Effect of alcohol on Glasgow Coma score in traumatic brain injury: a single, center, cross-sectional study

Authors

  • Minnu Thomas Department of Emergency Medicine, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India
  • Appu Suseel Department of Emergency Medicine, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India
  • Suresh Samuel David Department of Emergency Medicine, Pushpagiri Medical College and Research Institute, Thiruvalla, Kerala, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20231345

Keywords:

Blood alcohol concentration, Glasgow coma score, Rotterdam CT score, Traumatic brain injury

Abstract

Background: To study the effect of blood alcohol levels on GCS in Traumatic brain injury patients (TBI) and relate the findings to brain injury severity based on the admission CT scan.

Methods: This cross-sectional study with a comparison group is conducted in Emergency Department (ED) of Pushpagiri Institute of Medical Sciences and Research Centre, Central Travancore, Kerala, India from April 2016 to September 2017 including all patients of 18 - 70 years of age presenting with head injury. 200 participants, 100 each of alcohol intoxicated and non- intoxicated were selected by consecutive sampling. GCS, Blood alcohol concentration-BAC (derived from the reading of alcohol breath analyzer) and admission CT Rotterdam Score are collected and analyzed at the end of study.

Results: When CT Rotterdam Score is 1-3, GCS was found to decrease with increase in BAC (Chi-square test p value=0.011; Spearman’s Rank Correlation coefficient rs=-0.326). Independent t –test showed that at BAC 1-100 mg/dl, mean GCS decrease by 1.6 while only same decrease is found when the BAC levels ranges from 100-400 mg/dl. When the CT Rotterdam score is 4-6, no significant correlation was found between GCS and BAC (p value=0.092; rs=0.214). In the presence of alcohol, GCS had sensitivity 87.5% and specificity 70% in comparison to alcohol absent TBI patients (sensitivity 98.5%, specificity 69.7%). When features of hypoxia and shock are present, GCS have good agreement with actual CT findings of TBI. (Kappa coefficient: K 0.659, sensitivity 76%, specificity 100% in alcoholics and K 0.756, sensitivity 100%, specificity 80.6% in nonalcoholic).

Conclusions: Even in the setting of alcohol intoxicated TBI patient, Glasgow coma score is a useful tool for quick decision making in emergency department.

References

Global burden of disease study 2013 collaborators. global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the global burden of disease study. Lancet Lond Engl. 2015;386(9995):743-800.

Massenburg BB, Veetil DK, Raykar NP, Agrawal A, Roy N, Gerdin M. A systematic review of quantitative research on traumatic brain injury in India. Neurol India. 2017;65(2):305-14.

Teasdale G, Jennett B. Assessment of coma and impaired consciousness: a practical scale. Lancet. 1974;2:81-4.

Rundheug NP, Moen KG, Skandsen T, Mikalsen KS, Lund SB, Hara S, Vik A. Moderate and severe traumatic brain injury: effect of blood alcohol concentration on GCS and relation to computed tomography findings. J Neurosurg. 2015;122:211-8.

Jones AW. Medicolegal alcohol determination blood or breath alcohol concentration. Forensic Sci Rev. 2000;12(1-2):23-47.

Lange RT, Iverson GL, Brubacher JR, Franzen MD. Effect of blood alcohol level on Glasgow Coma Scale scores following traumatic brain injury. Brain Inj. 2010;24(7):919-27.

Teasdale G, Jennett B, Murray L, Murray G. Glasgow coma scale: to sum or not to sum. Lancet Lond Engl. 1983;2(8351):678.

Stålhammar D, Starmark JE. Assessment of responsiveness in head injury patients. The Glasgow Coma Scale and some comments on alternative methods. Acta Neurochir Suppl (Wien). 1986;36:91-4.

Shibahashi K, Sugiyama K, Okura Y, Hoda H, Hamabe Y. Multicenter retrospective cohort study of “talk and die” after traumatic brain injury. World Neurosurg. 2017;107:82-6.

Peterson EC, Chesnut RM. Talk and die revisited: bifrontal contusions and late deterioration. J Trauma. 2011;71(6):1588-92.

Goldschlager T, Rosenfeld JV, Winter CD. Talk and die patients presenting to a major trauma centre over a 10 year period: a critical review. J Clin Neurosci J Neurosurg Soc Australas. 2007;14(7):618-23.

Stuke L, Arrastia R, Gentilello LM, Shafi S. Effect of alcohol on glasgow coma scale in head-injured patients. Ann Surg. 2007;245(4):651-5.

Sperry JL, Gentilello LM, Minei JP, Diaz-Arrastia RR, Friese RS, Shafi S. Waiting for the patient to “sober up”: Effect of alcohol intoxication on glasgow coma scale score of brain injured patients. J Trauma. 2006;61(6):1305-11.

Rønning P, Gunstad PO, Skaga N-O, Langmoen IA, Stavem K, Helseth E. The impact of blood ethanol concentration on the classification of head injury severity in traumatic brain injury. Brain Inj. 2015;29(13-14):1648-53.

Shahin H, Gopinath SP, Robertson CS. Influence of alcohol on early Glasgow Coma Scale in head-injured patients. J Trauma. 2010;69(5):1176-81.

Kelly DF. Alcohol and head injury: an issue revisited. J Neurotrauma. 1995;12(5):883-90.

Andersson A, Hök B, Ekström M, Hedenstierna G. Influence from breathing pattern on alcohol and tracer gas expirograms--implications for alcolock use. Forensic Sci Int. 2011;206(1):52-7.

Grubb D, Rasmussen B, Linnet K, Olsson SG, Lindberg L. Breath alcohol analysis incorporating standardization to water vapour is as precise as blood alcohol analysis. Forensic Sci Int. 2012;216(1):88-91.

Hlastala MP, Anderson JC. The impact of breathing pattern and lung size on the alcohol breath test. Ann Biomed Eng. 2007;35(2):264-72.

Sadler DW, Fox J. Intra-individual and inter-individual variation in breath alcohol pharmacokinetics: The effect of food on absorption. Sci Justice J Forensic Sci Soc. 2011;51(1):3-9.

Healey C, Osler TM, Rogers FB, Healey MA, Glance LG, Kilgo PD. Improving the Glasgow coma scale score: motor score alone is a better predictor. J Trauma. 2003;54:671-80.

Segatore M, Way C. The Glasgow Coma Scale: time for change. Heart Lung J Crit Care. 1992;21(6):548-57.

Sternbach GL. The Glasgow coma scale. J Emerg Med. 2000;19(1):67-71.

Zuercher M, Ummenhofer W, Baltussen A, Walder B. The use of Glasgow coma scale in injury assessment: a critical review. Brain Inj. 2009;23(5):371-84.

Downloads

Published

2023-04-29

How to Cite

Thomas, M., Suseel, A., & David, S. S. (2023). Effect of alcohol on Glasgow Coma score in traumatic brain injury: a single, center, cross-sectional study. International Journal of Research in Medical Sciences, 11(5), 1735–1740. https://doi.org/10.18203/2320-6012.ijrms20231345

Issue

Section

Original Research Articles