{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T11:05:02Z","timestamp":1756811102730,"version":"3.44.0"},"reference-count":31,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2025,8,17]],"date-time":"2025-08-17T00:00:00Z","timestamp":1755388800000},"content-version":"unspecified","delay-in-days":47,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Trauma Surg Acute Care Open"],"accepted":{"date-parts":[[2025,7,21]]},"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Alcohol intoxication at the time of index trauma is associated with an increased risk of recurrent traumatic injury. It is unclear, however, whether the degree of intoxication impacts the risk of recurrence or its severity. This study aimed to analyze the relationship between alcohol level at index trauma and risk of recurrent trauma. We hypothesized that increasing levels of alcohol would be associated with an increased risk of trauma recurrence and severity.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We conducted a retrospective cohort study of adults who presented to our Level 1 trauma center between January 2020 and December 2022 with traumatic injury and a positive alcohol level (blood alcohol content (BAC)). The primary outcome of interest was recurrent trauma within 12 months. Secondary outcomes included injury severity score, hospital length of stay, and discharge location. We performed univariable and multivariable logistic regression with class balancing sensitivities controlling for baseline patient characteristics to analyze the association between risk factors and trauma recurrence.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of the 1,653 trauma encounters across 1,585 patients included in this study, 63 patients (3.8%) experienced re-injury within 12 months. Mean BAC at index trauma was higher among the recurrently injured compared with non-recurrently injured patients (270.0\u2009mg\/dL vs 221.0\u2009mg\/dL, p&lt;0.001). Multivariate analysis revealed that for all-comers increasing BAC was weakly associated with an increased risk of trauma recurrence (OR 1.004, 95%\u2009CI: 1.001 to 1.007, p=0.013), but that among the highest tertile of intoxicated patients, increasing BAC was strongly associated with recurrence (OR 2.607, 95%\u2009CI: 1.166 to 6.448, p=0.026). Recurrently injured patients were more likely to have at least one medical comorbidity.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>We found a differential effect of alcohol intoxication on the risk of trauma recurrence whereby increasing BAC was strongly associated with an increased risk of recurrence only among the most intoxicated patients.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Level of Evidence<\/jats:title>\n                  <jats:p>III, Prognostic and epidemiological<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/tsaco-2024-001743","type":"journal-article","created":{"date-parts":[[2025,8,17]],"date-time":"2025-08-17T22:25:18Z","timestamp":1755469518000},"page":"e001743","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Role of blood alcohol level on the risk and severity of trauma recurrence"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9868-3695","authenticated-orcid":false,"given":"Steven","family":"Char","sequence":"first","affiliation":[{"name":"Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bharti","family":"Sharma","sequence":"additional","affiliation":[{"name":"Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA"},{"name":"Surgery, NYC Health and Hospitals Elmhurst, Elmhurst, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Monique","family":"Arnold","sequence":"additional","affiliation":[{"name":"Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"George","family":"Agriantonis","sequence":"additional","affiliation":[{"name":"Surgery, NYC Health and Hospitals Elmhurst, Elmhurst, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer","family":"Whittington","sequence":"additional","affiliation":[{"name":"Surgery, NYC Health and Hospitals Elmhurst, Elmhurst, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Navin","family":"Bhatia","sequence":"additional","affiliation":[{"name":"Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA"},{"name":"Surgery, NYC Health and Hospitals Elmhurst, Elmhurst, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,8,17]]},"reference":[{"key":"2025081715251000000_10.3.e001743.1","first-page":"S53","article-title":"Alcohol and Trauma: The Perfect Storm","volume":"59","author":"Moore","year":"2005","journal-title":"Journal of Trauma"},{"key":"2025081715251000000_10.3.e001743.2","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.1993.01420200081015"},{"key":"2025081715251000000_10.3.e001743.3","doi-asserted-by":"crossref","first-page":"3097","DOI":"10.3390\/ijerph6123097","article-title":"Deadly partners: interdependence of alcohol and trauma in the clinical setting","volume":"6","author":"Hayman","year":"2009","journal-title":"Int J Environ Res Public Health"},{"key":"2025081715251000000_10.3.e001743.4","doi-asserted-by":"crossref","DOI":"10.1186\/1478-7954-10-9","article-title":"Global burden of injuries attributable to alcohol consumption in 2004: a novel way of calculating the burden of injuries attributable to alcohol consumption","volume":"10","author":"Shield","year":"2012","journal-title":"Popul Health Metr"},{"key":"2025081715251000000_10.3.e001743.5","doi-asserted-by":"crossref","first-page":"380","DOI":"10.15288\/jsa.2002.63.380","article-title":"A comparison of alcohol-positive and alcohol-negative trauma patients","volume":"63","author":"Blondell","year":"2002","journal-title":"J Stud Alcohol"},{"key":"2025081715251000000_10.3.e001743.6","doi-asserted-by":"crossref","first-page":"950","DOI":"10.1177\/000313480907501019","article-title":"Elevated blood alcohol level may be protective of trauma patient mortality","volume":"75","author":"Yaghoubian","year":"2009","journal-title":"Am Surg"},{"key":"2025081715251000000_10.3.e001743.7","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-199910000-00003"},{"key":"2025081715251000000_10.3.e001743.8","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1993.03510160080033"},{"key":"2025081715251000000_10.3.e001743.9","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000001823"},{"key":"2025081715251000000_10.3.e001743.10","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1097\/TA.0000000000002501","article-title":"Alcohol-related trauma reinjury prevention with hospital-based screening in adult populations: An Eastern Association for the Surgery of Trauma evidence-based systematic review","volume":"88","author":"Kodadek","year":"2020","journal-title":"J Trauma Acute Care Surg"},{"key":"2025081715251000000_10.3.e001743.11","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1097\/TA.0000000000000825","article-title":"Alcohol exposure, injury, and death in trauma patients","volume":"79","author":"Afshar","year":"2015","journal-title":"J Trauma Acute Care Surg"},{"key":"2025081715251000000_10.3.e001743.12","unstructured":"American college of surgeons . In: National Trauma Data Standard (NTDS) Data Dictionary. 2025. Available: https:\/\/www.facs.org\/quality-programs\/trauma\/quality\/national-trauma-data-bank\/national-trauma-data-standard\/"},{"key":"2025081715251000000_10.3.e001743.13","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1016\/j.jamcollsurg.2021.04.025","article-title":"Call to Action on the Categorization of Sex, Gender, Race, and Ethnicity in Surgical Research","volume":"233","author":"Nahmias","year":"2021","journal-title":"J Am Coll Surg"},{"key":"2025081715251000000_10.3.e001743.14","doi-asserted-by":"publisher","DOI":"10.1097\/00005373-199808000-00019"},{"key":"2025081715251000000_10.3.e001743.15","doi-asserted-by":"crossref","first-page":"79","DOI":"10.32614\/RJ-2014-008","article-title":"ROSE: a Package for Binary Imbalanced Learning","volume":"6","author":"Lunardon","year":"2014","journal-title":"R J"},{"key":"2025081715251000000_10.3.e001743.16","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1007\/s10618-012-0295-5","article-title":"Training and assessing classification rules with imbalanced data","volume":"28","author":"Menardi","year":"2014","journal-title":"Data Min Knowl Disc"},{"key":"2025081715251000000_10.3.e001743.17","doi-asserted-by":"crossref","unstructured":"Kuhn M . Building Predictive Models in R Using the caret Package. J Stat Soft 2008;28. doi:10.18637\/jss.v028.i05","DOI":"10.18637\/jss.v028.i05"},{"key":"2025081715251000000_10.3.e001743.18","doi-asserted-by":"publisher","DOI":"10.1613\/jair.953"},{"key":"2025081715251000000_10.3.e001743.19","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1016\/j.aci.2018.08.003","article-title":"Classification assessment methods","volume":"17","author":"Tharwat","year":"2021","journal-title":"ACI"},{"key":"2025081715251000000_10.3.e001743.20","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2008.570"},{"key":"2025081715251000000_10.3.e001743.21","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1111\/j.1530-0277.2003.tb02723.x","article-title":"Validity of Brief Alcohol Screening Tests Among Adolescents: A Comparison of the AUDIT, POSIT, CAGE, and CRAFFT","volume":"27","author":"Knight","year":"2003","journal-title":"Alcoholism Clin &Amp; Exp Res"},{"key":"2025081715251000000_10.3.e001743.22","doi-asserted-by":"publisher","DOI":"10.1300\/J465v28n03_03"},{"key":"2025081715251000000_10.3.e001743.23","doi-asserted-by":"crossref","unstructured":"Kaner EFS , Beyer F , Dickinson HO , Pienaar E , Campbell F , Schlesinger C , Heather N , Saunders J , Burnand B . Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database Syst Rev 2007:CD004148. doi:10.1002\/14651858.CD004148.pub3","DOI":"10.1002\/14651858.CD004148.pub3"},{"key":"2025081715251000000_10.3.e001743.24","article-title":"Brief interventions for heavy alcohol users admitted to general hospital wards","volume":"2011","author":"McQueen","year":"2011","journal-title":"Cochrane Database Syst Rev"},{"key":"2025081715251000000_10.3.e001743.25","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2012.02.006"},{"key":"2025081715251000000_10.3.e001743.26","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0182441","article-title":"Effect of a brief intervention for alcohol and illicit drug use on trauma recidivism in a cohort of trauma patients","volume":"12","author":"Cordovilla-Guardia","year":"2017","journal-title":"PLoS One"},{"key":"2025081715251000000_10.3.e001743.27","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1007\/s00068-025-02805-x","article-title":"Major trauma and comorbidity: a scoping review","volume":"51","author":"Glynn","year":"2025","journal-title":"Eur J Trauma Emerg Surg"},{"key":"2025081715251000000_10.3.e001743.28","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1177\/000313481908500130","article-title":"Comorbidities in Trauma Injury Severity Scoring System: Refining Current Trauma Scoring System","volume":"85","author":"Elkbuli","year":"2019","journal-title":"Am Surg"},{"key":"2025081715251000000_10.3.e001743.29","doi-asserted-by":"crossref","DOI":"10.1136\/tsaco-2024-001458","article-title":"Association of pediatric firearm injury with neighborhood social deprivation in Philadelphia","volume":"9","author":"Kauffman","year":"2024","journal-title":"Trauma Surg Acute Care Open"},{"key":"2025081715251000000_10.3.e001743.30","doi-asserted-by":"publisher","DOI":"10.1177\/003335491412900105"},{"key":"2025081715251000000_10.3.e001743.31","unstructured":"United States Census Buraeu . Census bureau quickfacts. 2024. Available: https:\/\/www.census.gov\/quickfacts\/fact\/table\/queenscountynewyork\/PST045224"}],"container-title":["Trauma Surgery &amp; Acute Care Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/tsaco-2024-001743","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,17]],"date-time":"2025-08-17T22:25:21Z","timestamp":1755469521000},"score":1,"resource":{"primary":{"URL":"https:\/\/tsaco.bmj.com\/lookup\/doi\/10.1136\/tsaco-2024-001743"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7]]},"references-count":31,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,8,17]]},"published-print":{"date-parts":[[2025,7]]}},"alternative-id":["10.1136\/tsaco-2024-001743"],"URL":"https:\/\/doi.org\/10.1136\/tsaco-2024-001743","relation":{},"ISSN":["2397-5776"],"issn-type":[{"type":"electronic","value":"2397-5776"}],"subject":[],"published":{"date-parts":[[2025,7]]}}}