The effects of alcohol and marijuana on survival after severe traumatic brain injury: A retrospective cohort study

Abstract

Background Alcohol (ETOH) and marijuana (THC) use have previously shown to improve outcomes after Traumatic Brain Injury (TBI). However, whether TBI severity impacts outcomes among patients tested positive for both ETOH and THC remains unclear. Materials and methods A retrospective review from the Northern Ohio Regional Trauma Registry, which includes deidentified data from six regional hospitals, including three Level 1 and three Level 3 trauma centers, was performed to assess adult (>18 years) patients with severe TBI (head Abbreviated Injury Score ≥ 3) between January 2012 and December 2018 having an alcohol and drug toxicology screen and data regarding outcome at discharge. Patients were divided into two groups: 1) patients with a negative ETOH and drug test, and 2) patients positive for ETOH + THC. Mortality at discharge was the primary outcome measure and multiple logistic regression was used to assess predictors of mortality at discharge. Results A total of 854 (median age: 51 years [range: 18–72]; 34.4% female [294/854]) patients were included. On multiple logistic regression, age (p = 0.003), days in intensive care unit (ICU) (p < 0.001), Glasgow Coma Scale (GCS) (p < 0.001), Injury Severity Score (ISS) (p < 0.001), length of stay (LOS) (p < 0.001), and days on ventilator support (p = 0.032) were significant predictors of mortality at discharge. Blood alcohol content (BAC), cause of TBI, drug class, and sex were not significant predictors of mortality at discharge. Conclusions After severe TBI, positive THC and BAC screening did not predict mortality at discharge after controlling for confounding variables, indicating no survival benefit for patients with severe TBI.

Isolated traumatic brain injury: Routine intubation for Glasgow Coma Scale 7 or 8 may be harmful!

“…Early intubated patients were more likely to have a GCS score of 7 (53.4% vs. 40.5%, p < 0.001) and a positive toxicology screen for illegal drugs (26.5% vs. 20.2%, p = 0.001), and also sustained more severe head injuries (p < 0.001). The respiratory rate on admission was similar between the two groups (18 [15][16][17][18][19][20][21][22] in the immediate intubation group vs. 18 [16][17][18][19][20][21] in the delayed/no intubation group, p = 0.356), whereas the oxygen saturation was higher in the immediate intubation group (99% [96-100%] vs. 98% [96-100%], p = 0.008). The overall mortality was 18.7% in patients with an immediate intubation, compared with 15.6% in patients with a delayed or no intubation (p = 0.046).…”

“…15,16 The evidence from clinical studies remains controversial, with some studies showing a lower mortality associated with alcohol consumption, [17][18][19][20][21] and others showing no effect. 22,23 Furthermore, head AIS, GCS score of 7, tachycardia, and younger age were identified as independent clinical factors associated with intubation. These factors could potentially be taken into account to formulate a more selective approach to immediate intubation.…”

“…In animal studies, alcohol has been shown to have a neuroprotective effect after traumatic brain injury 15,16 . The evidence from clinical studies remains controversial, with some studies showing a lower mortality associated with alcohol consumption, 17–21 and others showing no effect 22,23 …”

Long-Term Outcomes in Severe Traumatic Brain Injury and Associated Factors: A Prospective Cohort Study

“…Tohme et al [ 68 ] showed that GCS < 9 in emergency department, abnormal pupil reaction, and ISS ≥ 25 were factors associated with mortality at 14 days after severe TBI (Abbreviated Injury Scale score of head region > 3). Likewise, in the Leskovan study et al [ 73 ], age, ICU, GCS, ISS, LOS (day) are factors associated with mortality in patients those patients, however, the use of blood alcohol content was not a significant predictor of mortality at discharge. Finally, Bonow et al was also able to show in his study in Latin America that the location for the patient treatment was also related with their outcome [ 3 ].…”