Because alcohol intoxication is common among brain-injured patients, we performed this study to determine the extent to which alcohol alters the initial assessment of brain injury severity in these patients by depressing the level of consciousness. The Glasgow coma scale was used to measure the level of consciousness of 257 brain-injured adults admitted to the University of Virginia Hospital, both on arrival in the emergency room and 6 to 10 hours later. Improvement in the level of consciousness between the first and second measurements was significantly related to the blood alcohol concentration on admission. Patients with the highest blood alcohol concentrations showed the greatest improvement. Most of this effect occurred in patients with a blood alcohol concentration of 0.20% or higher. Alcohol intoxication is a potential source of bias in the clinical classification of brain injuries according to severity.
Motor vehicle crashes account for approximately one-half of all hospitalized patients with brain injury. Therefore, measures to reduce the frequency and severity of injuries from motor vehicle crashes have the potential for making a substantial impact on the incidence and severity of brain trauma. Occupant restraints, including seat belts and air bags, have been proven highly effective in preventing injuries, yet the specific benefits for the brain, the face, and the cervical spine provided by air bags have not been widely publicized. Air bags prevent the violent whiplash motion of the head in a frontal crash, resulting in a more controlled deceleration of the brain. Wrenching forces exerted on the cervical spine are attenuated, and the face is protected from contact with hard or lacerating surfaces. Furthermore, compliance is not a problem with air bags. When a car is equipped with air bags, they are in effect 100% of the time, which is important for the protection of high risk groups, such a teenage boys, who tend to wear seat belts less often than other groups. It is estimated from national data and from epidemiological studies that air bags could have prevented or reduced brain injury for 25% of the hospitalized, brain-injured population. If provided as standard equipment on both the driver and the passenger side, air bags could do more to reduce the toll of brain trauma than any other available intervention. Air bags were ready for introduction into the marketplace 15 years ago. Since then, approximately 150,000 preventable deaths and more than 1,500,000 preventable brain injuries have occurred.(ABSTRACT TRUNCATED AT 250 WORDS)
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