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Keywords:

  • injury;
  • cerebral injury;
  • cranial injury;
  • ethanol intoxication;
  • catecholamines;
  • CPK-BB

ABSTRACT

Objective: To determine whether biochemical markers can selectively identify those intoxicated patients with presumed minor head injuries who are likely to have CT evidence of intracranial injury.

Methods: Patients presenting to the ED with simultaneous presumed minor head trauma and ethanol intoxication were prospectively entered into this cross-sectional study. Following phlebotomy, all patients received cranial CT. Associations between the presence of an abnormal CT scan for injury and serum levels of the following biochemical markers were sought: serum catecholamines, creatine kinase-brain band (CK-BB), and serum amylase. Serum levels are reported as mean ± SEM.

Results: Nine of the 107 patients (8.4%; 95% CI 3.9–15.4%) had evidence of intracranial injury on CT. Mean serum CK-BB (16.1 ± 3.7 vs 13.2 ± 9.6 ng/mL), serum norepinephrine (913 ± 117 vs 1,089 ± 76 pg/mL), and serum amylase (64.9 ± 14.8 vs 84 ± 4.7 U/L) levels were not significantly different in patients with and without CT evidence of intracranial injury, respectively. Mean serum epinephrine (298 ± 54 vs 167 ± 18 pg/mL; p = 0.03) and serum dopamine (218 ± 50 vs 130 ± 9 pg/mL; p = 0.014) levels were significantly elevated in the group with intracranial injury on CT. A threshold level of serum dopamine ±140 pg/mL yields a sensitivity of 89% (95% CI 52–100%) and a specificity of 80% (95% CI 70–87%) for CT-evident injury. A threshold level of serum epinephrine ±218 pg/mL yields a sensitivity of 89% (95% CI 52–100%) and a specificity of 80% (95% CI 70–87%) for CT-evident injury.

Conclusion: Elevated serum epinephrine and dopamine levels are associated with intracranial CT-evident injury for ethanol-intoxicated patients with presumed minor head injuries. The potential use of these biochemical markers to guide a more selective approach to cranial CT scanning warrants further evaluation.