Positive Serum Ethanol Level and Mortality in Moderate to Severe Traumatic Brain Injury

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.