title: Ethanol and isolated traumatic brain injury.
abstract: The aim of this systematic review was to determine whether ethanol is neuroprotective or associated with adverse effects in the context of traumatic brain injury (TBI). Approximately 30-60% of TBI patients are intoxicated with ethanol at the time of injury. We performed a systematic review of the literature using a combination of keywords for ethanol and TBI. Manuscripts were included if the population studied was human subjects with isolated moderate to severe TBI, acute ethanol intoxication was studied as an exposure variable and mortality reported as an outcome. The included studies were assessed for heterogeneity. A meta-analysis was performed and the pooled odds ratio (OR) for the association between ethanol and in-hospital mortality reported. There were seven studies eligible for analysis. A statistically significant association favouring reduced mortality with ethanol intoxication was found (OR 0.78; 95% confidence interval 0.73-0.83). Heterogeneity among selected studies was not statistically significant (p=0.25). Following isolated moderate-severe TBI, ethanol intoxication was associated with reduced in-hospital mortality. The retrospective nature of the studies, varying definitions of brain injury, degree of intoxication and presence of potential confounders limits our confidence in this conclusion. Further research is recommended to explore the potential use of ethanol as a therapeutic strategy following TBI.
authors.affiliation: Emergency & Trauma Centre, The Alfred Hospital, Commercial Road, Melbourne, VIC 3004, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Clayton, VIC, Australia. Electronic address: jhbre2@student.monash.edu.
authors.forename: James H
authors.initials: JH
authors.lastname: Brennan
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Clayton, VIC, Australia; Intensive Care Unit, The Alfred Hospital, Melbourne, VIC, Australia.
authors.forename: Stephen
authors.initials: S
authors.lastname: Bernard
authors.affiliation: Emergency & Trauma Centre, The Alfred Hospital, Commercial Road, Melbourne, VIC 3004, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Clayton, VIC, Australia; Emergency Medicine, Hamad Medical Corporation, Doha, Qatar; National Trauma Research Institute, The Alfred Hospital, Melbourne, VIC, Australia.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Cameron
authors.affiliation: National Trauma Research Institute, The Alfred Hospital, Melbourne, VIC, Australia; Department of Neurosurgery, The Alfred Hospital, Melbourne, VIC, Australia; Department of Surgery, Monash University, Clayton, VIC, Australia; Department of Surgery, F. Edward Hébert School of Medicine, Uniformed Services University of The Health Sciences, Bethesda, MD, USA.
authors.forename: Jeffrey V
authors.initials: JV
authors.lastname: Rosenfeld
authors.affiliation: Emergency & Trauma Centre, The Alfred Hospital, Commercial Road, Melbourne, VIC 3004, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Clayton, VIC, Australia; National Trauma Research Institute, The Alfred Hospital, Melbourne, VIC, Australia.
authors.forename: Biswadev
authors.initials: B
authors.lastname: Mitra
mesh_terms: D000435:Alcoholic Intoxication / Q000453:epidemiology; D001930:Brain Injuries / Q000453:epidemiology / Q000401:mortality*; D015897:Comorbidity; D017052:Hospital Mortality; D006801:Humans
keywords: Alcohol; Blood alcohol; Brain injury; Ethanol; Ethanol intoxication; Traumatic brain injury