Alcohol and traumatic brain injury: the understated vector of a silent epidemic

Objective: Few studies have analysed the role of alcohol consumption in traumatic brain injury (TBI), with conflicting reports on its effect on outcome. Our aim was to investigate the incidence of alcohol intoxication in our TBI population and its relationship to the severity of injury, intracranial pathology and outcome.Methods: From the TBI database, demographic, injury and clinical details (including alcohol intoxication) were prospectively recorded for 362 patients aged >16 years and admitted to Neurosurgical ITU between September 2005 and September 2008. Data, including mortality and dichotomized GOS (favourable = 4–5; unfavourable = 1–3) at discharge, 6 and 12 months, were analysed using ?2, t-test and ANOVA after normalisation where appropriate.Results: Intoxication was present in 36% of patients who were slightly younger (mean 37.6 vs. 40.1 years) and predominantly males (83%vs. 76%) when compared with non-intoxicated. There was no significant difference between these groups in GCS (median 8 vs. 10), length of stay and outcome. At 6 months, 67% had a favourable outcome (71% at 12 months) and mortality was 8.4%. There was a strong association between alcohol and mechanism of injury (p = 0.02), with assaults being significantly more common in this subgroup.Conclusions: To our knowledge, this is the largest single-centre study on alcohol consumption and TBI. Despite no apparent effect on outcome, intoxication plays a role in over a third of the admissions. Given the disease burden of TBI, this further highlights public health concerns about alcohol in the UK. The focus should perhaps be on the rise in consumption in young people, a group for which TBI remains the largest cause of death and disability.