Effect of Alcohol on Glasgow Coma Scale in Head-injured Patients

Overview

Journal Ann Surg

Specialty General Surgery

Date 2007 Apr 7

PMID 17414616

Citations 25

Authors

Lance Stuke

Ramon Diaz-Arrastia

Larry M Gentilello

Shahid Shafi

Affiliations

Soon will be listed here.

Abstract

Objective: Almost 50% of traumatic brain-injured (TBI) patients are alcohol intoxicated. The Glasgow Coma Scale (GCS) is frequently used to direct diagnostic and therapeutic decisions in these patients. It is commonly assumed that alcohol intoxication reduces GCS, thus limiting its utility in intoxicated patients. The purpose of this study was to test the hypothesis that the presence of blood alcohol has a clinically significant impact on GCS in TBI patients.

Methods: The National Trauma Data Bank of the American College of Surgeons was queried (1994-2003). Patients 18 to 45 years of age with blunt injury mechanism, whose GCS in the emergency department, survival status, anatomic severity of TBI (Head Abbreviated Injury Score [AIS]), and blood alcohol testing status were known, were included. GCS of patients who tested positive for alcohol (n = 55,732) was compared with GCS of patients who tested negative (n = 53,197), stratified by head AIS.

Results: Groups were similar in age (31 +/- 8 vs. 30 +/- 8 years), Injury Severity Score (ISS; 12 +/- 11 vs. 12 +/- 11), systolic blood pressure in the ED (131 +/- 25 vs. 134 +/- 25 mm Hg), TRISS (Trauma Injury Severity Score; probability of survival (94% +/- 16% vs. 95% +/- 15%), and actual survival (96% vs. 96%). When stratified by anatomic severity of TBI, the presence of alcohol did not lower GCS by more than 1 point in any head AIS group (GCS in alcohol-positive vs. alcohol-negative patients; AIS 1 = 13.9 +/- 2.8 vs. 14.3 +/- 2.3; AIS 2 = 13.4 +/- 3.2 vs. 14.1 +/- 2.4; AIS 3 = 11.1 +/- 4.7 vs. 11.6 +/- 4.6; AIS 4 = 9.8 +/- 4.9 vs. 10.4 +/- 4.9; AIS 5 = 5.5 +/- 3.8 vs. 5.9 +/- 4.1, AIS 6: 3.4 +/- 1.1 vs. 3.8 +/- 2.8).

Conclusion: Alcohol use does not result in a clinically significant reduction in GCS in trauma patients. Attributing low GCS to alcohol intoxication in TBI patients may delay necessary diagnostic and therapeutic interventions.

Citing Articles

Mild Traumatic Brain Injury by the Glasgow Coma Scale Score and Early CT-Brain Findings in Acute Alcohol Intoxication Patients: A Prospective Observational Study.

Arunachalam Jeykumar N, Niban G, Vadivel P, Masanam Kasi S Cureus. 2024; 16(8):e67669.

PMID: 39318935 PMC: 11420600. DOI: 10.7759/cureus.67669.

Identification and Connectomic Profiling of Concussion Using Bayesian Machine Learning.

Hacker B, Imms P, Dharani A, Zhu J, Chowdhury N, Chaudhari N J Neurotrauma. 2024; 41(15-16):1883-1900.

PMID: 38482793 PMC: 11564847. DOI: 10.1089/neu.2023.0509.

Alcohol intake before injury and functional and survival outcomes after traumatic brain injury: Pan-Asian trauma outcomes study (PATOS).

Jung E, Ro Y, Jeong J, Ryu H, Shin S Medicine (Baltimore). 2023; 102(34):e34560.

PMID: 37653804 PMC: 10470812. DOI: 10.1097/MD.0000000000034560.

Saturday Night Fever: Interpersonal Violence as a Reason for Presentation in a University Emergency Department.

Horauf J, Franz J, Zabel J, Hartmann F, Stormann P, Marzi I Int J Environ Res Public Health. 2023; 20(5).

PMID: 36901561 PMC: 10001752. DOI: 10.3390/ijerph20054552.

Health Economic Challenge: Geriatric Trauma-An Age-Based Observational Analysis of Treatment Costs and Reimbursement Issues.

Schindler C, Woschek M, Muhlenfeld N, Seifert L, Marzi I, Stormann P Int J Environ Res Public Health. 2022; 19(14).

PMID: 35886122 PMC: 9323715. DOI: 10.3390/ijerph19148270.

References

Gentilello L, Villaveces A, Ries R, Nason K, Daranciang E, Donovan D . Detection of acute alcohol intoxication and chronic alcohol dependence by trauma center staff. J Trauma. 1999; 47(6):1131-5; discussion 1135-9. DOI: 10.1097/00005373-199912000-00027. View

Sperry J, Gentilello L, Minei J, Diaz-Arrastia R, Friese R, Shafi S . 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. DOI: 10.1097/01.ta.0000240113.13552.96. View

Schermer C, Gentilello L, Hoyt D, Moore E, Moore J, Rozycki G . National survey of trauma surgeons' use of alcohol screening and brief intervention. J Trauma. 2003; 55(5):849-56. DOI: 10.1097/01.TA.0000091110.83692.38. View

Johnston J, McGovern S . Alcohol related falls: an interesting pattern of injuries. Emerg Med J. 2004; 21(2):185-8. PMC: 1726307. DOI: 10.1136/emj.2003.006130. View

Demetriades D, Kuncir E, Murray J, Velmahos G, Rhee P, Chan L . Mortality prediction of head Abbreviated Injury Score and Glasgow Coma Scale: analysis of 7,764 head injuries. J Am Coll Surg. 2004; 199(2):216-22. DOI: 10.1016/j.jamcollsurg.2004.02.030. View

Teasdale G, Jennett B . Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974; 2(7872):81-4. DOI: 10.1016/s0140-6736(74)91639-0. View

Galbraith S, Murray W, Patel A . The relationship between alcohol and head injury and its effect on the conscious level. Br J Surg. 1976; 63(2):128-30. View

Soderstrom C, Trifillis A, Shankar B, Clark W, Cowley R . Marijuana and alcohol use among 1023 trauma patients. A prospective study. Arch Surg. 1988; 123(6):733-7. DOI: 10.1001/archsurg.1988.01400300079013. View

Soderstrom C, Carson S . Update: alcohol and other drug use among vehicular crash victims. Md Med J. 1988; 37(7):541-5. View

10.

Minion G, Slovis C, Boutiette L . Severe alcohol intoxication: a study of 204 consecutive patients. J Toxicol Clin Toxicol. 1989; 27(6):375-84. DOI: 10.3109/15563658909000358. View

11.

Pories S, Gamelli R, Vacek P, Goodwin G, Shinozaki T, Harris F . Intoxication and injury. J Trauma. 1992; 32(1):60-4. DOI: 10.1097/00005373-199201000-00013. View

12.

Brickley M, Shepherd J . The relationship between alcohol intoxication, injury severity and Glasgow Coma Score in assault patients. Injury. 1995; 26(5):311-4. DOI: 10.1016/0020-1383(95)00034-7. View

13.

Walder A, Yeoman P, Turnbull A . The abbreviated injury scale as a predictor of outcome of severe head injury. Intensive Care Med. 1995; 21(7):606-9. DOI: 10.1007/BF01700170. View

14.

Gentilello L, Rivara F, Donovan D, Jurkovich G, Daranciang E, Dunn C . Alcohol interventions in a trauma center as a means of reducing the risk of injury recurrence. Ann Surg. 1999; 230(4):473-80; discussion 480-3. PMC: 1420896. DOI: 10.1097/00000658-199910000-00003. View

15.

Dunne J, Tracy J, Scalea T, Napolitano L . Lactate and base deficit in trauma: does alcohol or drug use impair their predictive accuracy?. J Trauma. 2005; 58(5):959-66. DOI: 10.1097/01.ta.0000158508.84009.49. View

16.

Cherpitel C, Bond J, Ye Y, Room R, Poznyak V, Rehm J . Clinical assessment compared with breathalyser readings in the emergency room: concordance of ICD-10 Y90 and Y91 codes. Emerg Med J. 2005; 22(10):689-95. PMC: 1726581. DOI: 10.1136/emj.2004.016865. View

17.

Gentilello L, Donato A, Nolan S, Mackin R, Liebich F, Hoyt D . Effect of the Uniform Accident and Sickness Policy Provision Law on alcohol screening and intervention in trauma centers. J Trauma. 2005; 59(3):624-31. View

18.

. The Brain Trauma Foundation. The American Association of Neurological Surgeons. The Joint Section on Neurotrauma and Critical Care. Initial management. J Neurotrauma. 2000; 17(6-7):463-9. DOI: 10.1089/neu.2000.17.463. View