title: Adverse effects of admission blood alcohol on long-term cognitive function in patients with traumatic brain injury.
abstract: BACKGROUND
  Alcohol is known to be protective in patients with traumatic brain injury (TBI); however, its impact on the long-term cognitive function is unknown. We hypothesize that intoxication at the time of injury is associated with adverse long-term cognitive function in patients sustaining TBI.
  
  
  METHODS
  We performed a 2-year retrospective study of all trauma patients with isolated TBI presenting to our Level I trauma center and discharged to a single rehabilitation facility. Patients with moderate-to-severe TBI (head Abbreviated Injury Scale [AIS] score ≥ 3), measured admission blood alcohol concentration, and measured cognitive function on hospital discharge and rehabilitation center discharge were included. Cognitive function was assessed using Functional Independence Measure (FIM) scores. Delta cognitive FIM was defined as the difference between rehabilitation center discharge and hospital discharge cognitive FIM scores. Multivariate linear regression was performed.
  
  
  RESULTS
  A total of 64 patients were included. Mean (SD) age was 51.8 (23) years, median head AIS score was 3 (IQR, 3-5), and median Glasgow Coma Scale (GCS) score was 11 (IQR, 3-15). Mean (SD) cognitive FIM score on hospital discharge was 17 (6), and mean (SD) cognitive improvement was 8.6 (4.7). Sixty percent (n = 39) were under the influence of alcohol on admission, and the mean (SD) admission blood alcohol concentration was 132 (102).On multivariate linear regression analysis, admission blood alcohol concentration (β = -0.4; 95% confidence interval, -6.7 to -0.8; p = 0.01) and age (β = -0.13; 95% confidence interval, -0.2 to -0.04; p = 0.04) were negatively associated with improvement in long-term cognitive function.
  
  
  CONCLUSIONS
  Alcohol intoxication at the time of injury is associated with lower improvement in long-term cognitive function. Older intoxicated patients are likely to have a lower cognitive improvement.
  
  
  METHODS
  Prognostic and epidemiologic study, level III.
authors.affiliation: From the Division of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, University of Arizona, Tucson, Arizona.
authors.forename: Bellal
authors.initials: B
authors.lastname: Joseph
authors.forename: Mazhar
authors.initials: M
authors.lastname: Khalil
authors.forename: Viraj
authors.initials: V
authors.lastname: Pandit
authors.forename: Narong
authors.initials: N
authors.lastname: Kulvatunyou
authors.forename: Bardiya
authors.initials: B
authors.lastname: Zangbar
authors.forename: Terence
authors.initials: T
authors.lastname: O'Keeffe
authors.forename: Anum
authors.initials: A
authors.lastname: Asif
authors.forename: Andrew
authors.initials: A
authors.lastname: Tang
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Green
authors.forename: Lynn
authors.initials: L
authors.lastname: Gries
authors.forename: Randall S
authors.initials: RS
authors.lastname: Friese
authors.forename: Peter
authors.initials: P
authors.lastname: Rhee
mesh_terms: D015998:Abbreviated Injury Scale; D000367:Age Factors; D000435:Alcoholic Intoxication / Q000097:blood*; D001930:Brain Injuries / Q000097:blood* / Q000628:therapy*; D003072:Cognition Disorders / Q000097:blood* / Q000628:therapy*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D012189:Retrospective Studies; D014193:Trauma Centers