Identifying harmful alcohol use with phosphatidylethanol 16:0/18:1 in patients with suspected severe injury

Background: Acute and chronic alcohol use are known risk factors for accidents and injuries, and injury risk can be further increased by concurrent use of psychoactive drugs. Long-term alcohol consumption can be determined by blood sample analysis of the biomarker phosphatidylethanol (PEth). In this study, the aim was to investigate the prevalence of alcohol use measured by PEth 16:0/18:1 in patients with suspected severe injury, and how levels of alcohol use relate to injury mechanism and concurrent psychoactive medicinal and illicit drug use.

Methods: All patients aged >= 16 years admitted with trauma team activation in Norway during a 12-month period were included in the Impairing Drugs and Alcohol as Risk factors for Traumatic Injuries (IDART) study. Injury date and mechanism, gender and age were recorded. Left-over blood samples from routine diagnostics were analyzed for psychoactive medicinal and illicit drugs, ethanol and PEth 16:0/18:1. Patients with PEth >= 30 nM were included in the analyses.

Results: Totally, 2537 patients were included in the analyses. Of these, 35% had PEth 16:0/18:1 concentration >= 300 nM, indicative of harmful alcohol use. The highest proportion of harmful alcohol use was found among patients with violence and fall as injury mechanism (52% and 43%, respectively). In addition, psychoactive drug use was prevalent among patients with harmful alcohol use (38%).

Conclusions: Harmful alcohol use (PEth 16:0/18:1 concentration >= 300 nM) was prevalent among patients with suspected severe injury, especially among patients with violence and fall as injury mechanism. There was also a high proportion of concurrent psychoactive drug use among patients with harmful alcohol use. These findings emphasize the need to detect and treat harmful alcohol use among trauma patients to prevent further morbidity and mortality.