Can Alcohol Intoxication be Excluded as the Cause of Confusion following Head Injury?

Hall, Dennis B.; Riley, Jeffrey D.; Swann, I J

doi:10.1177/003693300505000110

Cited by 4 publications

(4 citation statements)

References 9 publications

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“…Patients observed at the OAEOC are hospitalised if they do not regain full consciousness within 4 h. The 4-h limit was set as patients poisoned by ethanol or heroin, the two most frequent toxic agents, should be awake and recovering by this time. If not awake or if confusion persists, other conditions must be suspected, most of them beyond the scope of what can be managed in the outpatient setting [ 15 , 16 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

Outpatient treatment of acute poisoning by substances of abuse: a prospective observational cohort study

Vallersnes

Jacobsen

Ekeberg

et al. 2016

Scand J Trauma Resusc Emerg Med

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BackgroundProcedures for the clinical assessment of acute poisoning by substances of abuse should identify patients in need of hospital admission and avoid hazardous discharges, while keeping the observation time short. We assess the safety of a systematic procedure developed at the Oslo Accident and Emergency Outpatient Clinic (OAEOC).MethodsAll patients 12 years and older treated for acute poisoning by substances of abuse at the OAEOC were included consecutively from October 2011 to September 2012. Data were collected on pre-set registration forms. Information on re-presentations to health services nation-wide during the first week following discharge was retrieved from the Norwegian Patient Register and from local electronic medical records. Information on fatalities was obtained from the Norwegian Cause of Death Registry.ResultsThere were 2343 cases of acute poisoning by substances of abuse. The main toxic agent was ethanol in 1291 (55 %) cases, opioids in 539 (23 %), benzodiazepines in 194 (8 %), central stimulants in 132 (6 %), and gamma-hydroxybutyrate (GHB) in 105 (4 %). Median observation time was four hours. The patient was hospitalised in 391 (17 %) cases. Two patients died during the first week following discharge, both from a new opioid poisoning. Among 1952 discharges, 375 (19 %) patients re-presented at the OAEOC or a hospital within a week; 13 (0.7 %) with a diagnosis missed at the index episode, 169 (9 %) with a new poisoning, 31 (2 %) for follow-up of concomitant conditions diagnosed at index, and 162 (8 %) for unrelated events. Among the patients with missed diagnoses, five needed further treatment for the same poisoning episode, two were admitted with psychosis, one had hemorrhagic gastritis, another had fractures in need of surgery and four had minor injuries.ConclusionThe procedure in use at the OAEOC can be considered safe and could be implemented elsewhere. The high re-presentation rate calls for better follow-up.

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Section: Discussionmentioning

confidence: 99%

Outpatient treatment of acute poisoning by substances of abuse: a prospective observational cohort study

Vallersnes

Jacobsen

Ekeberg

et al. 2016

Scand J Trauma Resusc Emerg Med

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“…However, the research findings in this area are inconclusive. Although some researchers have concluded that GCS scores are lowered by alcohol intoxication and thus fail to provide an accurate evaluation of brain injury severity [6][7][8][9][10][11][12][13], a number of studies have found that blood alcohol levels (BALs) have no effect on GCS [14][15][16][17][18][19][20][21].…”

Section: Introductionmentioning

confidence: 99%

Effect of blood alcohol level on Glasgow Coma Scale scores following traumatic brain injury

2010

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“…These effects are explained by CNS deterioration caused by the synergistic effects of brain damage and alcohol intoxication in the initial phase after brain injury [14]. Contrary to the general expectation of clinicians that alcohol intoxication in patients with brain injury would decrease consciousness, other studies have shown that BAC was not associated with GCS reduction in patients with TBI [12][13][14][15][16]. In a study of 1,075 patients with blunt TBI by Sperry et al [16], alcohol intoxication did not show a significant association with lower GCS scores in patients with TBI, and even high BACs (>250 mg/dL) did not affect the GCS score.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have found that GCS scores were decreased by alcohol [8][9][10][11]. However, other studies have also reported that the blood alcohol concentration (BAC) did not affect the GCS score [12][13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Alcohol Intoxication and Glasgow Coma Scale Scores in Patients with Head Trauma

Park

et al. 2020

J Trauma Inj

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Purpose: Alcohol intoxication is commonly associated with traumatic brain injury (TBI), but the influence of alcohol on the Glasgow Coma Scale (GCS) score remains unclear. This study investigates the effects of blood alcohol concentration (BAC) on the GCS score in head trauma patients with alcohol intoxication. methods: In total, 369 head trauma patients with alcohol intoxication in a 1-year period were retrospectively analyzed. The patients underwent head computed tomography and had a BAC ≥80 mg/dL. Patients were divided into TBI and non-TBI groups. Brain injury severity was further classified using the head Abbreviated Injury Score (AIS). The effects according to 5 BAC groups were examined. results: The TBI group consisted of 64 patients (16.2%). The mean BAC was significantly higher in the non-TBI group (293.4±87.3 mg/dL) than in the TBI group (242.8±89.9 mg/dL). The mean GCS score was significantly lower in the TBI group (10.3±4.6) than in the non-TBI group (13.0±2.5). A higher BAC showed a significant association with a lower mean GCS score in the TBI group, but not in the non-TBI group. Above ≥150 mg/dL, higher BACs showed significant odds ratios for a lower GCS score. Conclusions: The influence of alcohol in patients with head trauma depended on the presence of a brain injury. An association between a higher BAC and a lower GCS score was only observed in patients with TBI. Therefore, if a severe brain injury is suspected based on a GCS evaluation in patients with alcohol intoxication, prompt diagnosis and intensive care should be performed without delay.

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Can Alcohol Intoxication be Excluded as the Cause of Confusion following Head Injury?

Abstract: Confusion in the head injured patient with a BrAC of less than 1 mg/L, should alert one to the likelihood of causes other than alcohol intoxication.

Cited by 4 publications

References 9 publications

Outpatient treatment of acute poisoning by substances of abuse: a prospective observational cohort study

Outpatient treatment of acute poisoning by substances of abuse: a prospective observational cohort study

Effect of blood alcohol level on Glasgow Coma Scale scores following traumatic brain injury

Alcohol Intoxication and Glasgow Coma Scale Scores in Patients with Head Trauma

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