Association of Alcohol with Mortality after Traumatic Brain Injury
JournalAmerican Journal of Epidemiology
PublisherOxford University Press
MetadataShow full item record
AbstractAlthough alcohol exposure results in reduced mortality after traumatic brain injury (TBI) in animal models, clinical trials based on proposed mechanisms have been disappointing and have reported conflicting results. Methodological issues common to many of these clinical studies may have contributed to the spurious results. Our objective was to evaluate the association between blood alcohol concentration (BAC) and in-hospital mortality after TBI, and overcome methodological problems of prior studies. We conducted a retrospective cohort study on individuals treated for isolated TBI (n = 1,084) at the R Adams Cowley Shock Trauma Center (Baltimore, Maryland) from 1997 to 2012. We excluded individuals with injury to other body regions and examined multiple cutpoints of BAC. Our primary outcome was in-hospital mortality. In adjusted logistic regression models, the upper level of each blood alcohol categorization from 0.10 g/dL (odds ratio = 0.63, 95% confidence interval: 0.40, 0.97) through 0.30 g/dL (odds ratio = 0.25, 95% confidence interval: 0.08, 0.84) was associated with reduced risk of mortality after TBI compared with individuals with undetectable BAC. In sensitivity analyses among individuals without penetrating brain injuries (95% firearm-related) (n = 899), the protective association was eliminated. This study provides evidence that the observed protective association between BAC and in-hospital mortality after TBI resulted from bias introduced by inclusion of penetrating injuries. Copyright The Author(s) 2017. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved.
SponsorsAuthor affiliations: Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, Maryland (Jennifer S. Albrecht, Gordon S. Smith); Department of Public Health Sciences, Loyola University, Chicago, Illinois (Majid Afshar); Department of Surgery, Division of Surgical Critical Care, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, Maryland (Deborah M. Stein); and Shock, Trauma and Anesthesiology Research (STAR) Organized Research Center, National Study Center for Trauma and Emergency Medical Services, University of Maryland, Baltimore, Maryland (Gordon S. Smith). This work was supported by the National Institutes of Health (grants K12HD43489 (to J.S.A.), K23AA024503 (to M.A.), and R01AA18707 (to G.S.S.)) and the Agency for Healthcare Research and Quality (grant 1K01HS024560 (to J.S.A.)). Conflict of interest: none declared.
Identifier to cite or link to this itemhttps://www.scopus.com/inward/record.uri?eid=2-s2.0-85036501572&doi=10.1093%2faje%2fkwx254&partnerID=40&md5=477026404ad270a663ed567d07800283; http://hdl.handle.net/10713/8959