Alcohol use at time of injury and survival following traumatic brain injury: results from the National Trauma Data Bank - PubMed (original) (raw)

Alcohol use at time of injury and survival following traumatic brain injury: results from the National Trauma Data Bank

Chiung M Chen et al. J Stud Alcohol Drugs. 2012 Jul.

Abstract

Objective: Premised on biological evidence from animal research, recent clinical studies have, for the most part, concluded that elevated blood alcohol concentration levels are independently associated with higher survival or decreased mortality in patients with moderate to severe traumatic brain injury (TBI). This study aims to provide some counterevidence to this claim and to further future investigations.

Method: Incident data were drawn from the largest U.S. trauma registry, the National Trauma Data Bank, for emergency department admission years 2002-2006. TBI was identified according to the National Trauma Data Bank's definition using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), codes. To eliminate confounding, the exact matching method was used to match alcohol-positive with alcohol-negative incidents on sex, age, race/ethnicity, and facility. Logistic regression compared in-hospital mortality between 44,043 alcohol-positive and 59,817 matched alcohol-negative TBI incidents, with and without causes and intents of TBI and Injury Severity Score as covariates. A sensitivity analysis was performed within a subsample of isolated moderate to severe TBI incidents.

Results: Alcohol use at the time of injury was found to be significantly associated with an increased risk for TBI. Including varied causes and intents of TBI and Injury Severity Score as potential confounders in the regression model explained away the statistical significance of the seemingly protective effect of alcohol against TBI mortality for all TBIs and for isolated moderate to severe TBIs.

Conclusions: The null finding shows that the purported reduction in TBI mortality attributed to positive blood alcohol likely is attributable to residual confounding. Accordingly, the risk of TBI associated with alcohol use should not be overlooked.

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Figures

Figure 1

Figure 1

(a) Prevalence (%) of traumatic brain injury (TBI), by sex and race/ethnicity; (b) prevalence of TBI, by age; and (c) odds ratio for TBI, by age, among matched alcohol-positive (n = 104,654) and alcohol-negative (n = 166,711) trauma incidents, National Trauma Data Bank, 2002–2006. CI = confidence interval.

Figure 2

Figure 2

(a) Proportion of traumatic brain injury (TBI) death, by age; (b) odds ratio for TBI death, by age; and (c) probability density function of age, among matched alcohol-positive (n = 44,043) and alcohol-negative (n = 59,817) TBI incidents, National Trauma Data Bank, 2002–2006. CI = confidence interval.

Figure 3

Figure 3

(a) Proportion of traumatic brain injury (TBI) death, by International Classification of Diseases—based head/neck Abbreviated Injury Scale (AIS) score; (b) proportion of TBI death, by Injury Severity Score (ISS); and (c) odds ratio for TBI death, by ISS, among matched alcohol-positive (n = 44,043) and alcohol-negative (n = 59,817) TBI incidents, National Trauma Data Bank, 2002–2006. CI = confidence interval.

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References

    1. Baker S P, O’Neill B, Haddon W, Jr, Long W B. The injury severity score: A method for describing patients with multiple injuries and evaluating emergency care. Journal of Trauma. 1974;14:187–196. - PubMed
    1. Berry C, Ley E J, Margulies D R, Mirocha J, Bukur M, Malinoski D, Salim A. Correlating the blood alcohol concentration with outcome after traumatic brain injury: Too much is not a bad thing. American Surgeon. 2011;77:1416–1419. - PubMed
    1. Berry C, Salim A, Alban R, Mirocha J, Margulies D R, Ley E J. Serum ethanol levels in patients with moderate to severe traumatic brain injury influence outcomes: A surprising finding. American Surgeon. 2010;76:1067–1070. - PubMed
    1. Cebere A, Liljequist S. Ethanol differentially inhibits homo-quinolinic acid- and NMDA-induced neurotoxicity in primary cultures of cerebellar granule cells. Neurochemical Research. 2003;28:1193–1199. - PubMed
    1. Centers for Disease Control and Prevention. Recommended framework for presenting injury mortality data. MMWR. 1997;46(No. RR-14):1–30. Retrieved from http://www.cdc.gov/mmwr/pdf/rr/rr4614.pdf. - PubMed

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