Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Boston, MA 02114, Massachusetts, USA.
Department of Trauma Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
Eur J Emerg Med. 2021 Apr 1;28(2):97-103. doi: 10.1097/MEJ.0000000000000754.
Acute alcohol intoxication is very common in patients with severe traumatic brain injury (TBI). Whether there is an independent association between alcohol intoxication and mortality is debated. This study hypothesized that alcohol intoxication is independently associated with less mortality after severe TBI (sTBI).
This retrospective observational cohort study included all patients with sTBI [head-Abbreviated Injury Score (AIS) ≥3, corresponding to serious head injury or worse] admitted from 1 January 2011 to 31 December 2016 in an academic level I trauma center. Patients were classified as with alcohol intoxication or without intoxication based on blood alcohol concentration or description of alcohol intoxication on admission. The primary endpoint was in-hospital mortality. Multivariable logistic regression analysis, including patient and injury characteristics, was used to assess independent association with alcohol intoxication.
Of the 2865 TBI patients, 715 (25%) suffered from alcohol intoxication. They were younger (mean age 46 vs. 68 years), more often male (80 vs. 57%) and had a lower median Glasgow Coma Scale upon arrival (14 vs. 15) compared to the no-intoxication group. There was no difference in injury severity by head AIS or Rotterdam CT. Alcohol intoxication had an unadjusted association with in-hospital mortality [unadjusted odds ratio (OR) 0.51; 95% confidence interval (CI), 0.38-0.68]; however, there was no independent association after adjusting for potentially confounding patient and injury characteristics (adjusted OR 0.72; 95% CI, 0.48-1.09).
In this retrospective study, there was no independent association between alcohol intoxication and higher in-hospital mortality in emergency patients with sTBI.
急性酒精中毒在严重创伤性脑损伤（TBI）患者中非常常见。酒精中毒是否与死亡率独立相关仍存在争议。本研究假设酒精中毒与严重 TBI（sTBI）后死亡率降低独立相关。
本回顾性观察性队列研究纳入了 2011 年 1 月 1 日至 2016 年 12 月 31 日期间在一家学术一级创伤中心收治的所有 sTBI 患者[头部损伤简明损伤评分（AIS）≥3，对应严重头部损伤或更严重]。根据入院时的血液酒精浓度或酒精中毒描述，将患者分为酒精中毒组或非中毒组。主要终点是院内死亡率。采用多变量逻辑回归分析，包括患者和损伤特征，评估与酒精中毒的独立相关性。
在 2865 例 TBI 患者中，715 例（25%）存在酒精中毒。与非中毒组相比，酒精中毒组患者年龄更小（平均年龄 46 岁 vs. 68 岁）、男性更多（80% vs. 57%）、入院时格拉斯哥昏迷评分中位数更低（14 分 vs. 15 分）。头部 AIS 或鹿特丹 CT 损伤严重程度无差异。酒精中毒与院内死亡率有未调整的关联[未调整优势比（OR）0.51；95%置信区间（CI）0.38-0.68]；但在调整了潜在混杂的患者和损伤特征后，无独立相关性（调整后 OR 0.72；95%CI，0.48-1.09）。
在这项回顾性研究中，在急诊 sTBI 患者中，酒精中毒与较高的院内死亡率之间无独立相关性。
