Abstract
BackgroundThe aims of this study were to describe the occurrence of substance use at the time of injury and pre-injury substance abuse in patients with moderate-to-severe traumatic brain injury (TBI). Effects of acute substance use and pre-injury substance abuse on TBI severity were also investigated.MethodsA prospective study of 111 patients, aged 16-55 years, injured from May 2005 to May 2007 and hospitalised at the Trauma Referral Centre in Eastern Norway with acute TBI (Glasgow Coma Scale 3-12). Based on structural brain damages shown on a computed tomography (CT) scan, TBI severity was defined by modified Marshall classification as less severe (score <3) and more severe (score ≥3). Clinical definition of substance use (alcohol and/or other psychoactive substances) was applied when hospital admission records reflected blood alcohol levels or a positive drug screen, or when a physician verified influence by examining the patient. Pre-injury substance abuse (alcohol and drug problems) was screened by using the CAGE questionnaire.ResultsForty-seven percent of patients were positive for substance use on admission to hospital. Significant pre-injury substance abuse was reported by 26% of patients. Substance use at the time of injury was more frequent in the less severe group (p = 0.01). The frequency of pre-injury substance abuse was higher in the more severe group (30% vs. 23%). In a logistic regression model, acute substance use at time of injury tended to decrease the probability of more severe intracranial injury, but the effect was not statistically significant after adjusting for age, gender, education, cause of injury and substance abuse, OR = 0.39; 95% CI 0.11-1.35, p = 0.14. Patients with positive screens for pre-injury substance abuse (CAGE ≥2) were more likely to have more severe TBI in the adjusted regression analyses, OR = 4.05; 95% CI 1.10-15.64, p = 0.04.ConclusionsAcute substance use was more frequent in patients with less severe TBI caused by low-energy events such as falls, violence and sport accidents. Pre-injury substance abuse increased the probability of more severe TBI caused by high-energy trauma such as motor vehicle accidents and falls from higher levels. Preventive efforts to reduce substance consumption and abuse in at-risk populations are needed.
Highlights
The aims of this study were to describe the occurrence of substance use at the time of injury and preinjury substance abuse in patients with moderate-to-severe traumatic brain injury (TBI)
The initial severity of TBI was assessed by the Glasgow coma scale (GCS) either at the time of emergency admission to the hospital or based on pre-intubation values assigned at the site of injury; GCS 3-8 represents severe and 9-12 moderate TBI [11]
Education was significantly lower in the group with more severe injuries (p = 0.002)
Summary
The aims of this study were to describe the occurrence of substance use at the time of injury and preinjury substance abuse in patients with moderate-to-severe traumatic brain injury (TBI). Most studies related to substance consumption have focused on selected TBI populations such as victims of road traffic crashes [5], falls [6] or assaults [7]. In recent literature it has been debated whether the influence of alcohol increases [5] or decreases [8] the risk of more severe injuries, or if it has no effect [9]. As reported by Parry-Jones et al [4], most of the studies are conducted in the USA, which may limit applicability of findings to non-American countries, "given the potential influence of cultural factors on patterns of alcohol and drug consumption"[10]
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