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Ali Salim, MD; Eric J. Ley, MD; H. Gill Cryer, MD; Daniel R. Margulies, MD; Emily Ramicone, MS; Areti Tillou, MD

Arch Surg. 2009;144(9):865-871.

Hypothesis  Ethanol exposure is associated with decreased mortality in patients with moderate to severe traumatic brain injury.

Design  Retrospective database review.

Setting  Trauma centers contributing to the National Trauma Data Bank (NTDB).

Patients  Version 6.2 of the NTDB (2000-2005) was queried for all patients with moderate to severe traumatic brain injury (head Abbreviated Injury Score 3) and ethanol levels measured on admission. Demographics and outcomes were compared between patients with traumatic brain injuries with and without ethanol in their blood. Logistic regression analysis was used to investigate the relationship between mortality and ethanol.

Main Outcome Measures  Mortality and complications.

Results  A total of 38 019 patients with severe traumatic brain injuries were evaluated. Thirty-eight percent tested positive for ethanol. Ethanol-positive patients were younger (mean [SD], 37.7 [15.1] vs 44.1 [22.0] years, P < .001), had a lower Injury Severity Score (22.3 [10.0] vs 23.0 [10.3], P < .001), and a lower Glasgow Coma Scale score (10.0 [5.1] vs 11.0 [4.9], P < .001) compared with their ethanol-negative counterparts. After logistic regression analysis, ethanol was associated with reduced mortality (adjusted odds ratio, 0.88; 95% confidence interval, 0.80-0.96; P = .005) and higher complications (adjusted odds ratio, 1.24; 95% confidence interval, 1.15-1.33; P < .001).

Conclusions  Serum ethanol is independently associated with decreased mortality in patients with moderate to severe head injuries. Additional research is warranted to investigate the potential therapeutic implications of this association.

Author Affiliations: Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center (Drs Salim, Ley, and Margulies and Ms Ramicone); and Division of Trauma, University of California–Los Angeles (Drs Cryer and Tillou), Los Angeles, California.

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