Background: 20-50% of patients with traumatic brain injury (TBI) are under the influence of ethanol at hospital admission. The Glasgow Coma Scale (GCS) is used in the initial assessment of these patients, directing further diagnostic evaluation and therapy. Therefore, we investigated whether ethanol has an impact on the initial GCS assessment in TBI patients.
Methods: From the trauma registry at Oslo University Hospital Ullevål (OUHU), we included patients with blunt head injury between 14 and 80 years old, with known head Abbreviated Injury Score (AIS), blood ethanol concentration (BAC)- and GCS score at admission. 841 patients were included and categorized by BAC into an ethanol influenced- (n=474) and a non-influenced group (n=367). The two groups were compared by several admission and outcome variables.
Results: Mean BAC in the two groups were 0 ‰ and 2,1 ‰ ± 0,1 ‰. The groups were equal with regards to mean GCS (11,7 ± 0,41 vs. 11,3 ± 0,38, p=0,151) and within all AIS categories except for AIS=2. Uni- and multivariate regression analyses together with matched bootstrapped- and robust linear regression were unable to show a significant impact of ethanol on GCS. The groups were similar regarding gender, age, length of stay, ventilator requirements and presence of hypotension at admission. However, ethanol influenced patients sustained less severe injuries, had better survival, fewer days in the ICU and lesser need of intubation.
Conclusion: Ethanol intoxication does not reduce the GCS score to a clinically significant degree and reduced GCS score should not be attributed to ethanol intoxication.
Key words: Traumatic brain injury, Glasgow Coma Scale, Ethanol, Alcohol