Rønning Pål, Gunstad Per Ole, Skaga Nils-Oddvar, Langmoen Iver Arne, Stavem Knut, Helseth Eirik
a Department of Neurosurgery , Oslo University Hospital , Norway .
b The Faculty of Medicine, University of Oslo , Norway .
Brain Inj. 2015;29(13-14):1648-53. doi: 10.3109/02699052.2015.1075154. Epub 2015 Oct 19.
Traumatic brain injury (TBI) is classified into mild, moderate and severe, based on the Glasgow Coma Score (GCS). However, TBI patients are often influenced by ethanol, which in itself can attenuate the level of consciousness. This study investigated the effect of ethanol on the GCS group classification in TBI patients.
The Oslo University Hospital trauma database was searched for all patients admitted with a head injury where the blood ethanol concentration (BEC) had been measured (n = 1004). The effect of BEC on GCS groups was analysed using multivariate ordinal logistic regression.
This study identified 546, 142 and 316 patients in the mild, moderate and severe groups, respectively. Increasing BEC by 1 g kg(-1) and pre-hospital intubation had OR = 1.34 and 16.34 for being in a more severe GCS group, respectively. Increasing head abbreviated injury scale (head-AIS) was significantly associated with being in a more severe GCS group. The modelled probability of detecting a head-AIS of 4 or 5 in a patient with BEC of 2.0 g kg(-1) was 20%, 38% and 65% in the mild, moderate and severe groups, respectively.
Increasing BEC was associated with increasing odds of being in a more severe GCS group. However, because the modelled probability of significant brain injury was high in patients with high levels of BEC, a reduced level of consciousness in intoxicated patients mandates further radiological investigations.
根据格拉斯哥昏迷评分（GCS），创伤性脑损伤（TBI）分为轻度、中度和重度。然而，TBI患者常受乙醇影响，乙醇本身可降低意识水平。本研究调查了乙醇对TBI患者GCS分组的影响。
检索奥斯陆大学医院创伤数据库中所有测量过血液乙醇浓度（BEC）的头部受伤入院患者（n = 1004）。使用多变量有序逻辑回归分析BEC对GCS分组的影响。
本研究分别在轻度、中度和重度组中确定了546例、142例和316例患者。BEC每增加1 g·kg⁻¹和院前插管，处于更严重GCS组的比值比（OR）分别为1.34和16.34。头部简明损伤定级（head-AIS）增加与处于更严重GCS组显著相关。在BEC为2.0 g·kg⁻¹的患者中，检测到head-AIS为4或5的模型概率在轻度、中度和重度组中分别为20%、38%和65%。
BEC升高与处于更严重GCS组的几率增加相关。然而，由于BEC水平高的患者发生严重脑损伤的模型概率较高，醉酒患者意识水平降低需要进一步进行影像学检查。
