Research Reports - Head trauma sustained under the influence of alcohol is a predictor for future traumatic brain injury

Eur J Neurol. 2013 Nov 15

Vaaramo K, Puljula J, Tetri S, Juvela S, Hillbom M

BACKGROUND AND PURPOSE: Hazardous drinking may result in recurrent head trauma.
It was investigated whether head trauma sustained under the influence of alcohol
is a predictor of future traumatic brain injury (TBI).
METHODS: All subjects with head trauma (n = 827) brought to the emergency room at
Oulu University Hospital during 1999 were identified and followed up until death
or the end of 2009. The National Hospital Discharge Register and hospital charts
were used to identify TBIs during the follow-up and Kaplan-Meier curves and the
Cox proportional hazards model were used to characterize predictors of TBI.
RESULTS: During the total follow-up of 7386 person-years, 52/827 subjects
sustained a new head trauma with TBI and the risk of TBI was significantly
(P = 0.005) higher amongst subjects who had been under the influence of alcohol
at the time of the index trauma in 1999. New TBI occurred under the influence of
alcohol in 30/52 cases (57.7%). An alcohol-related index trauma [adjusted hazard
ratio (HR) 2.51, 95% confidence interval (CI) 1.38-4.56, P < 0.01] and history of
TBI (HR 3.39, 95% CI 1.32-8.72, P < 0.05) were independent risk factors for
subsequent TBI after adjustment for sex and age. A history of harmful drinking
was also a significant risk factor (adjusted HR 10.37, 95% CI 5.53-19.43,
P < 0.001). In the subset of 396 patients having an index head trauma without
TBI, this being alcohol related was also a significant risk factor for subsequent
TBI after adjustment for sex, age and history of TBI (HR 3.54, 95% CI 1.36-9.18,
P = 0.009).
CONCLUSIONS: Even head trauma without TBI under the influence of alcohol implies
an elevated risk of subsequent TBI. A brief intervention to reduce hazardous
drinking is needed to prevent TBI.

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