Influence of Alcohol on Early Glasgow Coma Scale in Head-Injured Patients

Shahin, Hazem; Gopinath, Shankar P.; Robertson, Claudia S.

doi:10.1097/ta.0b013e3181edbd47

Cited by 48 publications

(46 citation statements)

References 51 publications

(42 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…1,4,6,13 In the most recent study, Shahin et al found larger differences between GCS score on admission and best Day 1 GCS score in intoxicated patients (BAC > 80 mg/dl) than in the nonintoxicated patients. 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.…”

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%

“…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.…”

Section: Strengths and Limitations Of The Studymentioning

confidence: 99%

See 2 more Smart Citations

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

View full text Add to dashboard Cite

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.

show abstract

Section: Influence Of Alcohol and Effect On Gcs Scorementioning

confidence: 99%

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

confidence: 99%

Section: Strengths and Limitations Of The Studymentioning

confidence: 99%

See 1 more Smart Citation

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

View full text Add to dashboard Cite

show abstract

“…31 However, the relationship between alcohol and GCS score remains controversial, with some studies suggesting a significant reduction in GCS score due to alcohol intoxication and some suggesting no relationship. [32][33][34] This is of importance as alcohol intoxicated patients may be classified as having a more severe TBI due to the potential GCS score-lowering effects of alcohol. 34 Accordingly, when assessing the role of BAC on outcome, it may misleadingly appear that alcohol intoxicated patients have a better outcome, compared with sober patients (at the time of injury), as they drastically recover from low GCS score.…”

Section: Raj Et Almentioning

confidence: 99%

Acute Alcohol Intoxication and Long-Term Outcome in Patients with Traumatic Brain Injury

Raj

Skrifvars

Kivisaari

et al. 2015

Journal of Neurotrauma

View full text Add to dashboard Cite

The effect of blood alcohol concentration (BAC) on outcome after traumatic brain injury (TBI) is controversial. We sought to assess the independent effect of positive BAC on long-term outcome in patients with TBI treated in the intensive care unit (ICU). We performed a retrospective analysis of 405 patients with TBI, admitted to the ICU of a large urban Level 1 trauma center between January 2009 and December 2012. Outcome was six-month mortality and unfavorable neurological outcome (defined as a Glasgow Outcome Scale score of 1 [death], 2, [vegetative state], or 3 [severe disability]). Patients were categorized by admission BAC into: no BAC (0.0&; n = 99), low BAC ( < 2.3&; n = 140) and high BAC ( ‡ 2.3&; n = 166). Logistic regression analysis, adjusting for baseline risk and severity of illness, was used to assess the independent effect of BAC on outcome (using the no BAC group as the reference). Overall six-month mortality was 25% and unfavorable outcome was 46%. Multivariate analysis showed low BAC to independently reduce risk of sixmonth mortality compared with no BAC (low BAC adjusted odds ratio [AOR] 0.41, 95% confidence interval [CI] 0.19-0.88, p = 0.021) and high BAC (AOR 0.58, 95% CI 0.29-1.15, p = 0.120). Furthermore, a trend towards reduced risk of six-month unfavorable neurological outcome for patients with positive BAC, compared to patients with negative BAC, was noted, although this did not reach statistical significance (low BAC AOR 0.65, 95% CI 0.34-1.22, p = 0.178, and high BAC AOR 0.59, 95% CI 0.32-1.09, p = 0.089). In conclusion, low admission BAC ( < 2.3&) was found to independently reduce risk of six-month mortality for patients with TBI, and a trend towards improved long-term neurological outcome was found for BAC-positive patients. The role of alcohol as a neuroprotective agent warrants further studies.

show abstract

“…2,46 Although the GCS score is a strong predictor of outcome in TBI, its use may be limited in alcohol-intoxicated patients as it has been shown that alcohol may decrease the GCS score. 40 Adjusting for the GCS score may lead to outcome bias as patients with positive BAC may be classified as having a more severe TBI than they really have. Thus, lack of standardized data collection and inadequate baseline risk adjustment is a potential source of bias when interpreting the results of previous studies.…”

Section: Key Findingsmentioning

confidence: 99%

Alcohol and mortality after moderate to severe traumatic brain injury: a meta-analysis of observational studies

Raj¹,

Mikkonen

Siironen³

et al. 2016

JNS

View full text Add to dashboard Cite

T raumaTic brain injury (TBI) is defined as an alteration of brain function, or other evidence of brain pathology, caused by an external force.28 Moderate to severe TBI is a major cause of mortality and morbidity in the world. 27 Every year approximately 1.5 million people die and 10 million people are hospitalized due to TBI. 18 This leads to great suffering for patients and their relatives, with huge direct and indirect costs to society. 10,32 It has been estimated that the annual costs of TBI in the US are more than $76.5 billion.9 Numerous clinical trials have failed to demonstrate the efficacy of promising experimental neuroprotective agents despite convincing preclinical data. Over the past 2 decades there have not been clear improvements in the prognosis of patients with TBI. 24,25 Description of the interventionUp to half of all patients with TBI are under the influence of alcohol at the time of injury. 44,49 Clinical studies investigating the role of alcohol (ethanol, CH 3 CH 2 OH, referred to as alcohol in the present study) on the outcome of TBI have been either retrospective or observational, as it probably would be unethical, unless strong evidence can be laid out, to administer alcohol to patients presenting with TBI. This meta-analysis investigates the impact of the presence of blood alcohol concentration (BAC) on outcome after TBI. How Might alcohol work as a Neuroprotective agent?The neuroprotective properties of alcohol have been abbreviatioNs AIS = Abbreviated Injury Scale; BAC = blood alcohol concentration; GCS = Glasgow Coma Scale; NMDAR = N-methyl-d-aspartate receptor; TBI = traumatic brain injury. but with good study homogeneity (I 2 = 36% and 14%). coNclusioNs Positive BAC was significantly associated with lower mortality rates in moderate to severe TBI. Whether this observation is due to selection bias or neuroprotective effects of alcohol remains unknown. Future prospective studies adjusting for TBI heterogeneity is advocated to establish the potential favorable effects of alcohol on outcome after TBI.

show abstract

Influence of Alcohol on Early Glasgow Coma Scale in Head-Injured Patients

Cited by 48 publications

References 51 publications

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

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

Acute Alcohol Intoxication and Long-Term Outcome in Patients with Traumatic Brain Injury

Alcohol and mortality after moderate to severe traumatic brain injury: a meta-analysis of observational studies

Contact Info

Product

Resources

About