Sunday, March 22, 2015

Drinking after an accident, not drinking causing an accident.

Having fallen from my bike in September and sustained a head injury, and being keen on exploring the output of small Sheffield breweries (in moderation), I had a personal reason for looking into this, but it turns out to be quite an interesting exercise in literature searching.

I am talking about Medline.  First of all, "alcohol" as a search term leads you to the MeSH term Alcohols/, which is the chemical.  There is no mention in the scope note of any alternatives, but the definition does make you think it is the chemical.  "Drinking" leads you to Alcohol Drinking/, which looks better.  The scope note tells you this is an old term (first used in 1969) and previously material was put under Alcoholic Beverages/.  This term still exists, with narrower terms Absinthe/, Beer/ and Wine/ available.

If you use PubMed and type in alcohol, then you'll be mapped to Alcohols/ and not Alcohol Drinking/ or Alcoholic Beverages/.

The MeSH term Craniocerebral Trauma/, if exploded, covers skull fracture, head injuries (closed or penetrating) and brain injury.  The search term "head injury" will map to it.

So, exp Craniocerebral Trauma/ and (Alcohol Drinking/ or exp Alcoholic Beverages/) looks promising.  Note that if you explode Alcohol Drinking, you include Binge Drinking/, which you might not want, as it might lead to literature about excessive drinking as a contributory factor in head injury.

But even so, a lot of the results are about role of alcohol in causing brain injury.  Some, like this (the link sends me to ScienceDirect and a paywall, but many older issues are available for free on the journal's own site), seem to indicate that giving up drinking after a head injury is a good idea, as it aids recovery of the brain, but the article starts by mentioning that two thirds of people with  "TBI" (traumatic brain injury) have a history of heavy drinking, and half of people with TBI were injured while drunk.

Back to the personal side.   I was advised at the head injury rehabilitation clinic not to drink, but I do not have a history of heavy drinking, and I had not been drinking at the time of my incident.  The article quoted above (1) mentions that the brain is more sensitive to the effects of alcohol after injury. 

So, what evidence is there that not drinking after a head injury, regardless of your drinking patterns beforehand, is a good idea?   And is it possible to disentangle this evidence from material about changing drinking habits of people who perhaps drank too much before their injury, or material about drinking causing the injury?

I have no answer yet - perhaps reviewing all the results and excluding those you do not want is the only way - but I have been experimenting with:

Subheadings - Craniocerebral trauma/rh or de, or brain/de;

((alcohol or drink*) adj2 after adj2 (head or brain))

Or adj3.

Using and instead of the adjfinds thousands, but limiting to title only (for all terms) finds tens.  Some of those are about rats, others about excessive alcohol use, but some look potentially useful.  At least one seems to suggest (from a reading of the abstract) that the reverse is true - higher blood alcohol concentration is linked with improved survival (2)!


(1) Bombardier CH. Alcohol use after traumatic brain injury. Arch Phys Med Rehab 2013; 94: 2040-1.
(2) Berry C, Ley EJ, Margulies DR, Mirocha J, Bukur M, Malinoski D, Salim A. Correlating the blood alcohol concentration the outcome after traumatic brain injury: too much is not a bad thing.   Am Surg 2011;77(10):1416-9.

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