• Iordanis N Papadopoulos, Stefanos Bonovas, Nikolaos K Kanakaris, Ioanna Konstantiadou, Georgios Nikolopoulos, George Konstantoudakis, and Christos Leukidis.
• Fourth Surgery Department, University General Hospital Attikon, National and Kapodistrian University of Athens, 1 Rimini Street, Athens, Greece. ipapado@med.uoa.gr
• Addiction. 2010 Nov 1; 105 (11): 1952-61.

AimsThe 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.DesignRetrospective case-control study based on autopsy and toxicology.SettingsSingle faculty accepting referrals from Greater Athens and prefectures.ParticipantsConsecutive pre-hospital and in hospital fatalities.MeasurementsDemographics, toxicology, abbreviated injury scale (AIS), injury severity score (ISS), and location of death.FindingsOf 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).ConclusionsIn 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.© 2010 The Authors, Addiction © 2010 Society for the Study of Addiction.

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