Association between alcohol and mortality in patients with severe traumatic head injury

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.