Traumatic Pedestrian and Bicyclist Injuries Associated with Intoxication

Overview

Journal Am J Emerg Med

Specialty Emergency Medicine

Date 2020 Oct 13

PMID 33046308

Citations 1

Authors

D J Tonellato

J R Ransohoff

C Nash

S E F Melanson

A K Petrides

N V Tolan

S A Goldberg

E W Boyer

P R Chai

T B Erickson

Affiliations

Soon will be listed here.

Abstract

Background: Drug and alcohol use are risk factors for trauma among operators of motor vehicles and contribute to trauma in pedestrians and bicyclists. We describe the prevalence of drug and alcohol use and clinical consequences in a cohort of pedestrians and bicyclists with trauma.

Methods: We analyzed a 25-month data set of 916 trauma team activations from January 2017-January 2019 at an urban, level I trauma center. Blood ethanol levels and urine toxicology screens were obtained in 94 pedestrian and bicyclist trauma activations. We compared pedestrians or bicyclists with a positive urine or blood screen (n = 69) to those with negative screens (n = 25). We conducted a retrospective chart review to determine mechanism of injury, injury pattern, and disposition from the emergency department (ED).

Results: Overall, 38 (55%) of injured patients with positive screen were pedestrians and 31 (45%) were bicyclists. Fentanyl was the most commonly detected drug (n = 38; 40%), followed by opiates (n = 27; 29%), and tetrahydrocannabiol (THC) (n = 23; 25%). Twenty-one patients were positive for ethanol. Pedestrians and bicyclists with positive toxicology screens were significantly more likely to sustain fractures (p < .01), require an operative procedure (p < .05), or intensive care unit admission (p < .05).

Conclusion: Our study builds on previous literature which suggests that intoxicated bicyclists and pedestrians suffer frequent and more severe injury than their sober counterparts. Public health campaigns should educate bicyclists and pedestrians about the risks of cycling or walking in areas of road traffic while under the influence of alcohol or illicit drugs.

Citing Articles

Sensorimotor Alterations Induced by Novel Fentanyl Analogs in Mice: Possible Impact on Human Driving Performances.

Bilel S, Giorgetti A, Tirri M, Arfe R, Cristofori V, Marchetti B Curr Neuropharmacol. 2022; 21(1):87-104.

PMID: 36397617 PMC: 10193765. DOI: 10.2174/1570159X21666221116160032.

References

Walsh J, Flegel R, Atkins R, Cangianelli L, Cooper C, Welsh C . Drug and alcohol use among drivers admitted to a Level-1 trauma center. Accid Anal Prev. 2005; 37(5):894-901. DOI: 10.1016/j.aap.2005.04.013. View

Demetriades D, Gkiokas G, Velmahos G, Brown C, Murray J, Noguchi T . Alcohol and illicit drugs in traumatic deaths: prevalence and association with type and severity of injuries. J Am Coll Surg. 2004; 199(5):687-92. DOI: 10.1016/j.jamcollsurg.2004.07.017. View

Soderstrom C, Dischinger P, Kufera J, Ho S, Shepard A . Crash culpability relative to age and sex for injured drivers using alcohol, marijuana or cocaine. Annu Proc Assoc Adv Automot Med. 2005; 49:327-41. PMC: 3217441. View

Reid S, Gentius J . Type and Context of Alcohol-Related Injury among Patients Presenting to Emergency Departments in a Caribbean Country. Int J Environ Res Public Health. 2017; 14(8). PMC: 5580581. DOI: 10.3390/ijerph14080877. View

Radjou A, Kumar S . Epidemiological and Clinical Profile of Fatality in Vulnerable Road Users at a High Volume Trauma Center. J Emerg Trauma Shock. 2018; 11(4):282-287. PMC: 6262654. DOI: 10.4103/JETS.JETS_55_17. View

Matsui Y, Oikawa S, Hitosugi M . Analysis of car-to-bicycle approach patterns for developing active safety devices. Traffic Inj Prev. 2015; 17(4):434-9. DOI: 10.1080/15389588.2015.1087641. View

Stubig T, Petri M, Zeckey C, Brand S, Muller C, Otte D . Alcohol intoxication in road traffic accidents leads to higher impact speed difference, higher ISS and MAIS, and higher preclinical mortality. Alcohol. 2012; 46(7):681-6. DOI: 10.1016/j.alcohol.2012.07.002. View

Shih H, Hu S, Yang C, Ko T, Wu J, Lee C . Alcohol intoxication increases morbidity in drivers involved in motor vehicle accidents. Am J Emerg Med. 2003; 21(2):91-4. DOI: 10.1053/ajem.2003.50025. View

Vanlaar W, Mainegra Hing M, Brown S, McAteer H, Crain J, McFaull S . Fatal and serious injuries related to vulnerable road users in Canada. J Safety Res. 2016; 58:67-77. DOI: 10.1016/j.jsr.2016.07.001. View

10.

Asbridge M, Mann R, Cusimano M, Tallon J, Pauley C, Rehm J . Cycling-related crash risk and the role of cannabis and alcohol: a case-crossover study. Prev Med. 2014; 66:80-6. DOI: 10.1016/j.ypmed.2014.06.006. View

11.

Salon D, McIntyre A . Determinants of pedestrian and bicyclist crash severity by party at fault in San Francisco, CA. Accid Anal Prev. 2017; 110:149-160. DOI: 10.1016/j.aap.2017.11.007. View

12.

OHern S, Oxley J . Fatal cyclist crashes in Australia. Traffic Inj Prev. 2018; 19(sup2):S27-S31. DOI: 10.1080/15389588.2018.1497166. View

13.

Mitra B, Charters K, Spencer J, Fitzgerald M, Cameron P . Alcohol intoxication in non-motorised road trauma. Emerg Med Australas. 2016; 29(1):96-100. DOI: 10.1111/1742-6723.12682. View

14.

Sethi M, Heyer J, Wall S, DiMaggio C, Shinseki M, Slaughter D . Alcohol use by urban bicyclists is associated with more severe injury, greater hospital resource use, and higher mortality. Alcohol. 2016; 53:1-7. PMC: 5248656. DOI: 10.1016/j.alcohol.2016.03.005. View

15.

Pawlowski W, Lasota D, Goniewicz M, Rzonca P, Goniewicz K, Krajewski P . The Effect of Ethyl Alcohol upon Pedestrian Trauma Sustained in Traffic Crashes. Int J Environ Res Public Health. 2019; 16(8). PMC: 6517985. DOI: 10.3390/ijerph16081471. View

16.

Koval K, Cooley M, Cantu R, Spratt K . The effects of alcohol on in-hospital mortality in drivers admitted after motor vehicle accidents. Bull NYU Hosp Jt Dis. 2008; 66(1):27-34. View

17.

Chong S, Chiang L, Allen Jr J, Fleegler E, Lee L . Epidemiology of Pedestrian-Motor Vehicle Fatalities and Injuries, 2006-2015. Am J Prev Med. 2018; 55(1):98-105. DOI: 10.1016/j.amepre.2018.04.005. View

18.

Glass N, Frangos S, Simon R, Bholat O, Todd S, Wilson C . Risky behaviors associated with pediatric pedestrians and bicyclists struck by motor vehicles. Pediatr Emerg Care. 2014; 30(6):409-12. DOI: 10.1097/PEC.0000000000000148. View

19.

Stiak P, Straka L . Alcohol abuse in road traffic: medical-legal aspects. Soud Lek. 2018; 63(2):14-18. View

20.

Dultz L, Foltin G, Simon R, Wall S, Levine D, Bholat O . Vulnerable roadway users struck by motor vehicles at the center of the safest, large US city. J Trauma Acute Care Surg. 2013; 74(4):1138-45. DOI: 10.1097/TA.0b013e31827ab722. View