Acute alcohol intoxication as a traumatic brain injury risk factor
Alcohol intoxication and the lack of a helmet were common in TBIs caused by electric scooter (ES) accidents. Most of the accidents occurred late at night. Targeting these modifiable factors could decrease the incidence of ES-related TBIs 1).
Acute alcohol intoxication is universally considered one of the traumatic brain injury risk factors (TBI), therefore an indication for head CT scan. There is no evidence in the literature for this attitude. Aim of a study was to assess the need for head CT scan in acutely alcohol-intoxicated subjects with mTBI and the role of the Glasgow coma scale (GCS) score in this kind of patient.
Uccella et al. retrospectively analyzed all 3358 consecutive patients presenting to the department in Switzerland, with TBI as chief complaint between January 2014 and January 2018.
Alcohol was a statistically significant factor for presentation with a GCS score lower than 15. As for bleedings in mild TBI patients, the results were somewhat contradictory with GCS 15 patients showing a higher percentage of hemorrhages than GCS 14 patients. By dividing alcohol-intoxicated subjects into groups per blood alcohol concentration, the higher was the alcohol level, the lower the GCS score.
They can affirm that GCS score is underestimated in acutely intoxicated head trauma patients. In this kind of patient, alcohol is a confounding factor and mild TBI could be safely managed by watchful waiting 2).