Brief intervention for patients with alcohol-related motor vehicle accident
Date First Published:
November 20, 2017
Last Updated:
November 20, 2017
Report by:
Catherine Michaud-Germain, Medical Intern (Laval University)
Three-Part Question:
In [Patients attending the emergency department for alcohol-related motor vehicle accident] is a [brief alcohol intervention better than standard of care] to [decrease future alcohol intake and/or risk of trauma recurrence]
Clinical Scenario:
A patient is sent to the ER after being involved in a car accident while driving under the influence of alcohol. Basic trauma interventions and investigations are applied to rule out life-threatening injuries, and you keep him under surveillance until his alcohol blood level normalizes. Could a brief alcohol intervention or counselling be useful in order to decrease the risk of trauma recidivism and alcohol intake?
Search Strategy:
Search performed on October 4th, 2017.
A.tMEDLINE using the PubMed interface (1900 – Août 2017)
Terms used: Alcohol AND intervention AND emergency department AND motor vehicle accident // 198 papers found
After reviewing the articles, 4 relevant papers were found
In addition, reference lists of relevant manuscripts were screened for potential studies. No new relevant studies were found. Studies on animal, cadaveric models and manikin were excluded.
B. Embase using the Elsevier interface (1966– August 2017)
Terms used: Alcohol AND intervention AND emergency department AND traffic accident OR driving under the influence // 113 papers found
After reviewing the articles, 1 relevant paper was found.
In addition, reference lists of relevant papers were checked for potential studies. No new relevant studies were found. Studies on animal, cadaveric models and manikin were excluded.
A.tMEDLINE using the PubMed interface (1900 – Août 2017)
Terms used: Alcohol AND intervention AND emergency department AND motor vehicle accident // 198 papers found
After reviewing the articles, 4 relevant papers were found
In addition, reference lists of relevant manuscripts were screened for potential studies. No new relevant studies were found. Studies on animal, cadaveric models and manikin were excluded.
B. Embase using the Elsevier interface (1966– August 2017)
Terms used: Alcohol AND intervention AND emergency department AND traffic accident OR driving under the influence // 113 papers found
After reviewing the articles, 1 relevant paper was found.
In addition, reference lists of relevant papers were checked for potential studies. No new relevant studies were found. Studies on animal, cadaveric models and manikin were excluded.
Outcome:
Altogether 3 papers were found in Medline and 1 in EMBASE. No papers were found by scanning the references of relevant papers.
All 4 relevant papers are summarized in the table 1.
All 4 relevant papers are summarized in the table 1.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Emergency Department Brief Motivational Interventions for Alcohol With Motor Vehicle Crash Patients Michael J. Mello, MD, MPH Ted D. Nirenberg, PhD Richard Longabaugh, EdD Robert Woolard, MD Alison Minugh, PhD Bruce Becker, MD, MPH Janette Baird, PhD Lynda Stein, PhD 2005 USA | Standard care (SC, n = 188) -Non-MVC n = 107 -MVC: n = 46 Brief motivational intervention (BI, n = 182) -Non-MVC: n = 95 -MVC: n = 53 Brief motivational intervention and booster (BIB, n = 169) -Non-MVC: n = 98 -MVC: n = 34 **Participants had an average baseline AUDIT score of 14.9 (SD=7.85) |
Randomized controlled trial | Reduction of alcohol-related negative consequences (DrInC) at 12months | No significant difference between MVC vs non-MVC | Limited applicability due to the large amount of resources used during interventions No analysis made comparing BI and BIB in MVC groups |
| Reduction of alcohol-related injuries (IBC) at 12 months | Significant difference in the MVC group between SC and BIB groups (p= 0.001) No significant difference in the non-MVC group between SC and BIB groups (p>0.05) | ||||
| Trauma Center Brief Interventions for Alcohol Disorders Decrease Subsequent Driving Under the Influence Arrests Carol R. Schermer, MD, MPH, Theresa B. Moyers, PhD, William R. Miller, PhD, and Lori A. Bloomfield, MSW 2006 USA | Patients involved in MVC receiving standard care (n = 62) Patients involved in MVC receiving brief intervention (n=64) ** all patients had either an admission BAC of 80 mg/dL or an Alcohol Use Disorders Identification Test (AUDIT) score of > or = 8 |
Randomized controlled trial | DUI arrest within 3 years of hospital discharge | Reduction of 10.6 % in BI vs SC group (11.3 % vs 21.9%) (p=0.11) | Potential selection bias since 25% of eligible patients declined study enrolment Possible underestimation of DUI arrest by the timing of follow-up and the limited information available that did not consider out-of-state arrests |
| Odds of having a DUI arrest within 3-years after hospital discharge based on treatment allocation, prior DUI arrests, gender, AUDIT score, and baseline BAC | BI was the strongest protective factor for DUI arrest (OR: 0.32, [95%CI: 0.11-0.96]) | ||||
| Effectiveness of Brief Interventions After Alcohol-Related Vehicular Injury: A Randomized Controlled Trial Marilyn S. Sommers, PhD, RN, FAAN, Janice M. Dyehouse, PhD, RN, Steven R. Howe, PhD, Michael Fleming, MD, MPH, Jamison D. Fargo, PhD, and John C. Schafer, PhD 2005 USA | No intervention group (n=56) Simple advice (SA) group (n = 68) Brief counseling (BC) group (n= 63) (Included booster session after a month) *only alcohol-positive participants were enrolled while patients with a potential alcohol dependency were excluded |
Randomized controlled trial | Difference in alcohol consumption 12 months after the MVC | Significant decline in alcohol consumption at 12-month follow-up in all groups No significant changes were found in alcohol consumption when the analysis was stratified by treatment condition | High number of participants lost to follow-up (47%) Participants who were excluded had a significantly higher BAC than those who were enrolled |
| Difference in adverse driving events 12 months after the MVC | No significant changes were found for any of the driving event variables when the analysis was stratified by treatment condition | ||||
| Difference in injury or health status 12 months after the MVC | The BC group only had demonstrated significant decrease (34%) in reporting injuries limiting physical activity for > or = 1 days (p = 0.003 | ||||
| Examining motor vehicle crash involvement and readiness to change on drinking and driving behaviors among injured emergency department patients Janette Baird, Eunice Yang, Valerie Strezsak & Michael J. Mello 2017 USA | Brief behavioral intervention (BI, n = 204) Attention placebo, home safety intervention (HS, n = 203) |
Randomized controlled trial | Changes in 6 impaired driving behaviours (IDS) at 12 months | No significant difference in IDS with group assignment Readiness to change alcohol use or ED visit being MVC-related at baseline did not result in greater changes in the IDS | Recruitment protocol included informing all participants that their drinking behaviors were being monitored |
| Report of MVCs and traffic violations at 12 months | No statistically significant difference reported |
Author Commentary:
Although previous studies seem to have shown that a brief alcohol intervention could decrease alcohol use and adverse effects in patients with general alcohol-related injuries admitted to the ED, the impact on patients with a MVC-related visit hasn’t been clearly demonstrated.
Most studies have failed to demonstrate that a brief alcohol intervention performed in the ED, with or without follow-up, modified significantly the alcohol drinking behaviours of this population. One hypothesis to explain these results is the MVC being, in itself, an incentive to change behaviours.
Most studies have failed to demonstrate that a brief alcohol intervention performed in the ED, with or without follow-up, modified significantly the alcohol drinking behaviours of this population. One hypothesis to explain these results is the MVC being, in itself, an incentive to change behaviours.
Bottom Line:
Based on current evidences, a brief alcohol intervention in the ED does not decrease alcohol intake, risk of trauma recidivism or modify driving behaviour in patients attending the ED for alcohol-related motor vehicle accidents.
References:
- Michael J. Mello, MD, MPH Ted D. Nirenberg, PhD Richard Longabaugh, EdD Robert Woolard, MD Alison Minugh, PhD Bruce Becker, MD, MPH Janette Baird, PhD Lynda Stein, PhD. Emergency Department Brief Motivational Interventions for Alcohol With Motor Vehicle Crash Patients
- Carol R. Schermer, MD, MPH, Theresa B. Moyers, PhD, William R. Miller, PhD, and Lori A. Bloomfield, MSW. Trauma Center Brief Interventions for Alcohol Disorders Decrease Subsequent Driving Under the Influence Arrests
- Marilyn S. Sommers, PhD, RN, FAAN, Janice M. Dyehouse, PhD, RN, Steven R. Howe, PhD, Michael Fleming, MD, MPH, Jamison D. Fargo, PhD, and John C. Schafer, PhD. Effectiveness of Brief Interventions After Alcohol-Related Vehicular Injury: A Randomized Controlled Trial
- Janette Baird, Eunice Yang, Valerie Strezsak & Michael J. Mello. Examining motor vehicle crash involvement and readiness to change on drinking and driving behaviors among injured emergency department patients