scholarly journals P052: The effect of blood alcohol on outcomes in patients with major traumatic brain injury in Nova Scotia

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S96-S96
Author(s):  
R. Green ◽  
N. Kureshi ◽  
L. Fenerty ◽  
G. Thibault-Halman ◽  
M. Erdogan ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Nova Scotia ◽  
Brain Injury ◽  
Injury Severity ◽  
Blood Alcohol Concentration ◽  
Alcohol Concentration ◽  
Blood Alcohol ◽  
Injury Score ◽  
Using Data ◽  
Alcohol Testing

Introduction: Although alcohol use increases the risk of experiencing a traumatic brain injury (TBI), it remains unclear whether outcomes in alcohol-impaired patients are different from those of unimpaired patients. The objective of this study was to evaluate the effect of alcohol on length of stay (LOS) and mortality in patients with major TBI. Methods: Using data collected from the Nova Scotia Trauma Registry, we performed a retrospective analysis of all patients with major TBI (defined as having an abbreviated injury score (AIS) head ≥3) seen in Nova Scotia hospitals between 2002 and 2013. Patients were compared by blood alcohol concentration (BAC) at time of injury: negative (0-1.9 mmol/L), low (2-21 mmol/L), and moderate/high (≥22 mmol/L). A logistic regression model was constructed to test for outcomes and adjusted for the effects of age, gender, location, injury severity score (ISS), and BAC level. Results: In a twelve-year period, there were 4152 major TBI patients in Nova Scotia. Alcohol testing was performed in 43% of cases (80% male, mean age 44±20 years), with 48% having a positive BAC. Mean acute LOS was similar for all three BAC groups. Increasing age (odds ratio [OR]=1.01; p<0.001), high ISS (OR=4.92; p<0.001), injuries occurring outside of Halifax Regional Municipality (OR=1.72; p<0.001), and having a lower BAC level (OR = 0.99; p<0.001) independently predicted mortality. Conclusion: Our findings suggest that low BAC levels are associated with increased mortality in major TBI patients. Further study is warranted to elucidate alcohol’s mechanism in TBI outcomes.

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

2015 ◽  
Vol 122 (1) ◽  
pp. 211-218 ◽  
Author(s):  
Nils Petter Rundhaug ◽  
Kent Gøran Moen ◽  
Toril Skandsen ◽  
Kari Schirmer-Mikalsen ◽  
Stine B. Lund ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Injury Severity ◽  
Blood Alcohol Concentration ◽  
Alcohol Concentration ◽  
Dependent Manner ◽  
Blood Alcohol ◽  
Severe Tbi ◽  
Gcs Score ◽  
Dose Dependent

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.

Correlating the Blood Alcohol Concentration with Outcome after Traumatic Brain Injury: Too Much Is Not a Bad Thing

2011 ◽  
Vol 77 (10) ◽  
pp. 1416-1419 ◽  
Author(s):  
Cherisse Berry ◽  
Eric J. Ley ◽  
Daniel R. Margulies ◽  
James Mirocha ◽  
Marko Bukur ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Los Angeles ◽  
Linear Trend ◽  
Blood Alcohol Concentration ◽  
Alcohol Concentration ◽  
Multivariable Logistic Regression Analysis ◽  
Blood Alcohol ◽  
Severe Tbi ◽  
The Relationship

Although recent evidence suggests a beneficial effect of alcohol for patients with traumatic brain injury (TBI), the level of alcohol that confers the protective effect is unknown. Our objective was to investigate the relationship between admission blood alcohol concentration (BAC) and outcomes in patients with isolated moderate to severe TBI. From 2005 to 2009, the Los Angeles County Trauma Database was queried for all patients ≥14 years of age with isolated moderate to severe TBI and admission serum alcohol levels. Patients were then stratified into four levels based on admission BAC: None (0 mg/dL), low (0-100 mg/dL), moderate (100-230 mg/dL), and high (≥230 mg/dL). Demographics, patient characteristics, and outcomes were compared across levels. In evaluating 3794 patients, the mortality rate decreased with increasing BAC levels (linear trend P < 0.0001). In determining the relationship between BAC and mortality, multivariable logistic regression analysis demonstrated a high BAC level was significantly protective (adjusted odds ratio 0.55; 95% confidence interval: 0.38-0.8; P = 0.002). In the largest study to date, a high (≥230 mg/dL) admission BAC was independently associated with improved survival in patients with isolated moderate to severe TBI. Additional research is warranted to investigate the potential therapeutic implications.

Traumatic brain injury in patients screened for blood alcohol concentration based on the mechanism of injury

Brain Injury ◽  
2019 ◽  
Vol 33 (4) ◽  
pp. 419-426 ◽  
Author(s):  
Ayman El-Menyar ◽  
Rafael Consunji ◽  
Mohammed Asim ◽  
Ahammed Mekkodathil ◽  
Rifat Latifi ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Blood Alcohol Concentration ◽  
Alcohol Concentration ◽  
Blood Alcohol ◽  
Mechanism Of Injury

The Importance of Alcohol Testing by Gas Chromatography vs the Cordebard Classical Method Modified in the Medico Legal Investigation

2018 ◽  
Vol 69 (9) ◽  
pp. 2407-2410
Author(s):  
Dan Perju Dumbrava ◽  
Carmen Corina Radu ◽  
Sofia David ◽  
Tatiana Iov ◽  
Catalin Jan Iov ◽  
...  
Keyword(s):  
Gas Chromatography ◽  
Chromatographic Method ◽  
Classical Method ◽  
Blood Alcohol Concentration ◽  
Alcohol Concentration ◽  
Blood Alcohol ◽  
Technical Details ◽  
Gas Chromatographic Method ◽  
Alcohol Testing ◽  
Living Person

Considering the growing number of requests from the criminal investigations authorities addressed to the institutions of legal medicine, testing of blood alcohol concentration both in the living person and in the corpse, we believe that a presentation of the two methods which are used in our country, is a topic of interest at present. The purpose of this article is to provide the reader with the technical details on how blodd alcohol concentration is realised by means of the gas chromatographic method and the classical one, (Cordebard modified by D. Banciu and I. Droc) respectively. Another purpose of this article is to also show, in a comparative way, the elements that make the gas chromatographic method superior to the former one.

Remarks on patients with traumatic brain injury due to traffic accident related to alcohol comsumption treated in Vietduc hospital after implementing the decree 100

2021 ◽  
Vol 2 (5) ◽  
Author(s):  
Nguyen Duc Chinh ◽  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Road Traffic Accident ◽  
Traffic Accident ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Blood Alcohol Concentration ◽  
Alcohol Concentration ◽  
Hospital Death ◽  
Risk Of Death

Purpose: Traumatic Brain Injury (TBI) is still considered as a leading cause of morbidity and mortality of victims by traffic accident. Despite a fact that many measurements and preventions have been applied, the rate of TBI is remained high. Aim of this study was to investigate treatment process of TBI caused by road traffic accident at Viet Duc Hospital after the Decree 100 which has been issued in Vietnam in early 2020. Materials and method: A retrospective and prospective study has been conducted in Viet Duc Hospital from Dec, 2020 to March, 2021. All the patients with TBI by road traffic accident were enrolled. Severity of TBI was identified by Glasgow Scale (GCS) and BAC (Blood Alcohol Concentration) test taken on arrival. The data was collected from medical record as well as autopsy report and analysed by SPSS.20.0 Results: A total of 150 patients with TBI by road traffic accidents were enrolled, age group from 21 to 60 years old accounted for 64%, male accounted for 86.7%. Associated injuries were maxillofacial lesions 48%, extremities 24.7%, chest accounted for 20%. Severity of TBI with GCS 6 - 8 was the highest rate 52%, from 3 - 5 GCS accounted for 30%. 40% were operated on emergency; BAC was positive 46.7%, of which over from 50 mg/L accounted for 32.6%. The patients with GCS from 6 to 8 were BAC positive accounted for a higher rate than groups with GCS above 9 or below 5. The most common TBI lesions were subarachnoid hemorrhage, subdural hematoma and cerebral edema accounted for 67.3%, 60% and 58% respectively. Overall mortality was 26% including in-hospital death and discharged to die. Conclusions and recommendations: Data from the study has shown that many young men with severe TBI by road traffic accident were BAC positive which can results in the high risk of death and disability. Thus, we highly recommend counterparts should constantly strengthen the propaganda and enforcement measures in order to reduce traffic accidents and TBI patients. Keywords: traffic accidents; injury; brain trauma severity.

scholarly journals P.184 Off-road vehicle fatalities and alcohol in patients with major traumatic brain injury: the risk of impaired driving

2021 ◽  
Vol 48 (s3) ◽  
pp. S73-S73
Author(s):  
S Walling ◽  
N Kureshi ◽  
DB Clarke ◽  
M Erdogan ◽  
RS Green
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Hospital Mortality ◽  
Injury Severity ◽  
Alcohol Intoxication ◽  
Blood Alcohol Concentration ◽  
Significant Risk ◽  
Road Vehicle ◽  
Hospital Deaths ◽  
The Impact

Background: Intoxicated patients injured in off road vehicle (ORV) crashes have higher rates of traumatic brain injury (TBI) and intensive care unit (ICU) admission, as well as prolonged ICU length of stay. This study evaluated the impact of alcohol intoxication on mortality among major TBI patients injured in off-road vehicle crashes. Methods: A retrospective analysis (2002-2014) of off-road vehicle injuries in Nova Scotia resulting in major TBI was performed. ORVs included ATVs, snowmobiles, and dirt bikes. A logistic regression model was constructed to test for in-hospital mortality and adjusted for age, Abbreviated Injury Scale (AIS) Head, Injury Severity Score, and blood alcohol concentration (BAC). Results: There were 176 drivers and passengers of off-road vehicles. Overall mortality was 28%. BAC testing was performed in 61% patients; 85% of pre-hospital deaths were BAC positive (mean BAC=31 ± 17.39 mmol/L) and 70% in-hospital deaths were BAC positive (mean BAC=26 ± 23.12 mmol/L). After adjusting for confounders, high injury severity and intoxication increased the likelihood of in-hospital mortality. Conclusions: These findings demonstrate that alcohol intoxication is a significant risk factor for mortality among off-road vehicle collisions; for every mmol/L change in BAC, there was a 10% increase in the chance of in-hospital mortality.

Does Level of Blood Alcohol Content Affect Clinical Outcomes After Trauma in Older Adult Patients?

2020 ◽  
Vol 86 (9) ◽  
pp. 1106-1112
Author(s):  
Mary K. Bryant ◽  
Katherine Reynolds ◽  
Connor Brittain ◽  
Zachery Patel ◽  
Trista D.S. Reid ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Older Patients ◽  
Injury Severity ◽  
Motor Vehicle ◽  
Blood Alcohol Concentration ◽  
Alcohol Concentration ◽  
Trauma Patients ◽  
Blood Alcohol ◽  
Matched Cohort ◽  
Poor Outcomes

Introduction Preinjury alcohol use and older age have independently been associated with poor outcomes. This study examined whether higher levels of blood alcohol concentration (BAC) correlated with an increased likelihood of poor outcomes in older trauma patients. Methods This was a retrospective cohort study of injured patients ≥65 years with BAC testing presenting to a Level 1 trauma center between 2015 and 2018. Patients were stratified by BAC at 4 thresholds of intoxication: BAC ≧10 mg/dL, BAC ≧80 mg/dL, BAC ≧150 mg/dL, and BAC ≧200 mg/dL. Propensity score matching using inverse probability of treatment weighting was used to estimate outcomes. Logistic and Poisson regression models were performed for each threshold of the BAC level with the matched cohort to assess clinical outcomes. Results Of all older patients (n = 3112), 32.5% (n = 1012) had BAC testing. In the matched cohort of 883 patients (76.7 ± 8.2 years; 48.1% female), 111 (12.5%) had BAC ≧10 mg/dL, 83 (74.8%) had BAC ≧80 mg/dL, 60 (54.1%) had BAC ≧150 mg/dL, and 37 (33.3%) had BAC ≧200 mg/dL. Falls (60.5%) and motor vehicle crashes (28.9%) were the most common mechanisms of injury. Median (IQR) of Injury Severity Score (ISS) was 5 (1-10). The risk of severe injury (ISS ≧15) was similar between alcohol-positive and alcohol-negative patients (9.9% vs 15.0%, P = .151). BAC ≧10 g/dL was not associated with length of stay, intensive care unit admission, or in-hospital complication, nor was any of the other 3 analyzed BAC thresholds. Conclusion Overall, any detectable BAC along and increasing thresholds of BAC was not associated with poor in-hospital outcomes of older patients after trauma. Alcohol screening was low in this population, and intoxication may bias injury assessment, leading to mistriage of older trauma patients.

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