The Effects of Admission Alcohol Level on Cerebral Blood Flow and Outcomes after Severe Traumatic Brain Injury

Alexander, Sheila; Kerr, Mary Margaret; Yonas, Howard; Marion, Donald W.

doi:10.1089/089771504774129900

Cited by 54 publications

(52 citation statements)

References 30 publications

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“…From the chosen abstracts a total of 11 full-text articles were fully reviewed. 1,3,4,6,7,22,37,38,41,45,47 Individual study characteristics are shown in Table 1. All studies included were considered to be of high quality by the Newcastle-Ottawa quality assessment scale ( Table 2).…”

Section: Resultsmentioning

confidence: 99%

“…Seven of the 11 included studies had dichotomized BAC to positive and negative. Four studies 1,3,41,47 had further categorized patients with positive BAC into low and high concentration levels (Table 1). Patients from these 4 studies were dichotomized into either BAC positive or negative for the primary analysis.…”

Section: Resultsmentioning

confidence: 99%

“…Several studies have found positive BAC to be an independent predictor of survival after TBI after baseline risk adjustment (low BAC), 3,4,22,37,38,45,47 while some studies have found no effect, 1,6,7,41 or even an increased mortality (high BAC). 47 Most included studies are register-based and thus are restricted to a limited repertoire of variables for baseline risk adjustment, such as the Injury Severity Score, AIS, and GCS.…”

Section: Key Findingsmentioning

confidence: 99%

“…Thus, lack of standardized data collection and inadequate baseline risk adjustment is a potential source of bias when interpreting the results of previous studies. On the other hand, only 2 studies, 1,6 which together composed 0.4% of the total study population, used the GCS score as the primary inclusion criteria, while the other studies mainly used the head AIS score. Head AIS score is based on head CT features and is not as sensitive as the GCS score to the level of consciousness-lowering effects of alcohol.…”

Section: Key Findingsmentioning

confidence: 99%

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

Raj¹,

Mikkonen

Siironen³

et al. 2016

JNS

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Key Findingsmentioning

confidence: 99%

Section: Key Findingsmentioning

confidence: 99%

See 2 more Smart Citations

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

Raj¹,

Mikkonen

Siironen³

et al. 2016

JNS

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“…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.…”

Section: Influence Of Alcohol and Effect On Gcs Scorementioning

confidence: 97%

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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Association Between Alcohol and Mortality in Patients With Severe Traumatic Head Injury

Tien¹

2006

Arch Surg

118

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The Effects of Admission Alcohol Level on Cerebral Blood Flow and Outcomes after Severe Traumatic Brain Injury

Cited by 54 publications

References 30 publications

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

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

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

Association Between Alcohol and Mortality in Patients With Severe Traumatic Head Injury

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