L. T. Knowlin1, S. Siram1, E. E. Cornwell1, M. Williams1 1Howard University College Of Medicine,General Surgery,Washington, DC, USA
Introduction: The “Found Down” descriptor for trauma patients in our urban setting is common. It often is unclear whether these patients have experienced significant traumatic injury necessitating an extensive trauma workup versus medical conditions that require acute management. Furthermore, many “Found Down” patients are not severely injured, but rather are suffering from acute substance abuse. We evaluated the association between overall blood alcohol levels (BAL) and injury severity.
Methods: A retrospective cohort study using trauma registry data for non-motorized patients presenting to a Level I Trauma Center between 2015-2018. Patients who had elevated BAL measurements were included. Patients were divided in 4 distinct subgroups based on BAL: 1. < 200 mg/dl 2. 200-300 mg/dl 3. 300-400 mg/dl 4. > 400 mg/dl. Descriptive analysis of the cohort was performed. Bivariate analysis was conducted comparing injuring level of patients in the 4 groups.
Results:The “Found Down” descriptor was utilized in 554 trauma patients in the study time frame. There were a total of 325 patients were included in this study with 312 (96%) having a BAL > 50 mg/dl. Concomitant substance abuse with an additional drug was seen in 39 patients (12%). Of the 325 patients labelled “Found Down” 314 (97%) had injuries on evaluation and 6 (2%) required surgical intervention. Of the 2% with surgical intervention, 3 (50%) had an Injury Severity Score (ISS) greater than 16. Moderate to severe injuries (ISS ≥ 8) was seen highest in patients with BAL < 200mg/dL. Found down patients with a BAL > 400 mg/dl were more likely to present with minor injuries (extremity and trunk contusions and lacerations) and have a lower Injury Severity Score.
Conclusion:The “Found Down” descriptor for urban trauma patients is associated with alcohol intoxication. Most of the cohort of “Found Down” trauma patients in this study were mildly injured. Alcohol intoxication of > 400 mg/dl (Group 4) was not associated with increased injury severity when compared to similar patients with BAL of < 200 mg/dl. Most “Found Down” trauma patients who were moderately to severely injured were found in Group 1 (BAL < 200 mg/dl). “Found Down” patients are likely to have a low injury severity and there is no association with injury severity and increasing BAL.
