The Impact of Drug and Alcohol Intoxication on Glasgow Coma Scale Assessment in Patients with Traumatic Brain Injury

DiGiorgio, Anthony M; Wittenberg, Blake; Crutcher, Clifford; Kennamer, Brooke; Greene, Clarence S.; Velander, Alan J.; Wilson, Jason; Tender, Gabriel C.; Culicchia, Frank; Hunt, John P.

doi:10.1016/j.wneu.2019.12.095

Cited by 25 publications

(15 citation statements)

References 17 publications

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“…DiGiorgio et al, for instance, suggests that alcohol and drug use can interfere with initial GCS assessment, by showing that there is a greater change in GCS score in impaired patients in follow up GCS assessments. 16 We found that there was no difference in BAC between patients who were later admitted to the ICU and those who were not. However, it is also interesting that, in those admitted to the ICU, patients with higher BAC had shorter ICU LOS, but no difference in hospital LOS.…”

Section: Discussionmentioning

confidence: 55%

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Higher Blood Alcohol Concentration is Related to Less Severe Injury Amongst Intoxicated Trauma Patients

Kumar

Prabhakaran

McIntyre

et al. 2020

Preprint

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Background Previous studies show varied results regarding the protective effects of alcohol intoxication upon injury and mortality in the setting of trauma. Our study aimed to determine the effects of blood alcohol content (BAC) amongst trauma patients with alcohol ingestion, upon injury type and severity, as well as outcomes. Methods This 4-year retrospective study (2013–2017) used an institutional trauma database to capture all Level 1 and 2 trauma patients (≥14 years old) with BAC > 10 mg/dL presenting to the emergency department at a Level 1 trauma center. Demographic variables including mechanism of injury (MOI) were collected. Patients’ BAC was compared to their calculated injury severity scores (ISS) and abbreviated injury scale (AIS) scores. Analysis included linear regression, T-tests and ANOVAs with Tukey’s post-hoc analysis for continuous variables and Fisher’s exact test for binary variables. Multivariate regression analysis was performed to determine independent predictors of injury severity. Results 332 intoxicated patients were identified (mean BAC: 210.2±87.14 mg/dL, range 12.7–460.0; 74.1% male; median age 35; range: 16–90). The median ISS was 6 (range: 1–48). Patients in motor vehicle collisions had lower BACs (186.0±5.59 mg/dL) than those who fell (233.8±10.42 mg/dL, p = 0.0002), were assaulted (230.4±14.04 mg/dL, p = 0.0261), or were pedestrians struck (259.4±14.17 mg/dL, p = 0.004). Overall, patients with higher BAC had lower GCS, lower ISS, and shorter intensive care unit (ICU) length of stay, but no differences in hospital stay, or ventilator days. Conclusions Trauma patients with higher BAC have lower ISS, less severe chest injury, and shorter ICU stays. These findings suggest that higher levels of alcohol ingestion may portend a protective effect in the setting of trauma with respect to severity of injury that does not mitigate the importance of education and injury prevention but warrants further study into the physiology of alcohol and trauma.

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Section: Discussionmentioning

confidence: 55%

“…There are con icting reports regarding the in uence of alcohol on GCS, but this supports various studies that show that GCS assessment is affected by alcohol. [16][17][18] There were no other signi cant relationships between BAC within MOI in respect to hospital course.…”

Section: Discussionmentioning

confidence: 81%

Higher Blood Alcohol Concentration is Related to Less Severe Injury Amongst Intoxicated Trauma Patients

Kumar

Prabhakaran

McIntyre

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…In addition, despite injuries being worse according to GCS scores in the ETOH + THC compared to the No Substances group, the No Substances group had a longer median LOS; this finding may be attributed to the older age distribution in the No Substances group, as older patients are known to have longer recovery times after TBI [ 10 ]. GCS scores measured in intoxicated patients, including positive BAC, THC, benzodiazepines, opiates, and cocaine, have also been shown to be confounded, possibly affecting performance metrics and predictive analytics [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

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

Leskovan

Patel

Pederson

et al. 2020

Annals of Medicine and Surgery

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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.

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“…With the individual effects of alcohol and marijuana on TBI still contested, their combined effects on mortality have not been explicitly studied. DiGiorgio et al investigated the impact of drug and alcohol intoxication on GCS assessment in patients with TBI, and found that intoxicating substances can confound GCS score with impaired patients having a significantly higher mean change in GCS score compared with patients with a negative screening test [ 19 ]. A retrospective review by O'Phelan et al studied the impact of substance abuse on mortality in patients with TBI by comparing amphetamine, benzodiazepine, narcotic, cannabis, cocaine, alcohol, polydrug, and polydrug, excluding alcohol, and found that methamphetamine use was a significant predictor of mortality [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

The combined effects of alcohol and marijuana use prior to traumatic brain injury on mortality

Leskovan

Patel

Pederson

et al. 2020

Annals of Medicine and Surgery

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Background Alcohol (ETOH) intoxication is a common comorbidity in traumatic brain injury (TBI), and marijuana (THC) has been implicated as a major risk factor for trauma. The objective this study was to investigate the combined effects of ETOH and THC on mortality after TBI. Materials and methods A retrospective review of patient data was performed to assess adult (>18 years) patients with brain injuries between January 2012 and December 2018. Included patients sustained TBI (Abbreviated Injury Scale (AIS 1-6)) and were divided into two groups: No Substances and THC + ETOH. Results 1085 (median age 52 years [range: 18–97 years]; 33.5% female (364/1085)) patients met the inclusion criteria. Significant differences for mortality at discharge were found between groups (p = 0.0025) with higher mortality in the No Substances group. On multiple logistic regression, a positive test for both ETOH + THC was found not to independently predict mortality at discharge, while age, Glasgow Coma Scale, intensive care unit stay, Injury Severity Score, length of hospital stay, and days on ventilator were independent predictors. Conclusions After controlling for confounding variables, positive ETOH + THC screens were not found to be independent predictors of mortality at discharge. Therefore, our results indicated no survival benefit for TBI patients with concomitant ETOH and THC use prior to injury.

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The Impact of Drug and Alcohol Intoxication on Glasgow Coma Scale Assessment in Patients with Traumatic Brain Injury

Cited by 25 publications

References 17 publications

Higher Blood Alcohol Concentration is Related to Less Severe Injury Amongst Intoxicated Trauma Patients

Higher Blood Alcohol Concentration is Related to Less Severe Injury Amongst Intoxicated Trauma Patients

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

The combined effects of alcohol and marijuana use prior to traumatic brain injury on mortality

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