The role of blood alcohol concentration in triage and management of patients with severe trauma: a systematic review

Abstract

Introduction. Alcohol is a significant modifiable risk factor for severe injuries worldwide. Blood alcohol content measured upon arrival at a trauma center significantly impacts triage accuracy, injury severity assessment, physiological reaction, and clinical outcomes. This systematic review assembles current research concerning the use of blood alcohol content in the triage and care of patients with severe trauma. Material and methods. From January 2000 to August 2025, a thorough search of PubMed/MEDLINE, EMBASE, Cochrane Library, Scopus, and Web of Science was conducted. Eligible studies involved adult patients (≥18 years) with severe trauma (Injury Severity Score ≥16 or Abbreviated Injury Scale ≥3), blood alcohol concentration measurements, and documented outcomes related to triage, clinical assessment, or care. Two independent reviewers screened the citations and extracted the information. The Newcastle-Ottawa Scale was used to assess bias. This review was conducted and published in compliance with the PRISMA 2020 guidelines. Results. Forty-seven studies met the inclusion criteria, encompassing 1,247,389 trauma patients. The percentage of blood alcohol content-positive patients in trauma hospital settings ranged from 26.2% to 62.5%. A positive blood alcohol content raised the probability of unexpected injuries (OR 4.98; 95% CI 3.62–6.87), being admitted to the intensive care unit (OR 1.87; 95% CI 1.01–3.46), and needing surgery (OR 1.91; 95% CI 1.37–2.66). Upon initial admission, patients who were inebriated scored roughly 1 Glasgow Coma Scale point worse, but they improved over the next 24 hours. This raised concerns regarding triage misclassification. The evidence regarding the neuroprotective impact of alcohol in traumatic brain injury is incongruous: numerous extensive studies have shown reduced adjusted mortality in high blood alcohol content traumatic brain injury patients, while others have shown elevated mortality and an increased risk of coagulopathy. Alcohol has two contradictory impacts on blood clotting: it makes it harder for blood to clot and inhibits the process of breaking down blood clots. It also weakens the body’s natural immunological response, increasing susceptibility to post-injury infections. Conclusions. Blood alcohol content is a clinically significant triage criterion that underutilized. Systematic blood alcohol content testing should be integrated into international trauma triage guidelines. Trauma teams must not postpone critical neurological interventions while awaiting alcohol metabolism. All major trauma hospitals should standardize alcohol screening and brief intervention programs.