Protocol and registration

This protocol has been registered with Open Science Framework (https://doi.org/10.17605/OSF.IO/Z84WK) and is being reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) statement [13]. This scoping review conforms to the requirements of JBI scoping reviews. Any amendments to this protocol will be documented and published alongside the results of the scoping review.

Eligibility criteria

Exclusion criteria.

Case reports, abstract only, or studies with full text articles that could not be accessed by the authors through the institutional access provided by the University of Manitoba will be excluded. Patients with traumatic brain injury as their only injury will be excluded because there already exists a large database of literature including systematic reviews and meta-analyses on this specific patient population [16, 17]. Literature with a study population consisting exclusively of the following cohorts will be excluded: military personnel, burn patients, substance use without concomitant alcohol use, and self-harm. These populations are often studied in isolation and the conclusions from these studies are not generalizable to the population presenting to trauma hospitals globally and therefore inclusion for the purpose of this scoping review may skew the results. In addition, study populations comprising exclusively of sexual assault victims and victims of psychological trauma are being excluded as our focus is on physical injuries and inclusion of these population may result in bias. Studies in which all patients died pre-hospital or in the ED will be excluded as the aim of this study is to examine the consequence of alcohol use on clinical outcomes throughout a hospital stay to identify intervenable measures. Patients who were not admitted to the hospital, those with only psychological trauma without physical trauma, or where data was collected from police reports or autopsy data, will be excluded as they typically lack data regarding key clinical outcomes evaluated in our study. Similarly, we will exclude studies that do not report on at least one of the outcome measures below. Inclusion and exclusion criteria are summarized in Table 1.

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Table 1. Scoping review inclusion and exclusion criteria.

https://doi.org/10.1371/journal.pone.0301241.t001

Outcome measures

We will evaluate studies with at least one of the following clinical outcomes: mortality; Injury Severity Score; surgery because of injury; in-hospital complications; resource use; long term functional impact; and psychological or abstinence-based interventions. This selection is in keeping with outcomes encountered in existing trauma literature [18–20]. In-hospital complications are defined as harmful events or negative outcomes occurring during inpatient hospitalization that occur during the processes of care and treatment rather than the natural progression of diseases as well as any complication that is listed as such by the respective publication [18, 20]. These can include but are not limited to: cardiac arrest; arrythmia; sepsis; multiorgan failure; pneumonia; respiratory distress; pulmonary embolism; seizures; delirium; and hepatic failure [18, 19]. Demographic information such as, mean age, gender, ethnicity, socioeconomic status, injury type and mechanism, will be included. Resource use will be defined as any of the following: hospital length of stay (LOS); intensive care unit (ICU) LOS; healthcare costs; and propensity to leave against medical advice [18]. Long term functional impact is defined as any of the following: trauma recidivism; discharge disposition; likelihood of return to work; financial burden; and psychological or substance use disorders after admission [21]. Preventative measures taken at the time of admission for prevention of psychological harm, risk reduction, and mitigation of substance abuse will also be discussed [22].

Search strategy

A structured search of the following electronic databases (from January 2000 onwards) will be undertaken including MEDLINE, Cochrane Library, EMBASE via OVID, SCOPUS, and CINAHL. The following keywords will be used: (injuries or wounds or trauma or traumas or wound or contusion or bruises or accident or MVC or penetrating or blunt or GSW) AND (alcohol* or binge drinking* or substance abuse* or ETOH or BAC or blood alcohol level or intoxication or substance misuse* or AWS or ethanol abuse) AND (acute care or level one trauma or trauma centre or trauma center or hospitaliz* or emergency department or emergency ward or ER or emergency room or emergency unit or intensive care unit or ICU or in-hospital). This search strategy was developed in consultation with a University of Manitoba librarian.

Data selection and screening process

Covidence will be used to manage records and data throughout the review [14]. Duplicates will be removed using this software. Following a pilot test of ten percent of the database, abstracts will be independently screened by two reviewers (DL, CG) for assessment against the inclusion criteria. In cases where decisions for inclusion/exclusion are discordant, the principal investigator will act as the tiebreaker (JN). Full-text copies of the studies will be retrieved and independently reviewed by two authors (DL, CG) to ensure inclusion/exclusion criteria are met. Excluded articles or articles requiring further consensus will be reviewed and discussed with the principal investigator (JN). Reasons for the exclusion of sources of evidence will be recorded in full in the final scoping review and presented in a PRISMA-ScR flow diagram.

Data extraction, evaluation, and synthesis

A data extraction table will be designed to record relevant information from each study including: author; study; year of publication; population; study design; objective; results; conclusions; limitations; and odds ratios for quantitative outcomes (Fig 1). This table will be piloted by two reviewers (DL, CG) using ten percent of the full text articles and reviewed with the research team before proceeding with the rest of the data extraction. Any inconsistencies in data extraction or changes required to the charting table between reviewers will be discussed and resolved prior to proceeding to ensure accuracy and cohesiveness between data collectors. The remainder of the data extraction will be done and recorded independently by one of the two reviewers conducting the initial reviews (DL, CG). Following data extraction, the table will be reorganized, and articles will be grouped based on similar study designs and outcomes. The completed table will be included as an appendix to our final scoping review.

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Fig 1. Data extraction table.

https://doi.org/10.1371/journal.pone.0301241.g001

Due to the expected variability of the reporting of outcomes, a meta-analysis will not be performed. The data will instead be analyzed based on Synthesis Without Meta-analysis (SWiM) and Enhancing transparency in reporting the synthesis of qualitative research (ENTREQ) guidelines [23, 24]. We will summarize findings for each outcome in narrative format. Where appropriate a Grading of Recommendations Assessment, Development and Evaluation (GRADE) score will be applied to the summary of outcomes [25]. Due to the nature of a scoping review and expected lack of high-quality studies (prospective studies, randomized controlled trials) there will be no formal risk of bias assessment however limitations to included studies will be recorded on an outcome level within the discussion and study level within the data extraction table.