The Impact of Drug and Alcohol Intoxication on Glasgow Coma Scale Assessment in Patients with Traumatic Brain Injury

Anthony M DiGiorgio; Blake A Wittenberg; Clifford L Crutcher 2nd; Brooke Kennamer; Clarence S Greene; Alan J Velander; Jason D Wilson; Gabriel C Tender; Frank Culicchia; John P Hunt

doi:10.1016/j.wneu.2019.12.095

The Impact of Drug and Alcohol Intoxication on Glasgow Coma Scale Assessment in Patients with Traumatic Brain Injury

World Neurosurg. 2020 Mar:135:e664-e670. doi: 10.1016/j.wneu.2019.12.095. Epub 2019 Dec 24.

Affiliations

¹ Department of Neurosurgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA. Electronic address: amdigiorgio@gmail.com.
² Department of Neurosurgery, University of Colorado, Denver, Colorado, USA.
³ Department of Neurosurgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA.
⁴ Division of Neurosurgery, Department of Surgery, University of Arizona College of Medicine, Maricopa Medical Center, Phoenix, Arizona, USA.
⁵ Department of General Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA; Norman E. McSwain, Jr, MD, Spirit of Charity Trauma Center, University Medical Center New Orleans, New Orleans, Louisiana, USA.

PMID: 31881342
DOI: 10.1016/j.wneu.2019.12.095

Abstract

Background: The effect of intoxicating substances on assessment of Glasgow Coma Scale (GCS) in the trauma setting has not been completely elucidated.

Methods: A trauma registry was queried for patients with blunt head trauma in 2013-2017. Initial GCS score and toxicology screening from the database were reviewed. Next recorded GCS score from the neurosurgery evaluation and change in GCS score (ΔGCS) were compared.

Results: We reviewed 468 patients. In 217 (46.4%) patients, no toxic substances were found, whereas >1 toxic substance was found in 104 (22.2%) patients. Alcohol level above the legal limit was found in 109 (23.3%) patients, marijuana was found in 105 (22.4%) patients, benzodiazepines were found in 94 (20.1%) patients, opiates were found in 48 (10.3%) patients, and cocaine was found in 41 (8.8%) patients. Mean change in GCS score was significantly higher in impaired patients compared with patients with a negative screening test (1.74 ± 2.4 vs. 0.75 ± 2.7, P < 0.001); this is despite both groups having a similar initial GCS score (6.23 ± 3.86 in impaired group vs. 6.47 ± 3.52 in sober group, P = 0.677). Initial GCS score was 3 in 187 patients, of whom 150 had a positive toxicology screen. Change in GCS score was significantly higher in the impaired group (2.75 ± 2.7 vs. 1.19 ± 1.8, P < 0.001).

Conclusions: Intoxicating substances can confound GCS assessment in trauma patients. This can have effects on patient care as well as performance metrics and predictive analytics. These patients should be screened, and intoxicating substances should be reversed or allowed to wear off before GCS score is recorded for benchmarking or quality reporting.

Keywords: Glasgow coma scale; Intoxication; Traumatic brain injury.

MeSH terms

Adolescent
Adult
Aged
Aged, 80 and over
Alcoholic Intoxication / complications
Brain Injuries, Traumatic / complications*
Child
Child, Preschool
Female
Glasgow Coma Scale*
Head Injuries, Closed / complications
Hematoma, Subdural / complications
Humans
Infant
Infant, Newborn
Male
Middle Aged
Neurosurgical Procedures / methods
Prospective Studies
Registries
Subarachnoid Hemorrhage / complications
Substance-Related Disorders / complications*
United States
Young Adult