We read with interest the study by Salim et al1 describing an association between serum ethanol levels and decreased mortality after traumatic brain injury. Unfortunately, the authors failed to comment on the degree to which the Glasgow Coma Scale (GCS) score at presentation is affected by ethanol intoxication. The presence of ethanol could decrease the GCS score, and intoxicated patients may enter a poor prognostic risk group independent of the severity of their brain injury. This will exaggerate the impact of ethanol on outcome.
Bourdeaux CP, Marsh AJ. No Cheers Yet for Ethanol in Traumatic Brain Injury. Arch Surg. 2010;145(4):403. doi:10.1001/archsurg.2010.25