Thursday, December 3, 2009, 4:43 4:49 pm CSRS 2009

Paper #24a
Does Blood Alcohol Concentration on Admission at Emergency Department Influence
Survival, Impairment and Disability Following Traumatic Spinal Cord Injury?
Julio C Furlan, MD, MBA, MSc, PhD, Toronto, ON, Canada (n);
Michael G Fehlings, MD, PhD, Toronto, ON, Canada (3-DePuy Spine; 5-Medtronic, DePuy
Spine; 7-AOSpine North America, Creadpedics, Medtronic, Physicians Services Inc.
Foundation, Krembil Foundation, Canadian Institute of Health Research,
Ontario Neurotrauma Foundation, CSRS; 10-Medtronic)

Introduction: Preclinical studies suggested detrimental effects of administration of ethanol on

survival, tissue sparing and locomotor recovery in animals SCI models due to altered cell
membranes, blood flow and metabolism1-4. However, the potential effects of blood alcohol
concentration (BAC) in the clinical SCI setting remain unclear. Given this, we sought to examine
whether BAC on admission adversely affects survival, impairment and disability after acute
traumatic SCI.

Methods: This study included all patients enrolled in the Third National Acute SCI Study
(NASCIS-3), which compared the efficacy of 24-hour/48-hour regimen of methylprednisolone
and 48-hour administration of tirilazad mesylate in the management of acute SCI5.
The population was divided into: (i) patients without alcohol use on admission post-SCI
(BAC=0%), (ii) patients with legal BAC for driving (0<BAC0.08%), and patients with illegal
BAC (BAC>0.08%). Outcome measures included survival, motor/sensory scores, pain scores,
and Functional Independence Measure (FIM) at baseline (24 hours) and at 6 weeks, 6 and 12
months post-SCI.
Data were analysed using Fisher exact test, Mann-Whitney-U test, linear regression analysis
and log-rank test. In addition to unadjusted regression analysis, the potential correlation between
BAC and each score was examined using multivariate regression analyses controlled for
potential major confounders that included gender, ethnic group, Glasgow Coma Score (GCS),
serum alcohol concentration, drug protocol, cause of injury, level and severity of SCI.

Results: Of the 499 patients (423 males, 76 females; ages: 14-92 years, mean age of 35.7)
enrolled in the NASCIS-3 trial, 448 patients had the essential data for our study. The mean BAC
was 0.0540.006% (range: 0-1%). While most individuals had BAC=0% (n=295), 106 patients
showed illegal BAC and 47 individuals had legal BAC. The 3 groups were statistically
comparable regarding the potential confounders except for their mean age (p=0.025) and GCS
(p=0.004).
The survival rate within the first year post-SCI was 94.4%. The three patient BAC groups did
not significantly differ regarding survival at 1 year post-SCI (Figure 1). Among survivors, BAC
was not significantly correlated with motor and sensory recovery, change in pain scores and
degree of disability within the first year post-SCI when regression analyses were adjusted for
potential confounders (Table 1).

If noted, the author indicates he/she and/or a member of his/her immediate family something of value received. The codes are identified as
7-research or institutional support; 10-miscellaneous non-income support/miscellaneous funding; 3-royalties; 8-stock or stock options;
5a-paid consultant or employee; 5b-unpaid consultant; 4-speakers bureau/paid presentation; n-nothing of value received.
Thursday, December 3, 2009, 4:43 4:49 pm CSRS 2009
Paper #24a (cont.)
Conclusion: Our results indicate that BAC on admission does not adversely affect survival
during the first year following SCI. Among survivals, BAC was not significantly associated with
the degree of impairment and disability after controlling for potential confounders.
Forchheimer and colleagues reported that individuals with positive BAC (BAC>0%) had more
severe SCI within the first 24 hours post-SCI than individuals with negative BAC (BAC=0%)6.
In contrast, there were no significant differences among our 3 groups regarding the severity of SCI.
Although the history of drinking problem was associated with poorer inpatient rehabilitation
progress post-SCI7, the lack of data on alcohol use and abuse post-SCI precluded us to analyze
the influence of drinking problems on the rehabilitation of individuals with SCI.
Despite the deleterious effect of alcohol on outcomes post-SCI reported in preclinical studies, the
BAC on admission appears to have no effects on patients outcomes after acute traumatic SCI.

REFERENCES
1. Flamm ES, Demopoulos HB, Seligman ML, Tomasula JJ, De Crescito V, Ransohoff J. Ethanol
potentiation of central nervous system trauma. J Neurosurg 1977;46(3):328-35.
2. Halt PS, Swanson RA, Faden AI. Alcohol exacerbates behavioral and neurochemical effects
of rat spinal cord trauma. Arch Neurol 1992;49(11):1178-84.
3. Seligman ML, Flamm ES, Goldstein BD, Poser RG, Demopoulos HB, Ransohoff J.
Spectrofluorescent detection of malonaldehyde as a measure of lipid free radical damage in
response to ethanol potentiation of spinal cord trauma. Lipids 1977;12(11):945-50.
4. Brodner RA, Van Gilder JC, Collins WF, Jr. Experimental spinal cord trauma: potentiation by
alcohol. J Trauma 1981;21(2):124-9.
5. Bracken MB, Shepard MJ, Holford TR, et al. Administration of methylprednisolone for 24 or
48 hours or tirilazad mesylate for 48 hours in the treatment of acute spinal cord injury. Results
of the Third National Acute Spinal Cord Injury Randomized Controlled Trial. National Acute
Spinal Cord Injury Study. Jama 1997;277(20):1597-604.
6. Forchheimer M, Cunningham RM, Gater DR, Jr., Maio RF. The relationship of blood alcohol
concentration to impairment severity in spinal cord injury. J Spinal Cord Med 2005;28(4):303-7.
7. Bombardier CH, Stroud MW, Esselman PC, Rimmele CT. Do preinjury alcohol problems
predict poorer rehabilitation progress in persons with spinal cord injury? Arch Phys Med
Rehabil 2004;85(9):1488-92.

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Thursday, December 3, 2009, 4:43 4:49 pm CSRS 2009
Paper #24a
Figure 1. Survival analysis at 1 year after SCI comparing all three groups based on the patients
BAC on admission (log-rank test: p=0.374)

Table 1. Results of the linear regression analyses of the BAC on admission against the degree
of impairment and disability at 6 weeks, 6 months and 1 year after traumatic SCI (n=448).

If noted, the author indicates he/she and/or a member of his/her immediate family something of value received. The codes are identified as
7-research or institutional support; 10-miscellaneous non-income support/miscellaneous funding; 3-royalties; 8-stock or stock options;
5a-paid consultant or employee; 5b-unpaid consultant; 4-speakers bureau/paid presentation; n-nothing of value received.