Alcohol and Drug Use in Maxillofacial Trauma Patients

1. Alcohol and Drug Use amongst Maxillofacial Trauma PatientsDr IP Corbett, School of Dental Sciences, Newcastle University, UK • email i.p.corbett@ncl.ac.uk INEBRIA 2009 • Introduction • Research has shown a correlation of alcohol with maxillofacial trauma1, however, literature on the effects of drug abuse in maxillofacial trauma is scarce, despite patients frequently self-reporting drug use. Such a trauma population may be suited to screening and brief intervention. • Aims • To determine the prevalence of alcohol and drug use in trauma patients attending a UK Accident and Emergency department with maxillofacial injuries. • Methods • Data were collected for 150 consecutive adult patients attending an A&E department with maxillofacial injuries between June and August 2008. Information relating to presenting injury, alcohol and drug intake in the preceding 12 hours and alcohol and drug history was recorded. • Results • Of 150 patient attendances, 113 were eligible for inclusion in the study. The most common age group was 21-30years. Soft tissue injury and fractured mandibles were the most common injuries (76%), the most common cause being interpersonal violence (71%). • 76% of patients had consumed alcohol within 12 hours of presentation, mean 12 units. The mean reported weekly alcohol intake was 23 units. 10% of patients reported taking non-prescription drugs within 12 hours of injury, the most commonly abused drug being cannabis. • The mean alcohol intake amongst the drug-use group was 12 units in the preceding 12 hours, 29 units per week, similar to that of the non-drug users. Results • Assault was the mode of injury in 91% patients having taken drugs within 12 hours of injury and 93% with a history of drug use, compared to 66% of non-drug users. 54% of patients with a history of drug use had previously attended with a traumatic injury compared to 32% of non-drug users. • Discussion • Regular drug use was reported in 10% of the maxillofacial trauma patients in this study, more prevalent than that recorded in the UK general population2 Drug users are more likely to present with trauma relating to alleged assault and demonstrate recidivism. • Maxillofacial trauma patients are frequently treated in the accident and emergency department and subsequently discharged. This attendance may provide a unique opportunity for screening and provision of a brief intervention. Such interventions have been shown to be effective in a similar trauma population with regard to alcohol3. The use of a drugs related brief intervention for trauma patients has not been reported in the UK. • A suitable screening and intervention package has been developed by the WHO, the ‘alcohol, smoking and substance involvement screening test’, ASSIST4. Field testing of the ASSIST tool in a UK maxillofacial trauma population is proposed. • References • Warburton AL. Shepherd JP. Alcohol-related violence and the role of oral and maxillofacial surgeons in multi-agency prevention. Int J Oral & Maxillofac Surg. 31:657-63, 2002. • Walker A, Kershaw C, Nicholas S. Crime in England and Wales 2005/2006. http://www.homeoffice.gov.uk/rds/crimeew0506.html • Goodall, C.A. et al. Nurse-delivered brief interventions for hazardous drinkers with alcohol-related facial trauma: a prospective randomised controlled trial. Br J Oral MaxillofacSurg, 46: 96-101, 2008. • Validation of the Alcohol, Smoking And Substance Involvement Screening Test (ASSIST). Humeniuk R et al. Addiction. 103(6):1039-47, 2008. Weekly alcohol intake Alcohol intake preceding 12 hours Frequency of drug use