HMN 2026: How Alcohol-intoxicated, severely injured patients often misdiagnosed, receive less treatment before hospital arrival

Physical trauma is the leading cause of death in young adults. About 1 in 4 patients with multiple trauma is alcohol-intoxicated at the time of injury, typically suffering from a fall or a traffic accident. The medical assessment of severely injured people on the scene and en route to the hospital is a crucial and challenging step, determining life-saving measures, time-critical interventions, transport decisions, and hospital destinations.

This assessment is more difficult in patients who have used alcohol, which affects physiological, neurological, and cognitive processes and behavior. Little is known about the prehospital treatment of polytrauma patients who have used alcohol.

According to a new German study, emergency medical clinicians are more likely to misdiagnose severely injured patients with a positive blood alcohol level and provide fewer treatments before hospital arrival. The study is published in Alcohol: Clinical & Experimental Research.

The researchers analyzed a database of severely injured patients admitted to hospitals through the emergency room who were subsequently transferred to intensive care. Multiple trauma patients aged 16 and older with a documented blood alcohol level were matched with sober patients of similar age, sex, and injury patterns, resulting in a total of 3,234 patient pairs.

In both patient groups, the most common injuries were to the head, but the analysis revealed differences in prehospital diagnoses. Among people who later tested positive for blood alcohol, head and facial injuries were more often overdiagnosed or underdiagnosed than in sober patients. Moreover, among multiple trauma patients with similar injury patterns, alcohol-intoxicated patients received fewer prehospital interventions, including sedation, intubation, pelvic stabilization, fluid therapy, and circulatory support. However, this lower level of prehospital treatment was not associated with higher mortality.

The misdiagnosis of intoxicated patients may reflect clinician bias and/or the challenge of distinguishing between alcohol-related symptoms and signs of physiological trauma. This, along with disparate prehospital treatment decisions, has the potential to negatively influence outcomes. The researchers therefore recommend targeted training for emergency medical services and emergency physicians to enhance the assessment and care of alcohol-intoxicated trauma patients, reducing the risk of suboptimal prehospital management.

The content is provided for information purposes only.