Acute alcohol intoxication as a confounding factor for mild traumatic brain injury

Background: Acute alcohol intoxication is universally considered a risk factor for traumatic brain injury (TBI), therefore an indication for head CT scan. There is no evidence in the literature for this attitude. Aim of this study is to assess the need for head CT scan in acutely alcohol-intoxicated subjects with mTBI and the role of Glasgow coma scale (GCS) score in this kind of patients. Methods: We retrospectively analyzed all 3358 consecutive patients presenting to our department in Switzerland, with TBI as chief complaint between January 2014 and January 2018. Results: Alcohol was a statistically significant factor for presentation with a GCS score lower than 15. As for bleedings in mild TBI patients, the results were somewhat contradictory with GCS 15 patients showing a higher percentage of hemorrhages than GCS 14 patients. By dividing alcohol-intoxicated subjects into groups per blood alcohol concentration, the higher was the alcohol level, the lower the GCS score. Conclusions: We can affirm that GCS score is underestimated in acutely intoxicated head trauma patients. In this kind of patient, alcohol is a confounding factor and mild TBI could be safely managed by watchful waiting.