Evaluation of traumatic brain injury patients with signs of alcohol intoxication
Alcohol consumption is known to impair cognitive and physical abilities, increasing the risk of sustaining an injury. Global estimates suggest that 52.4 million alcohol-related injuries (resulting in 1 millions deaths) occurred in 2016 alone, many of which were traumatic brain injuries (TBI) caused by traffic accidents, violence, and falls. In fact, an estimated 30 to 50 percent of people who present to the emergency department with TBI were intoxicated at the time of the accident. Because alcohol consumption also reduces consciousness, clinicians find that consciousness-based measures of TBI severity (such as the Glasgow Coma Scale; GCS) may be inaccurate for patients who were drinking at the time of injury. Clinicians use assessments like the GCS to guide clinical decision-making, so it is imperative that these measurements accurately reflect injury severity for all patients, including those who are intoxicated.
A team of researchers in Brazil aimed to determine if intoxicated TBI patients receive late or inaccurate diagnoses as a result of their alcohol consumption. They collected hospital records from 183 patients who were treated for TBI in 2017, half of whom were intoxicated at the time of injury and half of whom were sober. The researchers analyzed data related to GCS score, mechanism and severity of injury, brain imaging scans, and time needed for diagnosis. They found that:
- Most intoxicated patients were injured by violence or car accident, while most sober patients were injured by car accident or falling from height.
- Intoxicated patients had lower GCS scores (indicating lower level of consciousness or more severe injury) than sober patients. Importantly, the drunk patients’ brain imaging scans did not indicate higher injury severity, indicating that the low GCS scores were solely a result of alcohol intoxication.
- Both groups of patients received brain imaging and diagnostic procedures within 70 minutes of admission to the emergency department. There was no timing difference between the groups.
The symptoms of alcohol intoxication are known to interfere with measures of TBI severity, such as the GCS. As a result, clinicians treating patients with signs of alcohol intoxication are advised to rely on objective measures of injury severity (such as brain imaging procedures) to ensure that these patients receive accurate diagnoses and appropriate treatment interventions.
Grzelczak AC, Ceccon A, Guetter CR, et al. Evaluation of traumatic brain injury patients with signs of alcohol intoxication. Journal of the Brazilian College of Surgeons. (October 2019).