Traumatic brain injury and alcohol intoxication: Effects on injury patterns and short-term outcome

A significant number of patients with traumatic brain injuries (TBI) are diagnosed with elevated blood alcohol concentration (BAC). Recent literature suggests a neuroprotective effect of alcohol on TBI, possibly associated with less morbidity and mortality. A study analysed the association of different levels of BAC with TBI characteristics and outcome.
Adult patients with moderate to severe TBI (AIS ≥ 2) and measured BAC admitted to the Trauma Centre West (TCW), during the period 2010-2015, were retrospectively analysed. Data included injury severity (AIS), length of hospitalization, admittance to the Intensive Care Unit (ICU) and in-hospital mortality. The association of BAC with ICU admittance and in-hospital mortality was analysed using multivariable logistic regression analysis with correction for potentially confounding variables.
BACs were available in 2,686 patients of whom 42% had high, 26% moderate, 6% low and 26% had normal levels. Patients with high BAC’s were predominantly male, were younger, had lower ISS scores, lower AIS-head scores and less concomitant injuries compared to patients in the other BAC subgroups. High BACs were associated with a lower risk for in-hospital mortality (AOR 0.36, 95% CI 0.14-0.97). Also, patients with moderate and high BACs were less often admitted to the ICU (respectively, AOR 0.36, 95% CI 0.25-0.52 and AOR 0.40, 95% CI 0.29-0.57).
The findings suggest that in patients with moderate to severe TBI, increasing blood alcohol concentrations (BAC) are associated with less severe TBI, less ICU admissions and a higher survival. Further research into the pathophysiological mechanism is necessary to help explain these findings.
Source: Leijdesdorff HA, Legué J, Krijnen P, Rhemrev S, Kleinveld S, Schipper IB. Traumatic brain injury and alcohol intoxication: effects on injury patterns and short-term outcome [published online ahead of print, 2020 May 6]. Eur J Trauma Emerg Surg.