screening and Brief Intervention (SBI) for Trauma Patients: COT Quick Guide.