1112 Postoperative Consequences of Legal Intoxication in Self-Inflicted Gunshot Wounds to the Head: A Propensity Score Matched Analysis

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INTRODUCTION: Alcohol is an intoxicant that causes disinhibition and is commonly implicated in traumatic injuries including self-inflicted gunshot wounds (GSWs) to the head. Many of these patients require neurosurgical intervention upon arrival at the hospital. While any amount may alter behavior, many states in the United States consider a blood alcohol content (BAC) of 0.08 or higher as legally intoxicated. METHODS: The National Trauma Dank Bank was queried from 2017-2019 for all adults with self-inflicted GSWs to the head who received BAC testing and neurosurgical intervention. Patients with a BAC 0.08 or above were propensity score matched with patients with a BAC less than 0.08 based on patient demographics, comorbidities, injury severity, and hospital trauma level. Group differences were compared using t-tests and chi-squared tests. Multivariable logistic regression was used to identify independent predictors of in-hospital mortality. RESULTS: A total of 946 patients meeting the inclusion criteria were identified. Of those, 211 were above the limit and 735 were below. Following matching, patients above the limit were more likely to be discharged to a long term care (36% vs. 24%, p=0.01) than patients below the limit, but were otherwise comparable in rates of death (26% vs. 29%, p=0.38), length of stay (21 days vs. 20 days, p=0.94), and hospital complications. Legal intoxication was not a predictor of postoperative mortality (OR 0.77, CI 0.42-1.41). CONCLUSIONS: In patients with self-inflicted GSWs to the head, alcohol intoxication above the legal limit is associated with higher rates of postoperative discharge to long term care but has otherwise comparable mortality rates, length of stay, and hospital complications. This suggests that levels of alcohol intoxication above the legally-defined limit does not have a significant effect on in-hospital outcomes following neurosurgical intervention.

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