Motor vehicle collision fatalities involving alcohol and illicit drugs in Greece: the need for management protocols and a reassessment of surveillance

Addiction. 2010 Nov;105(11):1952-61. doi: 10.1111/j.1360-0443.2010.03072.x. Epub 2010 Sep 15.


Aims: The frequency and the effect of alcohol and illicit drugs on injury type, severity and location of death in motor vehicle collision (MVC) fatalities were investigated.

Design: Retrospective case-control study based on autopsy and toxicology.

Settings: Single faculty accepting referrals from Greater Athens and prefectures.

Participants: Consecutive pre-hospital and in hospital fatalities.

Measurements: Demographics, toxicology, abbreviated injury scale (AIS), injury severity score (ISS), and location of death.

Findings: Of the 1860 screened subjects, 612 (32.9%) constituted the positive toxicology group (PTG) for alcohol or illicit drugs or both and the 1248 (67.1%) the negative toxicology group (NTG). The median age was 34 (4-90) years for the PTG and 45 (3-97) years for the NTG. The PTG included significantly higher proportions of males and motorcyclists. The PTG had a 50% increased risk for a severe (AIS ≥3) cervical spine and 85% for a severe upper extremity injury, compared to the NTG. A total of 29.2% of the PTG and 22.4% of the NTG deaths were non-preventable (ISS=75). The frequency of severe trauma (ISS ≥16) was comparable between PTG and NTG (P=0.87). The PTG presented with a median ISS of 43 (6-75) versus 41 (2-75) of the NTG, hence without significant difference (P=0.11). The pre-hospital death rate was 77.8% for the PTG versus 58% of the NTG (P<0.001). The analysis confirmed that the odds of positive toxicology were considerably higher in the subjects who arrived dead at the hospital (OR 2.62, P <0.001).

Conclusions: In the greater Athens region, almost a third of motor vehicle collision-related fatalities involved alcohol, illicit drugs or both. Individuals screened positive for alcohol or drugs were 2.6 times more likely to die before hospital admission than those with a negative toxicology screen, despite comparable injury severity. Specific evidence-based management protocols and reassessment of surveillance are required.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Accidents, Traffic / mortality*
  • Accidents, Traffic / statistics & numerical data
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Alcohol Drinking / adverse effects
  • Alcohol Drinking / blood
  • Alcohol Drinking / epidemiology
  • Alcoholic Intoxication / complications
  • Alcoholic Intoxication / epidemiology*
  • Automobile Driving
  • Autopsy
  • Case-Control Studies
  • Child
  • Child, Preschool
  • Female
  • Greece / epidemiology
  • Humans
  • Male
  • Middle Aged
  • Motor Vehicles
  • Retrospective Studies
  • Substance Abuse Detection / statistics & numerical data*
  • Substance-Related Disorders / blood
  • Substance-Related Disorders / complications
  • Substance-Related Disorders / epidemiology*
  • Trauma Severity Indices
  • Wounds and Injuries / blood
  • Wounds and Injuries / classification
  • Wounds and Injuries / mortality*
  • Young Adult