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Homer C. N. Tien, MD, FRCSC; Lorraine N. Tremblay, MD, PhD; Sandro B. Rizoli, MD, PhD; Jacob Gelberg, BSc; Talat Chughtai, MD; Peter Tikuisis, PhD; Pang Shek, PhD; Frederick D. Brenneman, MD

Arch Surg. 2006;141:1185-1191.

Hypothesis  Admission blood alcohol concentration (BAC) is associated with in-hospital death in patients with severe brain injury from blunt head trauma.

Design  Retrospective cohort study.

Setting  Academic level I trauma center in Toronto, Ontario.

Patients  Using trauma registry data, between January 1, 1988, and December 31, 2003, we identified 1158 consecutive patients with severe brain injury from blunt head trauma.

Intervention  There was no active intervention. The primary exposure of interest was the BAC at admission, stratified into the following 3 levels: 0, no BAC; 0 to less than 230 mg/dL, low to moderate BAC; and 230 mg/dL or greater, high BAC.

Main Outcome Measure  In-hospital death.

Results  In patients with severe brain injury, low to moderate BAC was associated with lower mortality than was no BAC (27.9% vs 36.3%; P = .008). High BAC was associated with higher mortality than was no BAC (44.7% vs 36.3%), although this was not statistically significant (P = .10). These associations were all statistically significant after adjusting for demographic data and injury factors using logistic regression analysis. The odds ratio for death was 0.76 (95% confidence interval, 0.52-0.98) for low to moderate BAC compared with no BAC. The odds ratio for death was 1.73 (95% confidence interval, 1.05-2.84) for high BAC compared with no BAC.

Conclusions  Low to moderate BAC may be beneficial in patients with severe brain injury from blunt head trauma. In contrast, high BAC seems to have a deleterious effect on in-hospital death in these patients, which may be related to its detrimental hemodynamic and physiologic effects. Alcohol-based fluids may have a role in the management of patients with severe brain injury after they have been well resuscitated.

Author Affiliations: Trauma Program and the Departments of Surgery and Critical Care Medicine, Sunnybrook and Women's College Health Sciences Centre, University of Toronto, Toronto, Ontario (Drs Tien, Tremblay, Rizoli, Chughtai, and Brenneman, and Mr Gelberg); Canadian Forces Health Services Group, Department of National Defence, Ottawa, Ontario (Dr Tien); Defence Research and Development, Toronto (Drs Tikuisis and Shek).

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