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Motor vehicle collision fatalities involving alcohol and illicit drugs in Greece: the need for management protocols and a reassessment of surveillance

Authors

  • Iordanis N. Papadopoulos,

    Corresponding author
    1. Fourth Surgery Department, University General Hospital ‘Attikon’, National and Kapodistrian University of Athens, Athens, Greece,
      Iordanis N. Papadopoulos, Fourth Surgery Department, University General Hospital ‘Attikon’, 1 Rimini Street, 124 62, Athens, Greece. E-mail: ipapado@med.uoa.gr
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  • Stefanos Bonovas,

    1. Centre for Disease Control and Prevention, Athens, Greece and
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  • Nikolaos K. Kanakaris,

    1. Fourth Surgery Department, University General Hospital ‘Attikon’, National and Kapodistrian University of Athens, Athens, Greece,
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  • Ioanna Konstantiadou,

    1. Fourth Surgery Department, University General Hospital ‘Attikon’, National and Kapodistrian University of Athens, Athens, Greece,
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  • Georgios Nikolopoulos,

    1. Centre for Disease Control and Prevention, Athens, Greece and
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  • George Konstantoudakis,

    1. Fourth Surgery Department, University General Hospital ‘Attikon’, National and Kapodistrian University of Athens, Athens, Greece,
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  • Christos Leukidis

    1. The Athens Forensic Medical Department, Ministry of Justice, Athens, Greece
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Iordanis N. Papadopoulos, Fourth Surgery Department, University General Hospital ‘Attikon’, 1 Rimini Street, 124 62, Athens, Greece. E-mail: ipapado@med.uoa.gr

ABSTRACT

Aims  The frequency and the effect of alcohol and illicit drugs on injury type, severity and location of death in motor vehicle collision (MVC) fatalities were investigated.

Design  Retrospective case–control study based on autopsy and toxicology.

Settings  Single faculty accepting referrals from Greater Athens and prefectures.

Participants  Consecutive pre-hospital and in hospital fatalities.

Measurements  Demographics, toxicology, abbreviated injury scale (AIS), injury severity score (ISS), and location of death.

Findings  Of the 1860 screened subjects, 612 (32.9%) constituted the positive toxicology group (PTG) for alcohol or illicit drugs or both and the 1248 (67.1%) the negative toxicology group (NTG). The median age was 34 (4–90) years for the PTG and 45 (3–97) years for the NTG. The PTG included significantly higher proportions of males and motorcyclists. The PTG had a 50% increased risk for a severe (AIS≥3) cervical spine and 85% for a severe upper extremity injury, compared to the NTG. A total of 29.2% of the PTG and 22.4% of the NTG deaths were non-preventable (ISS = 75). The frequency of severe trauma (ISS≥16) was comparable between PTG and NTG (P = 0.87). The PTG presented with a median ISS of 43 (6–75) versus 41 (2–75) of the NTG, hence without significant difference (P = 0.11). The pre-hospital death rate was 77.8% for the PTG versus 58% of the NTG (P < 0.001). The analysis confirmed that the odds of positive toxicology were considerably higher in the subjects who arrived dead at the hospital (OR 2.62, P < 0.001).

Conclusions  In the greater Athens region, almost a third of motor vehicle collision-related fatalities involved alcohol, illicit drugs or both. Individuals screened positive for alcohol or drugs were 2.6 times more likely to die before hospital admission than those with a negative toxicology screen, despite comparable injury severity. Specific evidence-based management protocols and reassessment of surveillance are required.

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