Injured, Intoxicated Car Crash Passengers at Risk for Later Injuries

A recent University of New Mexico Health Sciences Study study shows that intoxicated passengers injured in motor vehicle crashes are at the same risk as intoxicated drivers of ending up in hospitals and emergency departments, and are at increased risk of death for five years following injury, according to an article in the November issue of the Archives of Surgery, a member of the JAMA family of journals.

Burn and trauma physician, Dr. Carol R. Schermer, and colleagues conducted a historical cohort study of motor vehicle crash victims admitted to the UNM Hospital Trauma Center in 1993 to identify patients, in addition to intoxicated drivers, who may potentially benefit from alcohol intervention in the trauma setting to deter further injury and recurrent use of health care resources.

The researchers found that more than a quarter of the intoxicated passengers and drivers admitted to the trauma center in 1993 for injuries sustained in a vehicle crash had recurrent hospitalizations and emergency department visits. Intoxicated occupants were twice as likely to return to the hospital and 2.7 times more likely to return to the emergency department than the nonintoxicated control group.

Intoxicated passengers were more likely to die in the five years following injury than nonintoxicated occupants and almost six times more likely to die than the general public.

"Our data indicate that intoxicated passengers may take more risks than others, including intoxicated drivers," the authors explain. Additionally, intoxicated occupants were more likely to die from alcohol-related causes.

According to background information in the article, motor vehicle crashes are the leading cause of injury and death in the United States, with an estimated 40 people injured for every person killed. Drinking alcohol is the leading risk factor for injury and has been implicated in nearly 50 percent of all fatal crashes. Alcohol use is more prevalent in fatal than nonfatal injuries, and injury deaths occur with greater frequency among heavy drinkers. People with alcohol dependence are three to five times more likely than the general population to be killed in a motor vehicle crash. Alcohol use disorders are the most common comorbid condition in trauma patients, affecting 25 percent to 40 percent.

Drivers with a previous arrest for driving under the influence are at a substantially increased risk of future death in a motor vehicle crash. Intoxicated drivers are involved in more crashes, use more health care resources and have an increased likelihood of death subsequent to an injury episode, according to background information.

"To perform appropriate secondary prevention of injury, we need to accurately identify who will benefit from intervention during their first hospitalization for injury.

Intoxicated passengers and drivers have equivalent recidivism rates that far exceed those of nonintoxicated controls. Although in this study, mortality rates of intoxicated drivers did not exceed those of the control group, intoxicated drivers have otherwise been shown to have an increased mortality. Rather than the tri-modal distribution of death due to injury [injury-related death comes in three peaks: time of injury, within hours of injury and weeks after injury], there seems to be a fourth peak of delayed death due to ongoing alcohol use disorders, as demonstrated by the intoxicated passengers in this study. We have identified a group of drinkers, intoxicated passengers, at particularly high risk for adverse consequences of alcohol use who would potentially benefit from appropriate screening and treatment," the authors write.

(Arch Surg. 2001;136:1244-1248) Editor's Note: This study was supported in part by grants from the National Institute on Alcohol Abuse and Alcoholism and from the National Center for Research Resources, Bethesda, Md.
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