Weekday distribution of head traumas in patients admitted to the emergency department of a city hospital: effects of age, gender and drinking pattern

Alcohol & Alcoholism Vol. 42, No. 5, pp. 474–479, 2007 Advance Access publication 6 March 2007 doi:10.1093/alcalc/agm003 WEEKDAY DISTRIBUTION OF HEAD TRAUMAS IN PATIENTS ADMITTED TO THE EMERGENCY DEPARTMENT OF A CITY HOSPITAL: EFFECTS OF AGE, GENDER AND DRINKING PATTERN JUSSI PULJULA1∗ , OLLI SAVOLA2 , VELI TUOMIVAARA1 , JOSEPH PRIBULA3 and MATTI HILLBOM1 1 Department of Neurology, Oulu University Hospital, Finland 2 Department of Neurosurgery, Oulu University Hospital, Finland 3 Department of Neurology, District Central Hospital of Litomerice, Czech Republic (Received 6 June 2006; in revised form 21 December 2006; accepted 16 January 2007; advance access publication 6 March 2007) Abstract — Aims: To define the alcohol-related risk for head traumas and to compare the weekly and monthly variations in alcohol consumption, and the occurrence of head traumas in a population with heavy episodic drinking as the prevailing drinking pattern. Methods: All consecutive admissions due to head trauma into a Finnish city hospital during 1 year (1999) were recorded. 832 consecutive patients with data on alcohol consumption were covered. We compared the number of final diagnoses of head traumas per day and month to the anticipated frequency in the absence of any weekly or monthly variation. Official statistics on alcohol consumption in Finland are presented as reference. Results: Alcohol-related head traumas were most common in young adults and people of working age. The occurrence of head traumas in sober subjects showed no temporal variations. By contrast, alcohol-related cases peaked on weekends and in the most popular vacation month (July). The alcohol-related risk from Friday to Sunday was 27.3% in women and 20.3% in men. The additional risk related to alcohol consumption in July was 16.1% in women and 5.3% in men. Conclusions: We found an excess of head traumas during weekends and the primary vacation month, and this excess was associated with heavy episodic drinking. Active measures are needed to prevent head traumas caused by this type of behaviour. INTRODUCTION Brain injury is the leading cause of death in trauma patients, and it is also the most common cause of permanent disability in young adults. Every year about 20 000 subjects in Finland sustain traumatic brain injury, almost half of them are young adults (Alaranta et al ., 2002). The prevalence of traumatic brain injury in the population amounts to 2%. Alcohol drinking is a significant modifiable risk factor for traumatic brain injury. Alcohol drinking has been found to be related to 40% of all deaths due to intentional (suicides and homicides) and unintentional (motor vehicle injuries, etc.) injuries in Finland (Mäkelä, 1998). In the United States, alcohol drinking may have caused 29% and 17% of all unintentional and intentional injuries leading to death, respectively (Brust, 2004). Many studies have shown a significant overrepresentation of subjects who have been drinking alcohol prior to their admission into an emergency room among trauma patients compared to non-trauma patients (Cherpitel, 1993; Cherpitel et al ., 2003; Borges et al ., 2006). We do not know the risk of acute alcohol drinking for head trauma. It was recently reported that the social, health and economic costs of acute alcohol-related problems may even exceed those due to chronic drinking (Chikritzhs et al ., 2001). There are numerous reports indicating that chronic alcohol abuse is associated with different types of trauma, but the role of acute alcohol drinking has been poorly investigated. Accordingly, it is very important to know the exact role of acute alcohol drinking in relation to head injuries. More attention should be paid to *Author to whom correspondence should be addressed at: Department of Neurology, Oulu University Hospital, FIN-90029 OYS, Oulu, Finland; E-mail: heavy episodic drinking, in particular, because the risks of alcohol are not restricted to regular drinking (Savola et al ., 2005). We collected data from all head trauma patients admitted into a city hospital during 1 year. We hypothesized that the number of head traumas would increase during weekends and during the most popular vacation month (July) because of the acutely increased alcohol consumption and other leisure time activities. We wanted to see whether drinking of alcohol or other leisure time activities during weekends increase the number of head traumas. We were also interested in the associations between age, gender and the severity and external causes of head trauma. We compared the temporal pattern of head trauma admissions to our hospital and the available surveys of alcohol consumption in Finland. METHODS The study includes all head trauma patients (N = 832) admitted into the Oulu University Hospital emergency department during 1 year (1999). We included all kinds of head trauma, ranging from small wounds to severe brain injuries. The study was approved by the ethical committee of the Faculty of Medicine of the University of Oulu. Oulu University Hospital serves the city of Oulu and a large rural area in northern Finland. The hospital admits patients from a defined region, and there is no selection of patients on racial or economic grounds. It is the only hospital with modern neuroimaging facilities and neurological/neurosurgical services in northern Ostrobothnia, an area with a population of 373 800. Accordingly, all acute head trauma patients suspected to have brain injury should be admitted into this hospital.  The Author 2007. Published by Oxford University Press on behalf of the Medical Council on Alcohol. All rights reserved DRINKING INCREASES THE OCCURRENCE OF HEAD TRAUMA Information on age, sex, diagnoses, day of the week when the trauma occurred, month of the year when the trauma occurred, etc. were collected from the hospital records using a structured checklist developed for this purpose. All patients with alcohol in blood or breath as well as those who, according to the emergency department records, had been found by a nurse or a physician to be under the influence of alcohol were classified as having alcohol-related trauma. Breath or blood samples were obtained from 189/832 (22.7%) patients, and additional 113/832 (13.6%) patients were judged by professional emergency care providers to be intoxicated. The criteria were based on smell of alcohol in breath combined with signs suggesting alcoholic intoxication such as unsteady gait, slurred speech or aggressive behaviour. Informed consent to obtain breath or blood alcohol is not required in our hospital. Samples are usually taken at least from all head trauma subjects with impaired consciousness. If there was no precise determination of the patient being under the influence of alcohol by the care providers or measured alcohol concentration in the hospital data, the patient was classified as sober. The 113 non-tested alcohol-related cases were randomly distributed and showed the same di (...truncated)