The impact of ETOH intoxication on the development of admission coagulopathy after traumatic brain injury: a prospective evaluation

E Karamanos; E Sivrikoz; P Talving; K Inaba; S Resnick; D Demetriades

doi:10.1007/s00068-013-0308-0

The impact of ETOH intoxication on the development of admission coagulopathy after traumatic brain injury: a prospective evaluation

Eur J Trauma Emerg Surg. 2014 Feb;40(1):45-50. doi: 10.1007/s00068-013-0308-0. Epub 2013 Jun 15.

Authors

E Karamanos¹, E Sivrikoz², P Talving², K Inaba², S Resnick², D Demetriades³

Affiliations

¹ Division of Acute Care Surgery (Trauma and Critical Care), Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles County + University of Southern California Medical Center, 2051 Marengo Street, IPT C5L100, Los Angeles, CA, USA. ef.karamanos@gmail.com.
² Division of Acute Care Surgery (Trauma and Critical Care), Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles County + University of Southern California Medical Center, 2051 Marengo Street, IPT C5L100, Los Angeles, CA, USA.
³ Division of Acute Care Surgery (Trauma and Critical Care), Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles County + University of Southern California Medical Center, 2051 Marengo Street, IPT C5L100, Los Angeles, CA, USA. Demetrios.Demetriades@med.usc.edu.

PMID: 26815776
DOI: 10.1007/s00068-013-0308-0

Abstract

Introduction: Coagulopathy after severe traumatic brain injury (sTBI) results in a ten-fold increased risk of death. Our aim was to investigate the effect of ETOH intoxication on admission coagulopathy after sTBI.

Methods: Patients with sTBI [Glasgow Coma Scale <9 or evidence of intracranial pathology on computed tomography (CT)] from 1/2010 to 12/2011 were prospectively enrolled. Demographics, clinical characteristics, laboratory values, head CT scan findings, physical examination, injury severity indices, and interventions were recorded. ETOH blood levels were obtained. The incidence of admission coagulopathy was compared between patients who were ETOH-positive (ETOH+) and those who were ETOH-negative (ETOH-). Logistic regression was performed to identify independent risk factors.

Results: A total of 216 patients were enrolled. 20.4 % were ETOH+. Admission coagulopathy was significantly lower for ETOH+ patients (15.9 vs. 39.0 %, adjusted p = 0.020). Prothrombin time (PT) and International Normalized Ratio (INR) on admission were significantly lower for ETOH+ patients (16.7 vs. 14.3, adjusted p = 0.016 and 1.35 vs. 1.13, adjusted p = 0.040, respectively). Injury Severity Score ≥25, hypotension, and loss of gray/white differential were identified as independent risk factors for the development of admission coagulopathy. ETOH intoxication was the only protective predictor [AOR (95 % CI): 0.32 (0.12, 0.84), adjusted p = 0.021].

Conclusions: ETOH intoxication is associated with a lower incidence of admission coagulopathy in patients with sTBI. Further research is warranted.

Keywords: Coagulopathy; ETOH intoxication; Severe traumatic brain injury.