Nurses and doctors in emergency rooms know all too well the ravages of alcohol: Nearly half the patients who show up in emergency rooms with serious injuries -- head injuries in particular -- are intoxicated.
But new Canadian research shows that, paradoxically, alcohol may also play a key role in recovery from brain injury.
"Intoxicated patients with severe traumatic brain injury have better outcomes than non-intoxicated patients," said Homer Tien, a trauma surgeon at Sunnybrook Health Sciences Centre in Toronto, and lead author of the study.
He said this suggests alcohol may be an effective treatment for patients who suffer brain injuries.
After the brain is injured by a blunt trauma -- smashing one's head on the dashboard during a motor vehicle crash or being hit over the head by a baseball bat, for example -- brain cells continue to be deprived of oxygen and that worsens the initial damage.
Dr. Tien speculated that moderate doses of alcohol, perhaps infused through an intravenous line, could slow or stop the mechanisms that cause secondary brain injury.
"Right now, we don't have effective therapy for secondary brain injury," he said. "An alcohol-based resuscitation fluid may improve outcomes."
But Dr. Tien stressed that the research in no way suggests that drinking can prevent injury. On the contrary, it is well established that alcohol use increases the likelihood of severe injury.
"Let me be clear: Drinking and driving will not protect your head," he said.
The study, published in today's edition of the Archives of Surgery, involved 1,158 patients who were treated for severe brain injury at Sunnybrook between 1988 and 2003. The majority had been involved in motor vehicle crashes.
Of the total, 740 had a blood-alcohol concentration of zero; 315 had low-to-moderate BAC, meaning below 0.23 (230 milligrams of alcohol per 100 millilitres of blood); and 103 had a high BAC, in excess of 0.23. (In Canada, drivers are considered impaired when their BAC exceeds 0.08.)
A total of 403 of the patients with brain injuries died in hospital.
Researchers found that those with the highest blood-alcohol levels were 73 per cent more likely to die than those with no alcohol in their systems. But those with moderate BAC levels were 24 per cent less likely to die than those who had not been drinking.
Louis Francescutti, director of the Alberta Centre for Injury Control and Research and an ER doctor at Royal Alexandra Hospital in Edmonton, said the "study is interesting and hopefully other trauma centres will replicate it."
He said that while it is possible alcohol might serve as a drug to help lessen brain injury, there is another likely explanation for the findings.
"What we're seeing here is the red wine phenomenon: Those who drink in moderation are healthier because they take care of themselves. That's probably why they have better outcomes after traumatic brain injury."
Similarly, he said the heavy drinkers -- people with a BAC of at least three times the legal limit -- are probably chronic alcoholics with a host of underlying health problems.
But Dr. Francescutti also worried about how the research would be interpreted, especially by people looking for ways to justify dangerous behaviours such as impaired driving and binge drinking.
"I really hope the public doesn't get the take-home message that it's good to drink and then get a head injury," he said. "The last thing we need is more drunken people hurting themselves and others."