Association of Alcohol Intoxication With Better Outcomes and Relation With Hypothermia After Traumatic Brain Injury Depends on Differences in Patient and Trauma Characteristics
*Suzanne F. van Wijck1,2, *Napaporn Kongkaewpaisan1, *Ahmed I. Eid1, *Kelsey R. Han1, *Zhenyi Jia1, *Karien Meier1, *Nikolaos Kokoroskos1, *Manasnun Kongwibulwut1, *Jae Moo Lee1, *Ask T. Nordestgaard1, *Gabriel E. Rodriguez1, Haytham M. Kaafarani1, *David R. King1, George C. Velmahos1, *Gwendolyn M. Van der Wilden2, *Pieta Krijnen2, *Inger B. Schipper2
1Massachusetts General Hospital, Harvard Medical School, Boston, MA; 2Leiden University Medical Center, Leiden, Netherlands
Objective: Based on promising results from animal research, many clinical studies have investigated the effect of elevated serum alcohol levels (ESAL) on mortality and morbidity in patients with moderate to severe traumatic brain injury (TBI). However, the exact effect of ESAL on TBI remains controversial. This study hypothesized that ESAL is associated with better outcomes. Additionally, hypothermia has consistently demonstrated neuroprotective effects in animal studies. Therefore, low body temperature was investigated as a potentially related factor. Design: Retrospective observational cohort study. Setting: Tertiary referral, trauma level I, teaching hospital. Patients: All admitted adult (≥18) patients with moderate to severe TBI (head AIS≥2) from 2011-2016.
Main Outcome Measures: In-hospital mortality.
Results: Of the 2965 included TBI patients, 742 (25%) were alcohol intoxicated at time of injury. Intoxicated patients were younger and a higher proportion received neurosurgical intervention. ESAL was univariably associated with lower in-hospital mortality (OR 0.50; 95%CI 0.37-0.66). After adjustment for potential confounding factors, no independent association was found between ESAL and chances of survival of TBI (OR 0.86; 95%CI 0.53-1.40). Low body temperature was associated with the highest ESAL group, but no relation with better outcomes was identified. Lower body temperature was independently associated with worse mortality rates for polytrauma patients.
Conclusions: Alcohol intoxication at time of injury does not have an beneficiary effect on in-hospital mortality after TBI. The influence of alcohol on mortality might be attributable to differences in patient, injury and trauma characteristics, although no relation with alcohol, low body temperature and mortality was identified.