Effect of alcohol intoxication on the diagnosis and apparent severity of brain injury

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

“…The danger of attributing confusion to alcohol alone in an A&E setting is well recognised. 3 This has resulted in a number of studies involving blood and breath alcohol analysis some of which, have suggested blood alcohol levels below which a lowered level of consciousness should not be attributed to the effects of alcohol. Breath alcohol analysis was chosen for this study because it is rapid, non-invasive and precludes the need for laboratory facilities.…”

Head injury and the time interval to computerised tomography scan

“…The perceived influence on the delay to CT scan is possibly an underestimate. It is well known that alcohol intoxication depresses the level of consciousness but the effect on the GCS in individual patients is highly variable 24,25 . Brickley and Shepherd suggest that severe intoxication (blood alcohol concentrations over 0.24g/dL) reduces the GCS by two to three points but the range was zero to five points 25 .…”

Alcohol and the head-injured patient

“…One GCS score gives a snap shot of the patient’s consciousness at a certain point, but decision making usually relies on a series of scores to determine deterioration, stability, or improvement. Some studies report that intoxicated head-injured patients’ GCS score improves rapidly in a period of time that coincide with alcohol metabolism and elimination (Jagger et al, 1984; Shahin et al, 2010).…”

“…Concern over the later scenario, combined with other legal, social and financial considerations have led to a spectrum of attitudes within the medical literature that is sometimes contradictory and confusing. Some authors recognized the effect of alcohol intoxication on the level of consciousness a century ago (MacEwen, 1879) and stated that in evaluating patients of all grades of head injury severity, alcohol consistently had a depressive effect on the level of consciousness (Galbraith et al, 1976;Jagger et al, 1984;Sloan et al, 1989;Brickley and Shepherd, 1995) and associated intoxication with more severe injuries, and higher mortality (Pories et al, 1992;Cunningham et al, 2002). Others found no relation between alcohol in the presentation of TBI, the Glasgow Coma Scale (GCS) score, or severity and mortality (Huth et al, 1983;Nath et al, 1986;Sperry et al, 2006;Stuke et al, 2007).…”