Intoxication and Glasgow coma scale scores in patients with head trauma

• Published in: The American journal of emergency medicine Vol. 80; pp. 8 - 10
• Main Authors: Pina, Callie, Marco, Catherine A.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2024; Elsevier Limited
• Subjects: Adult; Aged; Alcohol use; Alcoholic Intoxication - complications; Alcoholic Intoxication - diagnosis; Alcohols; Case-Control Studies; Coma; Consciousness; Craniocerebral Trauma - diagnosis; Drug use; Emergency; Emergency medical care; Emergency medical services; Emergency Service, Hospital; Female; Glasgow Coma Scale; Head; Head injuries; Head trauma; Humans; Injury Severity Score; Intoxication; Male; Mann-Whitney U test; Middle Aged; Mortality; Patients; Pennsylvania - epidemiology; Retrospective Studies; Statistical analysis; Substance abuse treatment; Substance use; Substance-Related Disorders - diagnosis; Trauma; Pennsylvania; United States > US; Substance use; Glasgow coma scale; Intoxication; Head trauma; Emergency; Alcohol use
• ISSN: 0735-6757; 1532-8171; 1532-8171
• DOI: 10.1016/j.ajem.2024.02.039

The Glasgow Coma Scale (GCS) is an assessment tool commonly used by emergency department (ED) clinicians to objectively describe level of consciousness, especially in trauma patients. This study aims to assess the effect of drug and alcohol intoxication on GCS scores in cases of traumatic head injury. In this retrospective chart review study, data were extracted from The Pennsylvania Trauma Systems Foundation Data Base Collection System. Eligible subjects included trauma patients aged 18 years and older, with head trauma, who presented between January 2019 and August 2023. Subjects were matched to controls who did not test positive for drugs or alcohol, matched by Injury Severity Score (ISS) category. Among 1088 subjects, the mean age was 63 (95% CI 62–64). The mean Injury Severity Score was 21 (95% CI 21–22). The median GCS among all subjects was 14 (IQR 6–15). Cases with alcohol or drug use were matched to controls without alcohol or drug use, and were matched by categories of Injury Severity Score. Cases with alcohol or drug use had lower GCS (median 13; IQR 3–15), compared to cases without alcohol or drug use (median 15; IQR 13–15) (p < 0.0001, Wilcoxon Rank Sum Test). Among patients with head trauma, intoxicated patients had statistically significant lower GCS scores as compared to matched patients with similar Injury Severity Scores.