Alcohol intoxication is a major predisposing factor for trauma in general and head injury in particular. The management of the head-injured patient is highly contingent on the accurate assessment of this patient’s consciousness, which is invariably impaired if the patient is intoxicated. This complicates the decision-making process and impedes the promptness needed in management when the head injury is severe. Furthermore, the prognosis of the head injury can depend on the patient’s degree and pattern of intoxication. This article presents some of the latest epidemiological data about the association of alcohol and head injury. It also highlights some of the challenges posed by alcohol intoxication in the management of head-injured patients, and examines the importance of documenting intoxication in head-injured patients.
AlturaBMAlturaBTGebrewoldA (1983) Alcohol-induced spasms of cerebral blood vessels: relation to cerebrovascular accidents and sudden death. Science220: 331–333.
2.
AndelicNJerstadTSigurdardottirSSchankeAKSandvikLRoeC (2010) Effects of acute substance use and pre-injury substance abuse on traumatic brain injury severity in adults admitted to a trauma centre. The Journal of Trauma Management and Outcomes4: 6–6.
3.
AndelicNSigurdardottirSBrunborgCRoeC (2008) Incidence of hospital-treated traumatic brain injury in the Oslo population. Neuroepidemiology30: 120–128.
4.
BaughmanVLHoffmanWEThomasCMiletichDJAlbrechtRF (1990) Hypothermia versus ethanol: neurologic outcome after incomplete cerebral ischemia in midazolam-anesthetized rats. Journal of Neurosurgical Anesthesiology2: 290–295.
5.
BjorkJMGrantSJ (2009) Does traumatic brain injury increase risk for substance abuse?Journal of Neurotrauma26: 1077–1082.
6.
BlondellRDLooneySWKriegCLSpainDA (2002) A comparison of alcohol-positive and alcohol-negative trauma patients. Journal of Studies on Alcohol63: 380–383.
7.
BombardierCHTemkinNRMachamerJDikmenSS (2003) The natural history of drinking and alcohol-related problems after traumatic brain injury. Archives of Physical Medicine and Rehabilitation84: 185–191.
8.
BrattonSLChestnutRMGhajarJMcconnell HammondFFHarrisOAHartlR (2007) Guidelines for the management of severe traumatic brain injury. VI. Indications for intracranial pressure monitoring. Journal of Neurotrauma24(Suppl 1): S37–S44.
9.
BrickleyMRShepherdJP (1995) The relationship between alcohol intoxication, injury severity and Glasgow Coma Score in assault patients. Injury26: 311–314.
10.
BrismarBEngstromARydbergU (1983) Head injury and intoxication: a diagnostic and therapeutic dilemma. Acta Chirugica Scandinavica149: 11–14.
11.
BrodnerRAVan GilderJCCollinsWFJr (1981) Experimental spinal cord trauma: potentiation by alcohol. The Journal of Trauma21: 124–129.
12.
BullockMRChesnutRGhajarJGordonDHartlRNewellDW (2006) Surgical management of acute epidural and subdural hematomas. Neurosurgery58: S7–S24;. discussion Si–Siv.
13.
ChandlerLJSumnersCCrewsFT (1993) Ethanol inhibits NMDA receptor-mediated excitotoxicity in rat primary neuronal cultures. Alcoholism: Clinical and Experimental Research17: 54–60.
14.
ChangGAstrachanBM (1988) The emergency department surveillance of alcohol intoxication after motor vehicle accidents. The Journal of the American Medical Association260: 2533–2536.
15.
Coronado V, Xu L, Basavaraju S, Mcguire L, Wald M, Faul M, et al. (2011) Surveillance for trumatic brain injury related deaths United States, 1997-2007. Morbidity and Mortality Weekly Report. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control.
16.
CunninghamRMMaioRFHillEMZinkBJ (2002) The effects of alcohol on head injury in the motor vehicle crash victim. Alcohol and Alcoholism37: 236–240.
17.
DashPKMooreANMoodyMRTreadwellRFelixJLCliftonGL (2004) Post-trauma administration of caffeine plus ethanol reduces contusion volume and improves working memory in rats. Journal of Neurotrauma21: 1573–1583.
18.
DOH (2001) Hospital episode statistics 2000–2001. London, England: Department of Health.
19.
ElmerOGoranssonGZoucasE (1984) Impairment of primary hemostasis and platelet function after alcohol ingestion in man. Haemostasis14: 223–228.
20.
EzzatiMLopezADRodgersAVander HoornSMurrayCJ (2002) Selected major risk factors and global and regional burden of disease. Lancet360: 1347–1360.
21.
FaulMXuLWaldMMCoronadoV (2010) Emergency department visits, hospitalizations, and deaths, 2002–2006. Traumatic brain injury in the United States. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control.
22.
FieldJH (1976) Epidemiology of head injuries in England and Wales: with particular application to rehabilitation. London: H.M.S.O.
23.
FlammESDemopoulosHBSeligmanMLTomasulaJJDe CrescitoVRansohoffJ (1977) Ethanol potentiation of central nervous system trauma. Journal of Neurosurgery46: 328–335.
24.
GalbraithSMurrayWRPatelARKnill-JonesR (1976) The relationship between alcohol and head injury and its effect on the conscious level. British Journal of Surgery63: 128–130.
25.
GolanJDMarcouxJGolanESchapiroRJohnstonKMMalekiM (2007) Traumatic brain injury in intoxicated patients. The Journal of Trauma63: 365–369.
26.
HarrMEHeskestadBIngebrigtsenTRomnerBRonningPHelsethE (2011) Alcohol consumption, blood alcohol concentration level and guideline compliance in hospital referred patients with minimal, mild and moderate head injuries. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine19: 25–25.
HuthJFMaierRVSimonowitzDAHermanCM (1983) Effect of acute ethanolism on the hospital course and outcome of injured automobile drivers. The Journal of Trauma23: 494–498.
29.
InglisFMBullockRChenMHGrahamDIMillerJDMccullochJ (1990) Ischaemic brain damage associated with tissue hypermetabolism in acute subdural haematoma: reduction by a glutamate antagonist. Acta Neurochirurgica. Supplementum (Wien)51: 277–279.
30.
JaggerJFifeDVernbergKJaneJA (1984) Effect of alcohol intoxication on the diagnosis and apparent severity of brain injury. Neurosurgery15: 303–306.
31.
JanisLSHoaneMRCondeDFulopZSteinDG (1998) Acute ethanol administration reduces the cognitive deficits associated with traumatic brain injury in rats. Journal of Neurotrauma15: 105–115.
32.
JennettBTeasdaleGGalbraithSPickardJGrantHBraakmanR (1977) Severe head injuries in three countries. Journal of Neurology, Neurosurgery and Psychiatry40: 291–298.
33.
KawamataTKatayamaYHovdaDAYoshinoABeckerDP (1992) Administration of excitatory amino acid antagonists via microdialysis attenuates the increase in glucose utilization seen following concussive brain injury. Journal of Cerebral Blood Flow and Metabolism12: 12–24.
34.
KellyDF (1995) Alcohol and head injury: an issue revisited. Journal of Neurotrauma12: 883–890.
35.
KellyDFLeeSMPinanongPAHovdaDA (1997) Paradoxical effects of acute ethanolism in experimental brain injury. Journal of Neurosurgery86: 876–882.
36.
KerrTAKayDWLassmanLP (1971) Characteristics of patients, type of accident, and mortality in a consecutive series of head injuries admitted to a neurosurgical unit. British Journal of Preventive and Social Medicine25: 179–185.
37.
KreutzerJSWitolADMarwitzJH (1996) Alcohol and drug use among young persons with traumatic brain injury. Journal of Learning Disability29: 643–651.
38.
LangeRTBrubacherJRIversonGLProcyshynRMMitrovicS (2010) Differential effects of alcohol intoxication on S100B levels following traumatic brain injury. The Journal of Trauma68: 1065–1071.
39.
LieberCS (1991) Hepatic, metabolic and toxic effects of ethanol: 1991 update. Alcoholism: Clinical and Experimental Research15: 573–592.
40.
MacewenW (1879) The diagnosis of alcoholic coma. The Glasgow Medical Journal1: 1–14.
41.
MarcoCAKelenGD (1990) Acute intoxication. Emergency Medicine Clinics of North America8: 731–748.
42.
MarshallLFGautilleTKlauberMREisenbergHMJaneJALuerssenTG (1991) The outcome of severe closed head injury. Neurosurgery75: S28–S36.
43.
MaullKIKinningLSHickmanJK (1984) Culpability and accountability of hospitalized injured alcohol-impaired drivers. A prospective study. The Journal of the American Medical Association252: 1880–1883.
44.
MenonDKSchwabKWrightDWMaasAI (2010) Position statement: definition of traumatic brain injury. Archives of Physical Medicine and Rehabilitation91: 1637–1640.
45.
Moskowitz H and Fiorentino D. (2000) A review of the literature on the effects of low doses of alcohol on driving-related skills. Report No. HS-809-028. Washington, DC: US Department of Transportation, National Highway Traffic Safety Administration.
46.
MurrayGDButcherIMchughGSLuJMushkudianiNAMaasAI (2007) Multivariable prognostic analysis in traumatic brain injury: results from the IMPACT study. Journal of Neurotrauma24: 329–337.
47.
NathFPBeastalGTeasdaleGM (1986) Alcohol and traumatic brain damage. Injury17: 150–153.
48.
NIH (2007) Head injury: triage, assessment, investigation and early management of head injury in infants, children and adults. London: National Collaborating Centre for Acute Care.
49.
Oscar-BermanMMarinkovicK (2003) Alcoholism and the brain: an overview. Alcohol Research and Health27: 125–133.
50.
ParkinsonDStephensenSPhillipsS (1985) Head injuries: a prospective, computerized study. Canadian Journal of Surgery28: 79–83.
51.
PerssonLRosengrenL (1977) Increased blood-brain barrier permeability around cerebral stab wounds, aggravated by acute ethanol intoxication. Acta Neurologica Scandinavica56: 7–16.
52.
PonsfordJWhelan-GoodinsonRBahar-FuchsA (2007) Alcohol and drug use following traumatic brain injury: a prospective study. Brain Injury21: 1385–1392.
53.
PoriesSEGamelliRLVacekPGoodwinGShinozakiTHarrisF (1992) Intoxication and injury. The Journal of Trauma32: 60–64.
54.
RutherfordWH (1977) Diagnosis of alcohol ingestion in mild head injuries. Lancet1: 1021–1023.
55.
Rutland-BrownWLangloisJAThomasKEXiYL (2006) Incidence of traumatic brain injury in the United States, 2003. The Journal of Head Trauma Rehabilitation21: 544–548.
56.
ShahinHGopinathSPRobertsonCS (2010) Influence of alcohol on early Glasgow Coma Scale in head-injured patients. The Journal of Trauma69: 1176–1181. discussion 1181.
57.
ShapiraYYadidGCotevSNiskaAShohamiE (1990) Protective effect of MK801 in experimental brain injury. Journal of Neurotrauma7: 131–139.
58.
SimelDLFeussnerJR (1988) Blood alcohol measurements in the emergency department: who needs them?The American Journal of Public Health78: 1478–1479.
59.
SloanEPZalenskiRJSmithRFSheaffCMChenEHKeysNI (1989) Toxicology screening in urban trauma patients: drug prevalence and its relationship to trauma severity and management. The Journal of Trauma29: 1647–1653.
60.
SoderstromCACowleyRA (1987) A national alcohol and trauma center survey. Missed opportunities, failures of responsibility. Archives of Surgery122: 1067–1071.
61.
SperryJLGentilelloLMMineiJPDiaz-ArrastiaRRFrieseRSShafiS (2006) Waiting for the patient to ‘sober up’: effect of alcohol intoxication on Glasgow Coma Scale score of brain injured patients. The Journal of Trauma61: 1305–11.
62.
Steyerberg EW, Mushkudiani N, Perel P, Butcher I, Lu J, Mchugh GS, et al. (2008) Predicting outcome after traumatic brain injury: development and international validation of prognostic scores based on admission characteristics. PLoS Medicine 5: e165; discussion e165.
63.
StrongRGrottaJCAronowskiJ (2000) Combination of low dose ethanol and caffeine protects brain from damage produced by focal ischemia in rats. Neuropharmacology39: 515–522.
64.
StukeLDiaz-ArrastiaRGentilelloLMShafiS (2007) Effect of alcohol on Glasgow Coma Scale in head-injured patients. Annals of Surgery245: 651–655.
65.
TagliaferriFCompagnoneCKorsicMKrausJ (2008) A systemic review of brain injury epidemiology in Europe. Acta Neurochirurgica148: 255–268.
66.
TeasdaleGJennettB (1974) Assessment of coma and impaired consciousness. A practical scale. Lancet2: 81–84.
67.
TienHCTremblayLNRizoliSBGelbergJChughtaiTTikuisisP (2006) Association between alcohol and mortality in patients with severe traumatic head injury. Archives of Surgery141: 1185–1191; discussion 1192.
68.
TureciEDashtiRTanriverdiTSanusGZOzBUzanM (2004) Acute ethanol intoxication in a model of traumatic brain injury: the protective role of moderate doses demonstrated by immunoreactivity of synaptophysin in hippocampal neurons. Neurological Research26: 108–112.
69.
ValadkaA(2000) Injury to the cranium. In: MattoxKFMooreEE (eds) Trauma, 4th ed. New York: McGraw-Hill, pp.377–399.
70.
VosPEBattistinLBirbamerGGerstenbrandFPotapovAPrevecT (2002) EFNS guideline on mild traumatic brain injury: report of an EFNS task force. European Journal of Neurology9: 207–219.
71.
WardREFlynnTCMillerPWBlaisdellWF (1982) Effects of ethanol ingestion on the severity and outcome of trauma. The American Journal of Surgery144: 153–157.
72.
WHO (2002) The world health report 2002: reducing risks, promoting healthy life. Geneva: World Health Organization.
73.
WHO (2007) World health organization collaborative study on alcohol and injuries: final report. Geneva: World Health Organization.
74.
YamakamiIVinkRFadenAIGennarelliTALenkinskiRMcintoshTK (1995) Effects of acute ethanol intoxication on experimental brain injury in the rat: neurobehavioral and phosphorus-31 nuclear magnetic resonance spectroscopy studies. Journal of Neurosurgery82: 813–821.
