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

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

The American Surgeon ◽

10.1177/000313481107701033 ◽

2011 ◽

Vol 77 (10) ◽

pp. 1416-1419 ◽

Cited By ~ 28

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.

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High blood alcohol concentration associated with traumatic brain injury among traffic injury patients during New Year festivals in Thailand

Traffic Injury Prevention ◽

10.1080/15389588.2018.1547379 ◽

2019 ◽

Vol 20 (2) ◽

pp. 115-121 ◽

Cited By ~ 1

Author(s):

Mathuramat Seesen ◽

Penprapa Siviroj ◽

Ratana Sapbamrer ◽

Sompong Morarit

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Blood Alcohol Concentration ◽

Alcohol Concentration ◽

Blood Alcohol ◽

Traffic Injury

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

CJEM ◽

10.1017/cem.2016.228 ◽

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.

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

Journal of Clinical Images and Medical Case Reports ◽

10.52768/2766-7820/1327 ◽

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.

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

Revista de Chimie ◽

10.37358/rc.18.9.6543 ◽

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.

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A Driving Simulator Study of the Performance Effects of Low Blood Alcohol Concentration

Proceedings of the Human Factors and Ergonomics Society Annual Meeting ◽

10.1177/154193129604001817 ◽

1996 ◽

Vol 40 (18) ◽

pp. 943-946 ◽

Cited By ~ 2

Author(s):

R. Wade Allen ◽

Zareh Parseghian ◽

Anthony C. Stein

Keyword(s):

Divided Attention ◽

Driving Simulator ◽

Blood Alcohol Concentration ◽

Large Body ◽

Alcohol Concentration ◽

Blood Alcohol ◽

Performance Effects ◽

Driving Task ◽

Simulator Study ◽

And Performance

There is a large body of research that documents the impairing effect of alcohol on driving behavior and performance. Some of the most significant alcohol influence seems to occur in divided attention situations when the driver must simultaneously attend to several aspects of the driving task. This paper describes a driving simulator study of the effect of a low alcohol dose, .055 BAC (blood alcohol concentration %/wt), on divided attention performance. The simulation was mechanized on a PC and presented visual and auditory feedback in a truck cab surround. Subjects were required to control speed and steering on a rural two lane road while attending to a peripheral secondary task. The subject population was composed of 33 heavy equipment operators who were tested during both placebo and drinking sessions. Multivariate Analysis of Variance showed a significant and practical alcohol effect on a range of variables in the divided attention driving task.

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4. Are a Blood Alcohol Concentration of 256mg/dl and Minimal Signs of Impairment Reliable Indications of Alcohol Dependence?

Medicine Science and the Law ◽

10.1177/002580249403400316 ◽

1994 ◽

Vol 34 (3) ◽

pp. 265-270 ◽

Cited By ~ 1

Author(s):

A W Jones

Keyword(s):

Expert Witness ◽

Blood Alcohol Concentration ◽

Drunk Driving ◽

Alcohol Concentration ◽

Driving Under The Influence ◽

Blood Alcohol ◽

Lower Court ◽

Dna Profile ◽

Court Of Appeals ◽

Driving Scenario

This article describes a drink-driving scenario where a woman was apprehended for driving under the influence (DUI) with a blood alcohol concentration (BAC) of 256mg/dl1 The correctness of this result was vigorously challenged by a medical expert witness for the defence, who was actually a specialist in alcohol diseases. Despite reanalysis to confirm the BAC as well as a DNA profile to prove the identity of the blood specimen, the woman was acquitted of the charge of drunk driving by the lower court. However, she was subsequently found guilty in the High Court of Appeals with a unanimous decision and sentenced to four weeks imprisonment. This case report illustrates some of the problems surrounding the use of expert medical evidence by the defence to challenge the validity of the prosecution evidence based solely on a suspect's BAC. In situations such as these, an expert witness should be called by the prosecution to clarify and, if necessary, rebut medical and/or scientific opinions that might mislead the court and influence the outcome of the trial.

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