Traumatic brain injury in intoxicated patients

Area of Science:

• Neuroscience
• Trauma Surgery
• Toxicology

Background:

• Severe traumatic brain injury (TBI) poses significant management challenges.
• The influence of alcohol intoxication on TBI patient outcomes requires further elucidation.
• Nonsurgical management of severe TBI necessitates careful monitoring and timely interventions.

Purpose of the Study:

• To evaluate the impact of alcohol intoxication on the management of severe traumatic brain injury patients.
• To determine if alcohol intoxication influences the timeliness of critical interventions.
• To assess alcohol's role as a confounding factor in TBI treatment.

Main Methods:

• Retrospective review of adult patients with Glasgow Coma Scale score ≤8 at admission from the Montreal General Hospital Traumatic Brain Injury Registry.
• Classification of patients based on blood alcohol levels (BAL): toxic (≥21.7 mmol/L), alcohol-negative (<3 mmol/L), and alcohol-influenced/unknown.
• Analysis of factors influencing intracranial pressure (ICP) monitoring and comparison of insertion times between intoxicated and non-intoxicated groups.

Main Results:

• Twenty-three patients presented with toxic blood alcohol levels, while 24 were alcohol-negative.
• Intoxicated patients experienced a mean delay of 151 minutes in intracranial pressure monitoring device insertion compared to alcohol-negative patients.
• Factors influencing ICP monitoring included multiple intracranial hemorrhages, multiple injuries, and post-resuscitation Glasgow Coma Scale score ≤8.

Conclusions:

• Alcohol intoxication was identified as a significant confounding factor in the treatment of severe traumatic brain injury patients.
• Delayed intracranial pressure monitoring in intoxicated patients may impact clinical management and outcomes.
• Further research is warranted to understand the specific mechanisms by which alcohol affects TBI management.