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Neurobehavioral improvement in severe TBI patients with a positive blood alcohol level on initial hospital admission
Sindelar B, Pape TL. Neurobehavioral improvement in severe TBI patients with a positive blood alcohol level on initial hospital admission. Poster session presented at: Federal Interagency Conference on Traumatic Brain Injury; 2011 Jun 13; Washington, DC.
Alcohol intoxication has been postulated to provide neuro-protection when in concert with traumatic brain injury (TBI), but limited research has addressed the effect of alcohol on neuronal improvement through evaluation of patients' evolving functional abilities. The objective of this study was to examine the relationship between alcohol at time of severe TBI with three measures of neurobehavioral functioning: the Disorders of Consciousness Scale (DOCS), a bedside assessment of neurobehavioral gain during acute rehabilitation among the unconscious, the duration of unconsciousness following injury, and the Functional Independence Measure (FIMTM), a scale that
determines a conscious individual's dependence/independence on a caregiver, measured 1-year from established consciousness. Together, these three measures capture the spectrum of recovery from severe TBI.
We extracted participants from a larger observational study who met the following criteria: 18 years of age, 28 consecutive days of unconsciousness, reported blood alcohol status at injury (+ BAL/-BAL), and more than three DOCS evaluations (every 7 days) during acute rehabilitation. Patients either had a closed head injury (contra coup and blast injury), blunt trauma, gunshot wound (brain penetrating and non-brain penetrating), or anoxic brain injury. For this sample of 99 participants, we then extracted DOCS scores, acute rehabilitation admission date, date of emergence into consciousness, and 1-year FIM scores.
Of the 99 participants, 18 had a positive BAL at injury. No statistical difference existed among the mean time from injury to last DOCS score for the -BAL group (95.7 14.6 days) and the +BAL group (89.4 29.8 days). Findings indicate that the +BAL group had significantly greater mean change in the DOCS auditory score of 24.4 16.86 compared to the -BAL group's of 6.6 7.22(p = 0.0437). The +BAL group also was found to have a shorter average time to re-emergence into consciousness (73.46 19.1 days) relative to the -BAL group (169.3 38.8 days, p < 0.01). The FIM scores were not significantly different between groups.
Individuals with +BAL at time of injury, compared to -BAL at injury, made greater DOCS gains during acute rehabilitation, re-emerged into consciousness earlier, but were found to have no significant improvements in FIM scores. While the underlying mechanisms for the differences between these groups cannot be definitively determined, these findings suggest that alcohol does provide a neuro-protective role.