Alcohol Intoxication Increases Morbidity in
Drivers Involved in Motor Vehicle Accidents
HSIN-CHIN SHIH, MD,*† SHENG-CHUAN HU, MD,* CHIH-CHIEH YANG, MD,*
TUN-JEN KO, MD,* JER-KAN WU, MD,* AND CHEN-HSEN LEE, MD*
We prospectively examined the correlation of alcohol intoxication with
injury severity, morbidity, and mortality in drivers involved in motor
vehicle accidents in a prospective cohort study. The study enrolled 923
injured patients, of whom 421 were legally intoxicated (blood alcohol
concentration [BAC] > 50 mg/dL) and 502 were nonintoxicated (BAC <
50 mg/dL). The intoxicated drivers had a signiﬁcantly higher injury se-
verity score (ISS), lower Glasgow Coma Score, lower systolic blood
pressure; higher rate in old age, male sex, greater rate of habitual drink-
ing, greater lack of use of safety gear, and greater accident-related
morbidity. After logistic regression analysis, alcohol intoxication was
not associated with severe injury (ISS > 9); however, alcohol intoxication
analyzed either as a preinjury or postinjury risk factor, was one of the
predictors for morbidity. Severe head injury was the only predictor of
mortality. In conclusion, although alcohol intoxication is not associated
with an increased incidence of severe injury or mortality in drivers
involved in motor vehicle crashes, it is one of the signiﬁcant predic-
tors for morbidity after injury. (Am J Emerg Med 2003;21:91-94.
Copyright 2003, Elsevier Science (USA). All rights reserved.)
Many studies have consistently reported that the driver’s
risk of injury in motor vehicle accidents increases with his
or her blood alcohol concentration (BAC); however,
whether alcohol affects the severity and outcome of such
injury is still controversial.
Most experimental studies in
animals have shown that alcohol may inﬂuence the patho-
physiologic response to injury and increase the severity of
Findings in different clinical and epidemiological
studies of the relationship between alcohol and injury se-
verity continue to be conﬂicting. Some studies have found
that alcohol did not adversely affect the degree and outcome
Other studies found that alcohol was signiﬁ-
cantly associated with increased injury severity or fatal-
We performed the present, a prospective cohort
study to see whether there was a correlation of alcohol
intoxication with the severity and outcome of injury to
drivers of motor vehicle accidents.
Five medical centers were involved in the study. During
the study period, patients injured in motor vehicle accidents
were included as follows: if they had impaired conscious-
ness or were suspected of having consumed alcohol, or had
unimpaired consciousness and consented to a blood alcohol
examination. Excluded were those who refused to have a
blood alcohol examination or were transferred from other
hospitals. Measurement of BAC was done immediately
when a patient was enrolled in the study. Patient demo-
graphic variables that were recorded included age, sex,
history of habitual drinking, injury time, injury mechanism,
type of vehicle, initial vital signs, Glasgow Coma Score
(GCS), and injury sites and severity (from which the injury
severity score [ISS] was calculated). The clinical outcome,
including morbidity and mortality, was assayed. The deﬁ-
nition of morbidity included organ failure requiring inten-
sive care, or the development of infection (pneumonia,
intraabdominal sepsis, wound infection, etc) after injury.
The accuracy of the clinical judgement of alcohol consump-
tion by the medical staff was also analyzed. The study data
were recorded by nurses or residents, completed by attend-
ing physicians in the emergency medicine or trauma divi-
sions at the hospitals participating in the study.
SPSS software (SPSS 9.0 for Windows; SPSS, Inc., Chi-
cago, IL) was used for statistical analysis. All continuous
data were expressed as mean Ϯ SEM. One-way analysis of
variance was used for comparison of independent continu-
ous variables; Scheffe’s test was used for post hoc exami-
nation. For categorical data, a cross table with the chi-
square test was used. To clarify the effect of alcohol on
injury severity, morbidity, and mortality, confounding fac-
tors were controlled by using multiple logistic regression
analysis. A value of P Ͻ 0.05 was accepted as signiﬁcant.
In the 1-year study period of 1997, 923 injured drivers
were enrolled, consisting of 742 males and 181 females.
The patients’ ages ranged from 16 to 78 years, with an
average of 33.4 Ϯ 0.5 years. Eleven percent of the patients
were of old age (over 54 years old). Of the 923 patients, 206
were drivers of automobiles (22.3%) and 717 (77.7%) were
motorcyclists. There was no signiﬁcant discrepancy
between automobile drivers and motorcyclists in ISS,
GCS score, morbidity, or mortality. Alcohol intoxication
From the *Department of Emergency Medicine, Veterans General
Hospital-Taipei, and the †Institute of Clinical Medicine, National
Yang-Ming University, Taipei, Taiwan.
Manuscript received February 1, 2002; accepted March 12, 2002.
Address reprint requests to Hsin-Chin Shih MD, Department of
Emergency Medicine, Veterans General Hospital-Taipei, No. 201,
Sec. 2, Shih-Pai Rd., Taipei, Taiwan. E-mail: firstname.lastname@example.org
Key Words: Alcohol intoxication, morbidity, trauma.
Copyright 2003, Elsevier Science (USA). All rights reserved.