Variability in antemortem and postmortem blood alcohol concentration levels among fatally injured adults

ABSTRACT

Background: Excessive alcohol use is a risk factor for injury-related deaths. Postmortem blood samples are commonly used to approximate antemortem blood alcohol concentration (BAC) levels.

Objectives: To assess differences between antemortem and postmortem BACs among fatally injured adults admitted to one shock trauma center (STC).

Method: Fifty-two adult decedents (45 male, 7 female) admitted to a STC in Baltimore, Maryland during 2006–2016 were included. STC records were matched with records from Maryland’s Office of the Chief Medical Examiner (OCME). The antemortem and postmortem BAC distributions were compared. After stratifying by antemortem BACs <0.10 versus ≥0.10 g/dL, differences in postmortem and antemortem BACs were plotted as a function of length of hospital stay.

Results: Among the 52 decedents, 22 died from transportation-related injuries, 20 died by homicide or intentional assault, and 10 died from other injuries. The median BAC antemortem was 0.10 g/dL and postmortem was 0.06 g/dL. Thirty-one (59.6%) decedents had antemortem BACs ≥0.08 g/dL versus 22 (42.3%) decedents using postmortem BACs. Postmortem BACs were lower than the antemortem BACs for 42 decedents, by an average of 0.07 g/dL. Postmortem BACs were higher than the antemortem BACs for 10 decedents, by an average of 0.06 g/dL.

Conclusion: Postmortem BACs were generally lower than antemortem BACs for the fatally injured decedents in this study, though not consistently. More routine antemortem BAC testing, when possible, would improve the surveillance of alcohol involvement in injuries. The findings emphasize the usefulness of routine testing and recording of BACs in acute care facilities.

KEYWORDS:

• Alcohol
• binge drinking
• blood alcohol concentration (BAC)
• injury
• deaths

Acknowledgements

The authors would like to acknowledge Maryland’s Office of the Chief Medical Examiner for granting access to some of the data used in this study. This study was partially supported by Cooperative Agreements Numbers 5U48DP005045 for Naomi Greene and NU38OT000203 for Roumen Vesselinov, Timothy Kerns, Kimberly Auman, Margaret Lauerman from the Centers for Disease Control and Prevention. Naomi Greene was also partially supported by NCI National Research Service Award T32 CA009314. Its contents are solely the responsibility of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention or the Department of Health and Human Services.

Disclosure of interest

Margaret Lauerman reports grants from the National Highway Traffic Safety Association, the Maryland Highway Safety Office and the Surgical Infection Society, outside the submitted work. The authors report no other potential disclosures of interest.

Additional information

Funding

This study was partially supported by Cooperative Agreements Numbers [5U48DP005045] for Naomi Greene and [NU38OT000203] for Roumen Vesselinov, Timothy Kerns, Kimberly Auman, Margaret Lauerman from the Centers for Disease Control and Prevention. Naomi Greene was also partially supported by a Cancer Epidemiology, Prevention, and Control Training Grant from the National Cancer Institute of the National Institutes of Health [T32-CA-009314]. Its contents are solely the responsibility of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention or the Department of Health and Human Services.