An estimated 1.5 million people in the United States incur a traumatic brain injury (TBI) every year and 60,000 people die annually from these injuries. TBI is the ultimate cause of death in 40 percent of all fatal trauma cases. TBI may result from a direct blow to the brain or from the secondary effects of head trauma such as bleeding, swelling, decreased oxygen, or increased pressure on the brain. Intracranial hemorrhage (ICH) or bleeding inside the head is the cause of death in 70-80 percent of patients presenting with TBI.
ICH increases the risk of brain damage, which can lead to serious residual neurological disabilities in surviving patients. Every year, 80,000 to 90,000 people experience the onset of long-term or lifelong disabilities associated with TBI. In the United States today, there are currently as many as 5.3 million TBI survivors living with these disabilities.
There have been many studies dedicated to predicting overall clinical outcome in TBI patients. The factors which have been identified thus far are age, level of consciousness on first admission to the hospital, and degree of injury on computed tomography (CT) scanning. It is known that up to 50 percent all cases of ICH can increase with time, resulting in worsening neurological status and appearance on CT scan.
More than half of the patients brought to the hospital with TBI are intoxicated and many have cardiovascular disease requiring them to be on blood-thinners such as aspirin. Yet no prior studies have examined the potential effects of alcohol and aspirin consumption on worsening ICH in patients with TBI. Researchers at Elmhurst Hospital Center performed a one-year observational study on 150 patients treated at this Level 1 Trauma Center.
Aspirin thins the blood, and reduces the risk of clots forming in key blood vessels, yet can cause bleeding problems in people with certain conditions Theoretically, TBI patients who are aspirin users could be prime candidates at risk for increased hemorrhaging associated with aspirin consumption.
When used in excess, alcohol damages brain structure and function. Besides the acute effects of alcohol consumption on the neurological function of the brain, there are physical changes that may result from moderate to heavy drinking of long duration. One concern is brain atrophy, which leaves more room inside the cranium for blood to collect during a brain injury. Alcohol weakens the walls of blood vessels and makes them more susceptible to rupture and bleeding. It is theorized that the combination of these factors can lead to an increase of ICH.
The study included 150 patients with a mean age of 49, admitted to the hospital with ICH after acute TBI. All pertinent patient information including history of blood-thinner usage was recorded. Initial alcohol levels were measured in all patients suspected of intoxication. Other labs were drawn including those used to assess the clotting ability of the blood. All patients underwent two sequential CT scans within 6-12 hours after admission. The CT scans were evaluated by the investigative team and the on-call radiologist for worsening brain hemorrhage. High blood alcohol levels were present in 56.2 percent of the patients. Patients taking aspirin comprised 8.2 percent of this study population.
"Interestingly, we found that neither alcohol nor aspirin were significantly associated with worsening ICH. However increasing age was significantly correlated with worsening hemorrhage," stated Dr. Smith. Overall outcome was negatively associated with worsening ICH and was measured by mortality (3 percent) and discharges to home (78.1 percent), a rehabilitation center (16.4 percent), or a skilled nursing facility (2.3 percent).