A study found that self-reported alcohol use among adults aged 65 years and older who presented to the emergency department (ED) with head trauma from a fall was significantly associated with an increased risk of intracranial hemorrhage (ICH). The study also found a dose-response relationship, with higher frequency of reported alcohol use linked to greater odds of ICH.

Data were collected from the Geriatric Head Trauma Short Term Outcomes Project, a prospective study conducted at two level I trauma centers in Florida. Patients aged 65 years and older with blunt head trauma from a fall were included. Alcohol use frequency was self-reported as none, occasional, weekly, or daily. The primary outcome was ICH on initial head computed tomography.

The retrospective analysis, published in JACEP Open, included 3,128 older ED patients, of whom 18.2% (n = 567) reported alcohol use: 10.3% occasional use, 1.9% weekly use, and 6.0% daily use.

ICH was significantly more common in alcohol users compared with nonusers (22% vs 12%; P < .001). The prevalence of ICH increased with alcohol use frequency: 20.5% for occasional users, 22.0% for weekly users, and 25.1% for daily users. Compared with nonusers, the adjusted odds ratios (aORs) for ICH were as follows:

• Occasional alcohol use: aOR = 2.0; 95% confidence interval [CI] = 1.5-2.8
• Weekly alcohol use: aOR = 2.1; 95% CI = 1.1-4.1
• Daily alcohol use: aOR = 2.5; 95% CI = 1.7-3.6.

The absolute risk differences for ICH rose from 8.5% (95% CI = 4.0%-13.0%) in occasional alcohol users to 13.1% (95% CI = 7.6%-18.5%) in daily users compared with nonusers. A multivariable logistic regression test-of-trend analysis confirmed the dose-response effect (aOR = 1.4 per alcohol use category increase; 95% CI = 1.2-1.6; P < .001).

The association between alcohol use frequency and ICH remained significant after adjusting for patient factors (eg, demographics, medical history) and head injury risk factors (eg, loss of consciousness, signs of head trauma). Alcohol use was more common in males. Weekly and daily alcohol users tended to be younger compared with nonusers.

Limitations of the study included reliance on self-reported alcohol use and limited racial/ethnic diversity (90% of participants were White and non-Hispanic), which may have underestimated true prevalence due to social desirability bias. Approximately 33% of participants did not provide detailed alcohol use data. Strengths of the study included the large sample size and adjustment for multiple potential confounders.

The authors concluded that alcohol use mitigation should be considered as a modifiable risk factor in fall prevention strategies for older adults. They noted that 6.0% of patients reported daily alcohol use, similar to rates reported in population-based surveys. The authors stated that future research is needed to determine if alcohol screening and abatement programs can reduce serious fall-related outcomes in this high-risk population. They also suggested that potential biological mechanisms linking alcohol use to increased ICH risk, such as factors related to trauma and/or chronic alcohol use pathophysiology, warrant further investigation.

The authors declared they have no conflicts of interest.