BACKGROUND: The prehospital assessment and subsequent therapeutic interventions are crucial for the optimal management of severely injured patients. Many trauma patients are alcohol-intoxicated. Therefore, this study investigated the prehospital assessment of the injury pattern and management of alcohol-intoxicated patients.

METHODS: In a retrospective matched-pair analysis of TraumaRegister DGU® data patients from 2015 to 2018 with a blood alcohol level (BAL+) > 1.0‰ and without a blood alcohol level (BAL-: 0.0‰) were investigated, matched by age, gender, injured region, and mechanism. We evaluated injury assessment, prehospital therapy, and transport modalities.

RESULTS: A total of 6468 patients (3234 BAL-, 3234 BAL+) were included. Head injuries were common (56.9%), but BAL+ patients were significantly less often correctly assessed with regard to head (BAL-: 77.8% vs. BAL+: 74.2%) and facial (BAL-: 75.4% vs. BAL+: 70.0%, p < 0.001) injuries. Head and facial injuries were significantly more often improperly overdiagnosed in alcohol-intoxicated patients (head: BAL-: 13.9% vs. BAL+: 21.4%, p < 0.05; face: BAL-: 19.8% vs. BAL+: 24.3%, p < 0.001), and the diagnosis of actual head injuries was underdiagnosed significantly more often in patients with BAL+. Alcohol-intoxicated patients were sedated (BAL-: 64.9% vs. BAL+: 55.6%, p < 0.001) and intubated (BAL-: 39.0% vs. BAL+: 28.3%, p < 0.001) significantly less often and received significantly less fluid therapy (BAL-: 92.6% vs. BAL+: 90.3%, p < 0.001), catecholamines (BAL-: 12.7% vs. BAL+: 8.5%, p < 0.001), or tranexamic acid (BAL-: 10.3% vs. BAL+: 6.3%, p < 0.001). Admission of alcohol-intoxicated patients to hospital was significantly more frequent at weekends and at night, and more frequent in regional and local trauma centers than in supraregional trauma centers.

CONCLUSIONS: There were significant differences in the prehospital assessment of head injuries between alcohol-intoxicated and nonalcohol-intoxicated patients. Alcohol-intoxicated patients were significantly less often correctly assessed, and alcohol-intoxicated patients received fewer prehospital therapeutic interventions.