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Journal Article

Citation

Eastman AB. Arch. Surg. (1960) 2006; 141(12): 1192.

Affiliation

Scripps Memorial Hospital, 4275 Campus Point Ct, CP222, San Diego, CA 92121 (Eastman.Brent@scrippshealth.org)

Copyright

(Copyright © 2006, American Medical Association)

DOI

unavailable

PMID

unavailable

Abstract

Invited comments upon: Arch Surg. 2006;141(12):1185-1191.

This is a well-designed, retrospective study using a large Canadian trauma system database. Tien et al examine the hypothesis that "admission blood alcohol concentration is associated with in-hospital death in patients with severe brain injury from blunt head trauma."



There is a long-held myth that intoxicated trauma victims are more relaxed and, therefore, fare better than nonintoxicated patients. In the interest of public health, this is a myth to be discredited.



However, this study did find that the cohort of patients with severe TBI and a low BAC had a higher survival rate than those with no BAC. This finding should stimulate clinical research to better understand the potential neuroprotective effects of a low BAC, but it should clearly not be a call for trauma patients with severe TBI to premedicate with alcohol. Rather, the emphasis more appropriately should be placed on the fact that 30% to 50% of all hospitalized trauma patients are intoxicated at the time of injury.



Conversely, a high BAC was associated with higher mortality. This suggests a detrimental effect of a high BAC on homeostasis (eg, hypotension), and we know that hypotension is a critical, negative factor in secondary brain injury. This finding should also stimulate clinical research to better understand and counter these negative physiologic changes. It also speaks to the trauma prevention dictum that decries drinking and driving.



This study should be further impetus for clinical research that will better define the dose-related effect, positive or negative, of alcohol on the physiologic status and outcome in patients with severe TBI. Perhaps this research can help answer the question as to whether there is a therapeutic role for alcohol in our management of the patient with severe TBI after adequate resuscitation.

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