Discussion In this study, we identified a relationship MK 801 clinical trial between a low GCS score and a low ISS, and alcohol consumption. Another significant finding was that, in patients with an ISS of <16, alcohol intoxication is associated with a shorter LOS and a lower likelihood of positive findings on brain CT. The GCS is the most commonly used means of quantifying the level of consciousness and for clinical decision-making involving patients with traumatic brain injury in emergency departments.10 Although prior studies have demonstrated that alcohol consumption is associated with a lower average GCS score,11 12 studies of the

impact of alcohol intoxication on the GCS score in trauma patients report conflicting results. Some studies have shown that alcohol consumption does not result in a clinically significant reduction in the GCS score of trauma patients.8 9 13 In a study of 108 929 patients registered with the National Trauma Data Bank of the American College of Surgeons between 1994 and 2003, alcohol consumption does not influence the GCS score irrespective of the severity of traumatic brain injury.8 In addition, when stratified by anatomic severity of head injuries, alcohol consumption did not reduce the total GCS score or any of its components (eg, motor, speech and eye-opening)

by more than 1 point in any group.8 In this study, the patients who had undergone a BAC test had a significantly lower GCS score than those who did not have a BAC test and the difference was more than

1 point. In addition, the patients with positive BAC and those with positive BAC and head injuries had a significantly lower GCS score; however, the difference was less than 1 point. When stratified by the ISS, patients with positive BAC had a significantly lower GCS score by more than 1 point among patients with an ISS of <16 or ≥25. Of note, the mean BAC of injured patients with a positive BAC admitted to a trauma centre is 192.3 mg/dL, a level nearly four times the limit legally permitted for driving in Taiwan and sufficient GSK-3 to induce tolerance in some patients. However, there is no reliable means with which to determine whether an altered mental status is characteristic of a chronic drinker with tolerance. These results support the assertion that injury severity had an impact on the observed level of consciousness and that significant alterations in the level of consciousness in trauma patients are predominantly a result of factors other than the consumption of alcohol alone. The safest strategy is to consider all mental status changes in trauma patients to be attributable to brain injury, rather than to alcohol consumption.8 Our results showed that patients who had undergone an alcohol test were associated with a higher ISS and NISS, a lower TRISS and higher in-hospital mortality.