Zero tolerance

Minimum legal drinking age (MLDA) laws exist in every state, making it illegal to sell alcohol to anyone under the age of 21. Enforcement through retailer compliance checks has resulted in a reduction in underage sales. Every state also has a zero tolerance law that makes it illegal for anyone under 21 to drive after consuming any amount of alcohol. These laws also have led to a reduction in drinking and driving crashes involving teenagers.

Deadly combination

According to the Centers for Disease Control and Prevention, Atlanta, GA, the percentage of teens in high school who drink and drive has decreased by more than half since 1991. Nonetheless, this risky behavior remains a threat to public safety. Currently about one in 10 high school teenagers drinks and drives. High school teens drive after drinking approximately 2.4 million times each month. Drivers ages 16 to 20 are 17 times more likely to die in a crash when their blood alcohol concentration is at or above .08 percent when compared with same-age drivers who have not been drinking.*

Hospital discharge status

Hospital discharge status

To examine the occurrence of underage drinking-related motor vehicle injuries in the National Trauma Data Bank® (NTDB®) research dataset for 2013, admissions medical records were searched using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnoses codes. Specifically searched were records for patients younger than 21 years of age, and external cause of injury codes (E-codes) E810–E819 (motor vehicle traffic crashes) with the fourth digit value of either 0, driver of a motor vehicle other than motorcycle, or 2, motorcyclist.

These records were then searched by the alcohol use indicator field where actual testing was performed with a field value of 2, no alcohol found, confirmed by test; 3, yes, trace confirmed by test; or 4, yes, beyond legal limit. A total of 13,484 records were found. Of these records, 11,100 contained a discharge status, including 8,975 patients discharged to home, 1,305 to acute care/rehab, and 508 sent to skilled nursing facilities; 312 died (see figure).

These patients were 66 percent male, typically 18.4 years of age, had an average hospital length of stay of 5.1 days, an intensive care unit length of stay of 5.5 days, an average injury severity score of 12.3, and were on the ventilator for an average of 6.3 days. Alcohol testing indicated 29 percent of patients with alcohol present.

Reducing the risk

Several strategies have worked to reduce teen drinking and driving. The MLDA and zero tolerance policies described previously are two examples of successful initiatives. Along with these laws, the graduated driver licensing (GDL) system, under which drivers pass through several stages of restricted driving before obtaining a license, helps new drivers gain experience under less risky conditions. Each state has a GDL, but the rules still vary from state to state.

Another major component of teen drinking and driving reduction strategies involves parental involvement. Whether it is through signing a parent-teen driving agreement or a focus on monitoring and enforcing the rules of the road, there should be zero tolerance for teenagers becoming victims in motor vehicle-related crashes.

Throughout the year, we will be highlighting data through brief reports in the Bulletin. The National Trauma Data Bank Annual Report 2013 is available on the ACS website as a PDF file at In addition, information about how to obtain NTDB data for more detailed study is available on the website. To learn more about submitting your trauma center’s data, contact Melanie L. Neal, Manager, NTDB, at

Statistical support for this article has been provided by Chrystal Caden-Price, data analyst, NTDB.

*Centers for Disease Control and Prevention. Teen drinking and driving. Available at: Accessed December 27, 2013.

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