Toxic alcohol poisoning characteristics and treatments from 2000 to 2017 at a United States regional poison center.

BACKGROUND: Toxic alcohol exposures are an ongoing concern in the United States. In the US, few studies characterize the local epidemiology of toxic alcohols over time. OBJECTIVES: The objective was to examine the incidence of toxic alcohol ingestions and changes in management over time. METHODS: This retrospective cohort study evaluates toxic alcohol ingestion phone calls to a regional poison center in the United States covering four states. Data were queried for this poison center from the National Poison Data System (NPDS) using generic codes for each toxic alcohol. Inclusion criteria were ingestion of toxic alcohol, age ≥ 13 years, from January 1, 2000 to Dec 31, 2017. Exclusion criteria were unrelated effects coded in the medical outcome, duplicate data, or incomplete demographic data. RESULTS: Of 926 subjects (adults and teenagers), 71.5% were male, and the mean age was 34.5 years. Toxic alcohol ingestion was more common in individuals younger than 40 years, with a significant relationship between age and intentional abuse or misuse (p = 0.001). There was also a significant relationship between age and reason for ingestion, with younger patients more likely to be suicidal (p < 0.001). Ethyleneglycol was the most common toxic alcohol. There was no change in the incidence of toxic alcohol ingestions over the study period. The mortality rate was 1.7%, and 31.2%of patients were hospitalized in a critical care unit. Major effects and death were more common in younger patients (p < 0.001). There was a significant difference in medical outcomes based on the type of toxic alcohol(p = 0.03). Fomepizole was the most common treatment. A Poisson regression model found no change in fomepizole use during the study period (p = 0.1). Ethanol administration over the study period increased (p = 0.02), while hemodialysis decreased (p = 0.02). CONCLUSION: Data obtained from a single regional United States poison center showed low mortality related to toxic alcohol ingestions. The most prevalent toxic alcohol was Ethylene glycol. In all cases, toxic alcohol ingestion was higher in the 20-29-year-old age group. Reasons for ingestion, in most cases, were suicidal. Fomepizole was the most common treatment, ethanol administration as an antidote is rising, and hemodialysis utilization is decreasing. Data may not be nationally representative.

Coronary deaths during Midsummer festival in Finland: miseries of long, light nights.

This paper examines whether the anomalous summer peak in deaths from coronary heart disease (CHD) in Finland could be attributed to adverse effects of the Midsummer festival and alcohol consumption during the festival. Daily deaths from CHD and alcohol poisoning in Finland, 1961-2014, that occurred during the 7 days centering on Midsummer Day were analysed in relation to deaths during 14 to 4 days before and 4 to 14 after Midsummer Day. Daily counts of deaths from CHD among persons aged 35-64 years were regressed on days around the Midsummer period by negative binomial regression. Mortality from CHD was highest on Midsummer Day (RR 1.25 (95% confidence interval 1.12-1.31), one day after the peak in deaths from alcohol poisonings. RR for CHD on Midsummer Day was particulary high (RR = 1.43; 1.09-1.86) in the 2000s, 30% of deaths being attributable to that day. In conclusion, the anomalous and prominent summer peak in deaths from CHD in Finland is an adverse consequence of the Midsummer festival. The most likely underlying reason is heavy alcohol consumption during the festival period, especially on Midsummer Eve. In the 2000s, one third of deaths from CHD on Midsummer Day are preventable.

Alcohol and drug use among road users involved in fatal crashes in Norway.

OBJECTIVE: To study the prevalence of alcohol and drugs in biological samples from drivers, motorcycle riders, bicyclists, and pedestrians involved in fatal road traffic crashes (RTCs) during 2016-2018 in Norway, both among fatally injured victims and those who survived fatal RTCs. METHODS: Anonymous information was extracted from police data. No personal data were recorded. RESULTS: There were 330 fatal RTCs with 349 killed road users and 384 survivors during the study period; this included 179 passengers who were excluded from the study. In total, 90% of the studied killed road users and 67% of the survivors were investigated for alcohol or drug use by analyzing biological samples. Alcohol or drugs in concentrations above the legal limits were detected in 21% of the analyzed samples. The proportion impaired by alcohol or drugs (blood alcohol concentrations equal to or greater than 0.05%, or drug concentrations above equivalent limits) was highest among killed bicyclists (43%), higher than among killed pedestrians (24%), car and van drivers (28%) and motorcyclists (20%), and significantly higher than among drivers who survived fatal crashes (4%). CONCLUSIONS: Impairment due to use of alcohol or drugs was often a contributing factor among bicyclists, pedestrians and motor vehicle drivers who died in RTCs. Driving under the influence of alcohol or drugs was more often a contributing factor in cases where the motor vehicle driver was killed than in cases where the driver survived.

Walking Under the Influence : Association of Time of the Day With the Incidence and Outcomes of Intoxicated Pedestrians Struck by Vehicles.

AIM: Pedestrian fatalities commonly involve alcohol. We sought to characterize alcohol intoxication among pedestrians struck by vehicles and examine correlations between admission time and injury severity. METHODS: The Los Angeles County Trauma and Emergency Medicine Information System database was reviewed for pedestrians struck by vehicles over a 16-year period starting January 2000. Subjects aged ≥18 years with available time and day of admission were selected. Patients with available blood alcohol content (BAC) were analyzed and those with positive (+) BAC (≥ 0.01%) were compared with those with negative (-) BAC. The primary outcome was mortality. RESULT: 35 840 patients met criteria, with 12 122 (33.8%) tested for BAC. 71.2% were (+) BAC. The proportion of (+) BAC pedestrians peaked at 02:00 (48.9% of admitted pedestrians, 88.5% of BAC tested pedestrians). Patients with a (+) BAC were more likely hypotensive (3.5% vs 2.7%, P = .019) and admitted with a Glasgow Coma Scale ≤ 8 (9.4% vs 7.1%, P < .001). Overall mortality was 4.6%. Those admitted from 06:00 to 11:00 had the highest odds of mortality in (+) BAC patients (4.7%, adjusted odds ratio 3.16, adjusted P < .001). CONCLUSION: Pedestrians struck by vehicles during late hours are commonly intoxicated. These findings could help legislators to implement changes and strategies to decrease the risk and burden of injury in intoxicated pedestrians.

Frequent Alcohol Intoxication and High Alcohol Tolerance During Adolescence as Predictors of Mortality: A Birth Cohort Study.

PURPOSE: Long-term prospective studies evaluating the health burden that is consequent to adolescent drinking are needed. The aim of this study was to examine the predictive associations between self-reported alcohol tolerance and frequent intoxication at age 15-16 years and the risk of death by age 33 years. METHODS: A sample (n = 6,615; 49.3% males) of the Northern Finland Birth Cohort Study 1986 was studied. Self-reported alcohol tolerance (drinks needed to feel intoxicated) and frequency of alcohol intoxication at age 15-16 years were analyzed along with background variables and data regarding subsequent psychiatric diagnoses. Categories were formed for both predictive variables from self-reported tolerance and frequency of intoxication in mid-adolescence. Cox regression was used to calculate hazard ratios (HRs) with 95% confidence interval (95% CI) for death by age 30 years. RESULTS: By the age of 33 years, of all 6,615 participants, 53 (.8%) were deceased. The HR for death by age 33 years was 3.08 (95% CI 1.17-8.07) among adolescents with high alcohol tolerance compared with adolescents without alcohol use or intoxication. The frequency of alcohol intoxication was also associated with mortality; HR 2.05 (95% CI 1.01-4.16) for those who had been intoxicated one to two times and HR 3.02 (95% CI 1.21-7.54) for those who had been intoxicated three or more times in the past 30 days compared with adolescents without intoxication. CONCLUSIONS: High self-reported alcohol tolerance and frequent alcohol intoxication during mid-adolescence significantly predicted death by age 33 years. These behaviors carry long-term repercussions with respect to premature loss of life. Substantial efforts should be made to diminish this mortality risk.

Alcohol Intoxication and Suicide by Hanging in Poland.

AIMS: An integral part of the World Health Organization (WHO) plan to reduce suicide by 10% by 2020 is to identify areas and demographic groups, which should be priority target groups for preventive activities. This study aimed to present the demographic differences between victims of suicide by hanging in the Warsaw metropolitan area, in Poland, by examining the sobriety of victims. METHODS: Data for analysis were obtained from the documentation of the Department of Forensic Medicine (DFM) at the Medical University of Warsaw (MUW). The retrospective analysis included 358 out of 466 victims of suicides by hanging in the Warsaw metropolitan area, in Poland, recorded in the DFM documentation covering 2011-2013. The data gathered included age, gender, the cause of death, a post-mortem examination as well as the level of ethanol in the blood and muscles of victims. RESULTS: In both groups, men accounted for a larger percentage of victims than women, P = 0.068. In the no-alcohol group, the victims were older than in the alcohol group (47.52 ± 19.21 vs. 40.88 ± 12.77) (P < 0.001). The majority of the studied population were victims aged 25-34 (22.90%), mainly men (20.95%). Young men were also the largest group among victims in the alcohol group (28.33%). The most numerous age group among no-alcohol group were older victims aged 55-64 (19.10%), especially men (16.29%). CONCLUSION: Regardless of sobriety, men were the largest group of suicide victims in the study population, which means that men die suicide more often than women. Differences in gender proportions are related to age. In the studied population, it was primarily young victims, mainly men. These are the groups that should be priority target groups for preventive activities aimed at reducing the number of suicides. The presence of ethanol in more than half of the victims of suicide in the study population indicates that alcohol is an important suicidal risk factor.

Comparing Logistic Regression Models with Alternative Machine Learning Methods to Predict the Risk of Drug Intoxication Mortality.

(1) Medical research has shown an increasing interest in machine learning, permitting massive multivariate data analysis. Thus, we developed drug intoxication mortality prediction models, and compared machine learning models and traditional logistic regression. (2) Categorized as drug intoxication, 8,937 samples were extracted from the Korea Centers for Disease Control and Prevention (2008-2017). We trained, validated, and tested each model through data and compared their performance using three measures: Brier score, calibration slope, and calibration-in-the-large. (3) A chi-square test demonstrated that mortality risk statistically significantly differed according to severity, intent, toxic substance, age, and sex. The multilayer perceptron model (MLP) had the highest area under the curve (AUC), and lowest Brier score in training and validation phases, while the logistic regression model (LR) showed the highest AUC (0.827) and lowest Brier score (0.0307) in the testing phase. MLP also had the second-highest AUC (0.816) and second-lowest Brier score (0.003258) in the testing phase, demonstrating better performance than the decision-making tree model. (4) Given the complexity of choosing tuning parameters, LR proved competitive when using medical datasets, which require strict accuracy.

Suicide, Alcohol Intoxication, and Age Among Whites and American Indians/Alaskan Natives.

BACKGROUND: Among American Indians/Alaskan Natives (AI/ANs), suicides are disproportionately high among those younger than 40 years of age. This paper examines suicide and alcohol intoxication (postmortem BAC ≥ 0.08 g/dl) by age among Whites and AI/ANs to better understand the reasons for the high rate of suicide among AI/ANs for those younger than 40. METHODS: Data come from the restricted 2003 to 2016 National Violent Death Reporting System (NVDRS), with postmortem information on 79,150 White and AI/AN suicide decedents of both genders who had a BAC test in 32 states of the United States. RESULTS: Among Whites, 39.3% of decedents legally intoxicated are younger than 40 years of age, while among AI/ANs the proportion is 72.9% (p < 0.001). Multivariable logistic regression with data divided by age shows that in the 18 to 39 age group, AI/ANs are about 2 times more likely than Whites to have a postmortem BAC ≥ 0.08. Veteran status compared to nonveteran, and history of alcohol problems prior to suicide were also associated with BAC ≥ 0.08. Suicide methods other than by firearm and a report of the presence of 2 or more suicide precipitating circumstances were protective against BAC ≥ 0.08. Results for the age group 40 years of age and older mirror those for the younger group with 1 exception: Race/ethnicity was not associated with BAC level. CONCLUSIONS: The proportion of suicide decedents with a BAC ≥ 0.08 is higher among AI/ANs than Whites, especially among those 18 to 39 years of age. However, acute alcohol intoxication does not fully explain differences in suicide age structure between AI/ANs and Whites.

Significant decrease in the rate of fatal alcohol poisonings in Finland validated by blood alcohol concentration statistics.

BACKGROUND: Alcohol may cause death directly by acute poisoning, as well as induce illnesses or accidents that lead to death. Our research question was whether the current decreasing trend in acute fatal alcohol poisonings in Finland is a real phenomenon or an artefact caused by possible changes in the process of determining the cause of death. METHODS: All cases in the national post-mortem toxicology database in which the underlying cause of death was acute alcohol poisoning in 1987-2018 were investigated in terms of blood alcohol concentration (BAC), age and gender. The number of acute alcohol poisonings was compared to the number of deaths from alcohol induced illness in the post-mortem toxicology database. RESULTS: A total of 12 126 acute alcohol poisoning cases were retrieved. Between 2004 and 2017 the number of acute alcohol poisonings decreased 60.1 %. At the same time the number of alcohol induced illnesses in the study material remained stable or decreased marginally. The median BAC in all acute alcohol poisonings was 3.2 g/kg. The annual median BAC values showed a small but significant decrease over the study period. The proportion of women in acute alcohol poisonings increased significantly over the study period, from 17.1%-22.3%. Women were on average 2.5 years older than men. CONCLUSIONS: On grounds of the BAC statistics and supporting evidence, we conclude that the significant decrease in the number of fatal alcohol poisonings is true and likely reflects changes in the overall consumption of alcohol.

[Morphological markers of liver function in alcohol intoxication]. / Morfologicheskie markery funktsional'noi aktivnosti pecheni pri alkogol'noi intoksikatsii.

The aim of this study was to find additional diagnostic markers characterizing the functional state of the liver to substantiate the cause of death from ethanol poisoning. A total of 95 deaths from acute ethanol poisoning and 15 deaths from craniocerebral injury were studied. Signs of steatosis, chronic hepatitis or cirrhosis were taken into account in histological examination of the liver. The histochemical activity of ethano-locking enzymes was determined in structurally functional zones of the acini: portal pathways (Zone 1), liver beams (Zone 2) and central veins (Zone 3). Quantitative indices characterizing functional-metabolic activity of the liver during acute ethanol poisoning were obtained.

[The forensic medical characteristic of the non-identified corpses based on the materials of Bureau of Forensic Medical Expertise of the Moscow Health Department]. / Sudebno-meditsinskaia kharakteristika neopoznannykh trupov po dannym Biuro sudebno-meditsinskoi ékspertizy Departamenta zdravookhraneniia Moskvy.

We undertook the analysis of the archive data of forensic medical expertises of the non-identified corpses accumulated at the tanatological divisions of the Moscow Bureau of Forensic Medical Expertise for the period from 2012 till 2016. Special attention was given to sex and age composition of the deceased as well as the structure of mortality and the traces of ethyl alcohol, if any, present in the blood. It was shown that the majority of the unidentified bodies were those of the young men, with the main cause of the non-violent deaths being the cardiovascular pathology. Ethyl alcohol was found in the blood of 43% of the corpses. The analysis encompassed also the most frequently used methods for personality identification based on the data available from the medical-criminalistic department of the Bureau of Forensic Medical Expertise. The statistical treatment of the results of the study provided materials making it possible to envision the tendencies of the further development and improvement of the methods for personality identification for the purpose of forensic medical expertise and judicial practice.

Minimum Legal Drinking Age and Youth Health: Evidence From Japan.

OBJECTIVE: Recent studies showed that reducing the minimum legal drinking age (MLDA) could cause negative health outcomes among youth. This evidence was drawn primarily from a limited set of geographical regions. This study seeks to widen available evidence by using data from Japan, where the government started considering reducing the MLDA from 20 to 18. METHOD: Using a regression discontinuity design, we compared emergency service event rates related to alcohol intoxication and mortality rates through external causes between those who were slightly younger and older than the age of 20. RESULTS: We showed that granting legal access to alcohol at age 20 doubled the use of emergency services used for alcohol intoxication but had little impact on mortality as measured by traffic fatalities, suicide, and other accidents. CONCLUSIONS: Our findings suggest that lowering the MLDA in Japan will increase (potentially reckless and excessive) drinking behavior among young adults ages 18 and 19 but will not increase their mortality from accidents.

Characteristics of sauna deaths in Korea in relation to different blood alcohol concentrations.

Although the benefits of sauna bathing have been demonstrated in epidemiological studies, sauna deaths have been reported. The aim of this study was to determine the demographic and forensic characteristics associated with different blood alcohol concentrations (BACs) in sauna deaths in Korea. In this retrospective analysis, data were collected from a nationwide pool in Korea between January 2008 and December 2015 to determine the role of alcohol intoxication in sauna deaths based on the subjects' BAC and to evaluate the demographic and forensic characteristics associated with different BACs. One hundred and three deaths were classified into 2 groups: the non-intoxication (NI) group (BAC,<0.08%; n = 27) and the intoxication (I) group (BAC,≥0.08%; n = 76). Demographic and forensic characteristics were compared between the groups using a multinomial logistic regression analysis. The proportions of decedents who were male (odds ratio: 17.4, 95.0% confidence interval: 3.8-79.8) and in a prone position at the scene of death (odds ratio: 11.3, 95.0% confidence interval: 2.1-60.1) were significantly higher (P < 0.001 and P < 0.05, retrospectively) in the I group than in the NI group. However, no significant differences were observed with respect to obesity, coronary artery narrowing, and liver pathology. Sauna deaths exhibited different characteristics according to BACs detected at autopsy. The differences in sauna deaths between the I and NI groups may have implications for the targeted prevention of sauna deaths associated with alcohol consumption.

[Clinical pathomorphology and tanatogenesis of various forms of alcoholic intoxication]. / Klinicheskaia patomorfologiia i tanatogenez razlichnykh form alkogol'noi intoksikatsii.

The objective of the present study was to identify the clinical and pathomorphological changes in the internal organs for the elucidation of the cause of death associated with various forms of alcoholic intoxication (chronic alcoholic intoxication, poisoning with surrogate alcohols, etc.). The analysis of the clinical conditions resulting from alcohol abuse has demonstrated that the principal pathology underlying the fatal outcome is complemented by a variety of non-lethal somatic disorders aggravating the patients' condition and enhancing its severity. The clinicians are known to give more attention to the accompanying somatic complications than to the cause underlying the main pathology (alcoholism). Such attitude in the absence of the adequate treatment of the alcohol dependency is neither clinically efficient nor economically appropriate. Poisoning with surrogate alcohols is characterized by the pulmonary-cerebral variant of tanatogenesis in the combination with hypercoagulation and the erosive processes in the gastrointestinal tract whereas death from alcoholic intoxication is usually associated with heart tanatogenesis.

Sixfold Post-Fracture Mortality in 16- To 30-Year-Old Patients-Suicides, Homicides, and Intoxications Among Leading Causes of Death.

BACKGROUND AND AIMS:: The death of any young individual is associated with the loss of many potentially fulfilling years of life. It has been suggested that the relative mortality of fracture patients may be higher in younger age groups than in older cohorts. We determined the mortality and causes of death in a cohort of 16- to 30-year-old patients that had been hospitalized for fractures. MATERIAL AND METHODS:: We collected data using criteria based on the diagnosis code (International Statistical Classification of Diseases and Related Health Problems, 10th Revision), surgical procedure code (Nordic Medico-Statistical Committee), and seven additional characteristics of patients admitted to the trauma ward at the Central Finland Hospital between 2002 and 2008. Patients were then followed to ascertain their mortality status until the end of 2012. Standardized mortality ratios were calculated and causes of death were determined by combining our registry data with data provided by Statistics Finland. RESULTS:: During the study, 199 women and 525 men aged 16-30 years had sustained fractures. None of these patients died during the primary hospital stay. At the end of follow-up (mean duration 7.4 years), 6 women and 23 men had died. The standardized mortality ratio for all patients was 6.2 (95% Confidence Interval: 4.3-8.9). Suicides and intoxications comprised over half, and motor vehicle accidents and homicides comprised nearly a third of the post-fracture deaths. CONCLUSION:: We found a concerning increase in mortality among young adults that had been hospitalized due to a fracture compared to the general population that had been standardized by age, sex, and calendar-period. Leading causes of death were suicides and intoxications or motor vehicle accidents and homicides, which may be indicative of depressive disorders or impulse control disorders, respectively. Identification of the underlying psychosocial problems may provide an opportunity for preventive interventions.

[Alcohol-associated mortality in Russia (based on the materials for the period from 2011 till 2016)]. / Alkogol'-assotsiirovannaia smertnost' v Rossii (po materialam 2011-2016 gg.).

The objective of the present study was to evaluate the frequency of alcoholic drunkenness documented during forensic medical expertises (investigations) of the corpses carried out in this country throughout the period from 2011 till 2016. The investigations were conducted with the use of medical statistics methods by calculating the fractional difference, dynamics, and rates of detection of the cases of alcoholic intoxication depending on the cause of death. The study has demonstrated the high frequency of the cases of alcoholic drunkenness revealed during forensic medical expertises (investigations) of the corpses that amounted to 30.5% [15, 16]. The total number of the corpses examined in 2016 was 8.6% higher than in 2011. The frequency of the documented cases of alcoholic drunkenness during the same period decreased by 19.7%. The frequency of the documented cases of alcoholic drunkenness in the cases of violent death was 2.8 times that in the cases of death from various diseases (52.8 and 19.0% respectively). The enhanced frequency of alcoholic drunkenness in relation to the number of the conducted forensic medical expertises was documented in the cases of death by drowning and from hypothermia whereas the lowest frequency of alcoholic intoxication was recorded for the corpses of the people who had died from malignant tumours and diseases of the nervous system. Various regions of Russia differed in terms of the frequency of alcoholic drunkenness recorded among the recently deceased people.

Age of first drunkenness and risks for all-cause mortality: A 27-year follow-up from the epidemiologic catchment area study.

BACKGROUND: Early-onset drunkenness is associated with an increased risk of developing an alcohol use disorder (AUD), which predicts excess mortality risk. Here, we estimated mortality risk for drinkers with and without early drunkenness. METHODS: For 14,848 adult participants interviewed about drinking, drunken episodes, and AUD in 1981-83 for the Epidemiologic Catchment Area in New Haven (Connecticut), Baltimore (Maryland), St. Louis (Missouri), and Durham (North Carolina), we linked National Death Index records through 2007. RESULTS: Cox regression modeling estimates showed excess mortality for drinkers with age of first drunkenness earlier than 15 years old (hazard ratio, HR: 1.47, 95% CI: 1.25, 1.72) and when first drunkenness occurred at or after age 15 (HR: 1.20, 95% CI: 1.11, 1.29), as compared with adults who had never been drunk. Consistent results were observed, irrespective of AUD history. That is, early drunkenness signaled excess mortality risk even in absence of AUD. CONCLUSIONS: In a large community sample from four cities in the US, early age of onset of drunkenness predicts mortality risk. We discuss experiments to investigate the possible causal significance of this predictive association.

Alcohol-control public service announcements (PSAs) and drunk-driving fatal accidents in the United States, 1996-2010.

Widespread concern regarding the detrimental effects of excessive alcohol consumption (especially by minors) and associated social problems (particularly drunk driving) continues to exist among policymakers, law enforcement officers, and the general public. Alcohol consumption is a leading contributor to death from injuries, which itself is one of the main causes of death for people under 21years of age in the United States. This study examines the relationship between the volume and timing of alcohol-control public service announcements (PSAs) and rates of drunk-driving fatal accidents in the U.S. We estimate ordinary least squares (OLS) regression models to predict rates of drunk-driving fatal accidents by state and month as a function of the volume of alcohol-control PSAs aired during the previous 8months. Models include controls for state anti-drunk-driving laws and regulations, state demographic characteristics, state taxes on alcohol, calendar year, and seasonality. Results indicate that higher volumes of anti-drunk driving PSAs airing in the preceding 2 to 3months are associated, albeit modest in magnitude, with reduced rates of drunk-driving fatal accidents. The regression coefficients are largest for adults (relative to underage drunk drivers) and when the PSAs air during prime time (relative to daytime or nighttime). We conclude that PSAs could play an important contributing role in reducing drunk-driving fatal accidents, although levels of exposure and potential effects likely remain modest due to reliance on donated air time. Well-funded anti-drunk driving campaigns could achieve higher levels of exposure and have a larger impact.

Fatal accidents at work in agriculture associated with alcohol intoxication in Lower Silesia in Poland.

BACKGROUND: Determining the prevalence of alcohol intoxication and the level of intoxication in victims of fatal occupational accidents is necessary to improve work safety. The circumstances of the accident and the time between alcohol consumption and death are important factors. MATERIAL AND METHODS: A retrospective review of 18 935 medico-legal autopsy reports and toxicological reports performed in the Department of Forensic Medicine at the Wroclaw Medical University, Poland, in the years 1991-2014. The study protocol included circumstances, time and cause of death, injuries, quantitative testing for the presence of ethyl alcohol, gender and age. RESULTS: There were 98 farm-related fatalities. There were 41.8% (N = 41) of victims who had been intoxicated - 95.1% (N = 39) of them were males aged 19-70 years old, 4,9% (N = 2) were females aged 37-65 years old. In 8 cases the blood alcohol concentration (BAC) was 50-150 mg/dl; in 15 cases it was 150-250 mg/dl and in 18 cases it was > 250 mg/dl. In 21 cases, the BAC was determined using alternative material and 76% (N = 16) victims were in the alcohol elimination phase with 19% (N = 4) victims in the alcohol absorption phase. The most common causes of death were traffic accidents, drowning and deaths resulting from being caught in or hit by moving parts of machinery or equipment. CONCLUSIONS: Alcohol consumption is a crucial risk factor in fatal agricultural accidents. In order to establish the time of alcohol consumption, all victims of agricultural accidents should be tested for alcohol concentration in their blood and urine or vitreous. Improving safety at work requires that the sobriety of employees should be monitored before and during work. Med Pr 2017;68(1):23-30.

Impact of Helmet Use on Severity of Epidural Hematomas in Cambodia.

BACKGROUND: Traumatic brain injury is a major cause of morbidity and mortality worldwide, often necessitating neurosurgical intervention to evacuate intracranial bleeding. Since the early 2000s, Cambodia has been undergoing a rapid increase in motorcycle transit and in road traffic accidents, but the prevalence of helmet usage remains low. Epidural hematomas are severe traumatic brain injuries that can necessitate neurosurgical intervention. METHODS: This is a retrospective cohort study of patients with epidural hematoma secondary to motorcycle accidents who presented to a major national tertiary care center in Phnom Penh, Cambodia, between November 2013 and March 2016. All patients were diagnosed with computed tomography of the head. RESULTS: In this cohort, 21.6% of patients in motorcycle accidents presented with epidural hematoma and 89.1% of patients were men, 47.6% were intoxicated, and were 87.8% were not wearing helmets at the moment of impact. Not wearing a helmet was associated with a 6.90-fold increase in odds of presenting with a moderate-to-severe Glasgow coma scale score and a 3.76-fold increase in odds of requiring craniotomy or craniectomy for evacuation of hematoma. Male sex was also associated with increased odds of higher clinical severity at presentation and indication for craniotomy or craniectomy, and alcohol intoxication at the time of accident was not associated with either. CONCLUSIONS: Helmet usage is protective in reducing the severity of presentation and need for neurosurgical intervention for patients with epidural hematoma secondary to motorcycle accidents.