Waiting for the Patient to ???Sober Up???: Effect of Alcohol Intoxication on Glasgow Coma Scale Score of Brain Injured Patients

Sperry, Jason L.; Gentilello, Larry M.; Minei, Joseph P.; Friese, Randall S.; Shafi, Shahid

doi:10.1097/01.ta.0000240113.13552.96

Cited by 70 publications

(62 citation statements)

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“…13 In contrast to this, 2 other studies failed to demonstrate a clinically significant effect of alcohol in the vast majority of TBI patients. 7,17 However, subgroup analyses in these 2 studies showed some effect in the more injured patients. Sperry et al found a clinically significant effect (defined as > 1 point GCS score difference) of alcohol among intoxicated patients (BAC > 80 mg/dl) in the most injured patients: those with head AIS scores of 5.…”

Section: Influence Of Alcohol and Effect On Gcs Scorementioning

confidence: 99%

“…7 Several other studies have, however, used a single cutoff for BAC to classify patients into 2 groups. 13,17,21 Thus, they fail to identify any dose-dependent relationships between BAC and GCS scores, and the effects from very high BAC may be missed. Large individual differences in alcohol tolerance also militate against the use of a single cutoff value.…”

Section: Effect Of Alcohol In Patients With Moderate and Severe Tbimentioning

confidence: 99%

“…Sperry et al found a clinically significant effect (defined as > 1 point GCS score difference) of alcohol among intoxicated patients (BAC > 80 mg/dl) in the most injured patients: those with head AIS scores of 5. 17 A limitation of their study is that BAC was measured selectively, and they do not report the percentage of patients from the total cohort who had measurement of BAC.…”

Section: Influence Of Alcohol and Effect On Gcs Scorementioning

confidence: 99%

“…The fact that 82% of the patients in the total cohort had their BAC measured is a strength; most alcohol TBI studies have a much lower percentage 7,13,21 or have not reported it. 17 Brain injury severity was measured with the Rotterdam CT score, which is an injury scoring system based on admission CT scans that includes factors known to affect consciousness in patients with TBI. However, a limitation of the Rotterdam CT classification is that an epidural mass lesion reduces the score by 1, since this scale was developed as a prognostic measure.…”

Section: Strengths and Limitations Of The Studymentioning

confidence: 99%

“…Some studies have found that high BAC lowers GCS scores, 1,4,6,13 whereas 2 large-scale studies concluded that no clinically significant effect existed. 17,21 In the latter studies brain injury severity was controlled for by using the Abbreviated Injury Scale (Head AIS). In a more recent study, Lange et al studied the effect of alcohol in patients with (23.4%) and without intracranial traumatic findings based on CT scans from the day of injury.…”

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confidence: 99%

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Moderate and severe traumatic brain injury: effect of blood alcohol concentration on Glasgow Coma Scale score and relation to computed tomography findings

Rundhaug¹,

Moen²,

Skandsen

et al. 2015

JNS

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OBJECT The influence of alcohol is assumed to reduce consciousness in patients with traumatic brain injury (TBI), but research findings are divergent. The aim of this investigation was to study the effects of different levels of blood alcohol concentration (BAC) on the Glasgow Coma Scale (GCS) scores in patients with moderate and severe TBI and to relate the findings to brain injury severity based on the admission CT scan. METHODS In this cohort study, 265 patients (age range 16–70 years) who were admitted to St. Olavs University Hospital with moderate and severe TBI during a 7-year period were prospectively registered. Of these, 217 patients (82%) had measured BAC. Effects of 4 BAC groups on GCS score were examined with ordinal logistic regression analyses, and the GCS scores were inverted to give an OR > 1. The Rotterdam CT score based on admission CT scan was used to adjust for brain injury severity (best score 1 and worst score 6) by stratifying patients into 2 brain injury severity groups (Rotterdam CT scores of 1–3 and 4–6). RESULTS Of all patients with measured BAC, 91% had intracranial CT findings and 43% had BAC > 0 mg/dl. The median GCS score was lower in the alcohol-positive patients (6.5, interquartile range [IQR] 4–10) than in the alcohol-negative patients (9, IQR 6–13; p < 0.01). No significant differences were found between alcohol-positive and alcohol-negative patients regarding other injury severity variables. Increasing BAC was a significant predictor of lower GCS score in a dose-dependent manner in age-adjusted analyses, with OR 2.7 (range 1.4–5.0) and 3.2 (range 1.5–6.9) for the 2 highest BAC groups (p < 0.01). Subgroup analyses showed an increasing effect of BAC group on GCS scores in patients with Rotterdam CT scores of 1–3: OR 3.1 (range 1.4–6.6) and 6.7 (range 2.7–16.7) for the 2 highest BAC groups (p < 0.01). No such relationship was found in patients with Rotterdam CT scores of 4–6 (p = 0.14–0.75). CONCLUSIONS Influence of alcohol significantly reduced the GCS score in a dose-dependent manner in patients with moderate and severe TBI and with Rotterdam CT scores of 1–3. In patients with Rotterdam CT scores of 4–6, and therefore more CT findings indicating increased intracranial pressure, the brain injury itself seemed to overrun the depressing effect of the alcohol on the CNS. This finding is in agreement with the assumption of many clinicians in the emergency situation.

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Section: Influence Of Alcohol and Effect On Gcs Scorementioning

confidence: 99%