Higher Rates of Traumatic Brain Injury in Blunt Trauma Patients With Cirrhosis: Worse Outcomes With Concomitant Alcohol Use Disorder

IntroductionBlunt trauma patients (BTPs) with cirrhosis are at an elevated risk for hemorrhagic complications, including traumatic brain injury (TBI). This study assessed whether BTPs with cirrhosis experience higher rates of TBI and severe TBI compared to those without cirrhosis and whether alcohol use disorder (AUD) further impacts these outcomes.MethodsWe analyzed data from the 2017-2022 Trauma Quality Improvement Program (TQIP) for BTPs aged ≥18 years<b>.</b> Patients were grouped by cirrhosis status, and those with cirrhosis were further stratified by AUD. Severe TBI was defined as an Abbreviated Injury Scale (AIS) > 5. The primary outcome was the incidence and adjusted risk of severe TBI in cirrhotic BTPs.ResultsAmong 4 182 335 BTPs, 53 190 (1.3%) had cirrhosis. Cirrhotic patients had higher rates of TBI (26.3% vs 17.8%, <i>P</i> < .001), severe TBI (7.2% vs 3.2%, <i>P</i> < .001), complications (11.9% vs 4.6%, <i>P</i> < .001), longer hospital stay (6 vs 4 days, <i>P</i> < .001), and mortality (9.7% vs 2.9%, <i>P</i> < .001) compared to non-cirrhotics. After adjusting for age and injury severity, on multivariable analysis, cirrhotic patients were independently associated with an increased risk of severe TBI (OR 2.02, 95% CI 1.88-2.17, <i>P</i> < .001). Among cirrhotics, those with AUD had higher rates of TBI (31.4% vs 23.1%, <i>P</i> < .001), severe TBI (10.6% vs 5.3%, <i>P</i> < .001), and increased adjusted mortality risk (OR 1.18, 95% CI 1.11-1.27, <i>P</i> < .001).ConclusionCirrhosis is associated with a significantly increased risk of TBI and severe TBI among BTPs, AUD further amplifies these risks. Awareness of these associations is essential for risk stratification and management in trauma care.Level of EvidenceIV.