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Waiting for the patient to "sober up": Effect of alcohol intoxication on glasgow coma scale score of brain injured patients.
J Trauma. 2006 Dec; 61(6):1305-11.JT

Abstract

BACKGROUND

Between 35% to 50% of traumatic brain injury (TBI) patients are under the influence of alcohol. Alcohol intoxication may limit the ability of the Glasgow Coma Scale (GCS) to accurately assess severity of TBI. We hypothesized that alcohol intoxication significantly depresses GCS scores of TBI patients.

METHODS

A 10-year, retrospective analysis of a Level I trauma center registry was undertaken. The study population consisted of all blunt injured TBI patients tested for blood alcohol concentration (BAC, n = 1,075). Patients were divided into two groups; intoxicated (mean BAC 202 +/- 77 mg/dL, n = 504) and nonintoxicated (BAC = 0, n = 571). TBI was classified using ICD-9 codes as concussion alone (ICD-9 850, n = 90) and intracranial injury (ICI, ICD-9 851-854, n = 985). Severity was further classified using the Abbreviated Injury Score (AIS). Mean GCS score was compared between the two groups. Patients who were either intubated or hypotensive upon arrival were analyzed separately to rule out confounding effects on GCS score. Severely intoxicated patients (BAC >250 mg/dL, [mean +/- SD] 309 +/- 54 SD, n = 118) were similarly compared. Finally, multivariate linear regression analysis was undertaken to determine whether BAC level was an independent predictor of GCS score while controlling for confounding factors.

RESULTS

Intoxicated and nonintoxicated TBI patients were clinically similar. Alcohol intoxication had little effect on GCS score, with less than a single point difference in all types of TBI, except the most severely injured (AIS 5 injuries, GCS score difference 1.4 points). These results were not altered by endotracheal intubation, systemic hypotension, or severe intoxication. Similarly, BAC was not a significant independent predictor of GCS score in a multivariate model.

CONCLUSION

Alcohol intoxication does not result in clinically significant changes in GCS score for patients with blunt TBI. Hence, alterations in GCS score after TBI should not be attributed to alcohol intoxication, as doing so might result in inappropriate delays in monitoring and therapeutic interventions.

Authors+Show Affiliations

Division of Burns, Trauma and Surgical Critical Care, Department of Surgery, University of Texas Southwestern Medical School, Dallas, Texas 75390-9158, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17159670

Citation

Sperry, Jason L., et al. "Waiting for the Patient to "sober Up": Effect of Alcohol Intoxication On Glasgow Coma Scale Score of Brain Injured Patients." The Journal of Trauma, vol. 61, no. 6, 2006, pp. 1305-11.
Sperry JL, Gentilello LM, Minei JP, et al. Waiting for the patient to "sober up": Effect of alcohol intoxication on glasgow coma scale score of brain injured patients. J Trauma. 2006;61(6):1305-11.
Sperry, J. L., Gentilello, L. M., Minei, J. P., Diaz-Arrastia, R. R., Friese, R. S., & Shafi, S. (2006). Waiting for the patient to "sober up": Effect of alcohol intoxication on glasgow coma scale score of brain injured patients. The Journal of Trauma, 61(6), 1305-11.
Sperry JL, et al. Waiting for the Patient to "sober Up": Effect of Alcohol Intoxication On Glasgow Coma Scale Score of Brain Injured Patients. J Trauma. 2006;61(6):1305-11. PubMed PMID: 17159670.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Waiting for the patient to "sober up": Effect of alcohol intoxication on glasgow coma scale score of brain injured patients. AU - Sperry,Jason L, AU - Gentilello,Larry M, AU - Minei,Joseph P, AU - Diaz-Arrastia,Ramon R, AU - Friese,Randall S, AU - Shafi,Shahid, PY - 2006/12/13/pubmed PY - 2007/1/20/medline PY - 2006/12/13/entrez SP - 1305 EP - 11 JF - The Journal of trauma JO - J Trauma VL - 61 IS - 6 N2 - BACKGROUND: Between 35% to 50% of traumatic brain injury (TBI) patients are under the influence of alcohol. Alcohol intoxication may limit the ability of the Glasgow Coma Scale (GCS) to accurately assess severity of TBI. We hypothesized that alcohol intoxication significantly depresses GCS scores of TBI patients. METHODS: A 10-year, retrospective analysis of a Level I trauma center registry was undertaken. The study population consisted of all blunt injured TBI patients tested for blood alcohol concentration (BAC, n = 1,075). Patients were divided into two groups; intoxicated (mean BAC 202 +/- 77 mg/dL, n = 504) and nonintoxicated (BAC = 0, n = 571). TBI was classified using ICD-9 codes as concussion alone (ICD-9 850, n = 90) and intracranial injury (ICI, ICD-9 851-854, n = 985). Severity was further classified using the Abbreviated Injury Score (AIS). Mean GCS score was compared between the two groups. Patients who were either intubated or hypotensive upon arrival were analyzed separately to rule out confounding effects on GCS score. Severely intoxicated patients (BAC >250 mg/dL, [mean +/- SD] 309 +/- 54 SD, n = 118) were similarly compared. Finally, multivariate linear regression analysis was undertaken to determine whether BAC level was an independent predictor of GCS score while controlling for confounding factors. RESULTS: Intoxicated and nonintoxicated TBI patients were clinically similar. Alcohol intoxication had little effect on GCS score, with less than a single point difference in all types of TBI, except the most severely injured (AIS 5 injuries, GCS score difference 1.4 points). These results were not altered by endotracheal intubation, systemic hypotension, or severe intoxication. Similarly, BAC was not a significant independent predictor of GCS score in a multivariate model. CONCLUSION: Alcohol intoxication does not result in clinically significant changes in GCS score for patients with blunt TBI. Hence, alterations in GCS score after TBI should not be attributed to alcohol intoxication, as doing so might result in inappropriate delays in monitoring and therapeutic interventions. SN - 0022-5282 UR - https://www.unboundmedicine.com/medline/citation/17159670/Waiting_for_the_patient_to_"sober_up":_Effect_of_alcohol_intoxication_on_glasgow_coma_scale_score_of_brain_injured_patients_ L2 - http://dx.doi.org/10.1097/01.ta.0000240113.13552.96 DB - PRIME DP - Unbound Medicine ER -