Acute intoxication and trauma severity in emergency department patients: a systematic review

BACKGROUND: Every day, trauma patients under the influence of alcohol and/or psychotropic drugs are treated in Emergency Departments (EDs). Psychoactive substances alter cognition, judgment, and behavior and may influence injury severity, clinical management, and outcomes following trauma. Although numerous observational studies have examined intoxication among trauma patients, only a limited number of reviews have synthesized evidence on its association with injury severity and clinical outcomes. OBJECTIVE: To evaluate the association between acute alcohol and/or psychotropic drug intoxication and trauma severity and outcomes, and to determine the prevalence of intoxication among trauma patients presenting to EDs. METHODS: A systematic literature search of MEDLINE and Embase was conducted in January 2024 with a top-up search in November 2025. Prospective cohort studies including patients aged ≥ 15 years presenting to hospital-based EDs were eligible. After screening 2,132 records, 88 articles underwent full-text review, and 18 studies met the inclusion criteria. RESULTS: Across the included studies, the prevalence of alcohol intoxication ranged from 8.3% to 65.9%, drug intoxication from 14.5% to 22.1%, and combined alcohol and drug intoxication from 6.0% to 38.8%. The average prevalence was 24.7% (range 8.3-65.9%) for alcohol intoxication, 17.3% (range 14.5-22.1%) for drug intoxication and combined alcohol and drug intoxication had an average prevalence of 13.1% (range 6.0-38.8%). Nine studies reported higher injury severity scores (ISS) or a higher proportion of severely injured patients among intoxicated individuals compared with non-intoxicated patients, while other studies reported no difference or lower injury severity. Trauma outcomes, including hospital length of stay and mortality, varied substantially across studies. Male sex and younger age were consistently associated with intoxicated trauma presentations. CONCLUSION: This systematic review found inconsistent evidence regarding the association between intoxication and trauma severity and outcomes. However, a majority of the included studies in this review reported higher injury severity among intoxicated patients, particularly in those under the influence of alcohol and/or drugs. Intoxicated trauma patients were predominantly male and younger, highlighting key risk groups for targeted prevention strategies.