Traumatic brain injury and alcohol intoxication: effects on injury patterns and short-term outcome

Abstract

Purpose A significant number of patients with traumatic brain injuries (TBI) are diagnosed with elevated blood alcohol concentration (BAC). Recent literature suggests a neuroprotective effect of alcohol on TBI, possibly associated with less morbidity and mortality. Our goal is to analyze the association of different levels of BAC with TBI characteristics and outcome. Methods Adult patients with moderate to severe TBI (AIS ≥ 2) and measured BAC admitted to the Trauma Centre West (TCW), during the period 2010–2015, were retrospectively analyzed. Data included injury severity (AIS), length of hospitalization, admittance to the Intensive Care Unit (ICU) and in-hospital mortality. The association of BAC with ICU admittance and in-hospital mortality was analyzed using multivariable logistic regression analysis with correction for potentially confounding variables. Results BACs were available in 2,686 patients of whom 42% had high, 26% moderate, 6% low and 26% had normal levels. Patients with high BAC’s were predominantly male, were younger, had lower ISS scores, lower AIS-head scores and less concomitant injuries compared to patients in the other BAC subgroups. High BACs were associated with a lower risk for in-hospital mortality (AOR 0.36, 95% CI 0.14–0.97). Also, patients with moderate and high BACs were less often admitted to the ICU (respectively, AOR 0.36, 95% CI 0.25–0.52 and AOR 0.40, 95% CI 0.29–0.57). Conclusion The current study suggests that in patients with moderate to severe TBI, increasing BACs are associated with less severe TBI, less ICU admissions and a higher survival. Further research into the pathophysiological mechanism is necessary to help explain these findings.

Pre-injury health status and excess mortality in persons with traumatic brain injury: A decade-long historical cohort study

“…There is growing evidence from human studies on the effect of alcohol in persons with TBI on mortality, given the metabolic and neurological effects of alcohol 33 . Several populationbased cohort studies reported that alcohol intoxication at the time of injury was not associated with in-hospital or long-term mortality or improved survivorship, taking into account TBI severity, age and sex 34,35,36 ; one study 37 reported the opposite -that alcohol intoxication increases risk of mortality. Such discrepancies may be due to the numerous dose-related effects of alcohol, the time of exposure in relation to the injury, temporary versus continuous effects 38 , or genetic susceptibility 39 .…”