Alcohol intoxication ups bladder injury, surgery in patients involved in vehicle collisions

Alcohol intoxication fuels the risk of bladder injury and subsequent surgical repair in people sustaining motor vehicle collisions (MVCs), reports a study. Moreover, intoxication above the legal limit is a stronger predictor of bladder injury requiring surgical repair than pelvic fracture.

“Indeed, among patients with bladder injury, pelvic fracture may predict nonoperative management,” the researchers said. “Trauma providers should have a high index of suspicion for bladder injuries in alcohol intoxicated patients, particularly those with seat belt restraints.”

Patients involved in MVCs were identified from the National Trauma Data Bank from 2017 to 2019. The researchers categorized participants into an intoxication and intoxication negative group. They also collected data on age, sex, driver status, seat belt restraint use, blood alcohol content (BAC) level, nonalcoholic intoxication, pelvic fracture, and Injury Severity Scale.

Bladder injury and bladder surgical repair, the primary outcomes, were evaluated, while the association with pelvic fracture and restraint use were explored.

A total of 594,484 patients were identified, of which 97,831 (16.5 percent) had a positive alcohol screen. Patients in the intoxication group were more likely to be high with other substances (32.8 percent vs 14.6 percent; p<0.001), have a bladder injury (1 percent vs 0.4 percent; p<0.001), and receive bladder surgical repair (0.7 percent vs 0.15 percent; p<0.001) than those in the intoxication negative group. [J Urol 2022;208:1090-1097]

Injury Severity Scale and pelvic fracture were significantly associated with bladder injury. Adjusted analysis confirmed the association of higher blood alcohol content with both outcomes. Of note, alcohol intoxication above the legal limit more strongly predicted bladder surgical repair than pelvic fracture. The interaction of intoxication with both outcomes did not differ by pelvic fracture but was more robust with seat belt use at higher BAC levels.

An earlier study reported the dose-dependent manner in which alcohol consumption causes injuries related to MVCs. [Alcohol Clin Exp Res 2012;36:1827-1834]

“We found alcohol intoxication at any level is associated with increased risk of bladder injury and bladder surgical repair,” the researchers said. “While an empty bladder is rarely injured, a full bladder is most susceptible to trauma and injury.” [Adv Urol 2019;2019:2614586; Springer 2013:55-71]

Ethanol suppresses the release of antidiuretic hormones, which then increases urine volume and bladder fullness. The acute diuretic response to alcohol is positively associated with BAC. [Physiol Behav 1968;3:319]

“Our observations confirmed this relationship in a dose-dependent manner, with higher BAC levels increasing the likelihood of bladder injury and need for bladder surgery,” the researchers said. “In patients involved in an MVC who have a positive blood alcohol screening, trauma providers should suspect and assess for signs of bladder injury.”

Early identification and intervention of bladder injury is vital since a delayed diagnosis may result in longer hospital stays, a greater risk of complications, and higher costs of care, according to the researchers. [Am Surg 2013;79:589-593; J Inj Violence Res 2019;11:101-106]