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Renger L, Dhanani J, Milford E, Tabah A, Shekar K, Ramanan M, Laupland KB. Cannabis use disorders and outcome of admission to intensive care: A retrospective multi-centre cohort study. J Crit Care 2024; 80:154504. [PMID: 38128218 DOI: 10.1016/j.jcrc.2023.154504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE To identify factors associated with cannabinoid use among patients admitted to ICU and its impact on survival. METHODS A cohort of adult patients admitted to four public Australian ICUs was assembled. Individuals with mental and behavioural disorders related to cannabinoids were identified using ICD10-AM codes. RESULTS Of a cohort of 34,680 admissions among 28,689 adults, 292 (0.8%) had an associated diagnosis related to cannabinoids, of which 66% were classified as harmful use, 26% as dependence syndrome/withdrawal state, 4% as psychosis/delirium, and 4% as acute intoxication. Patients with cannabinoid-use disorders were more likely to be male (73%), tended to be younger (36 vs 62 years), with fewer comorbidities and lesser severity of disease. ICU LOS was longer for those with cannabinoid-use disorders (2 vs 1 days; p < 0.0001). Patients with cannabinoid-use disorders had lower 90-day case-fatality (6% vs. 10%; p = 0.034), however no significant effect on mortality was present after adjustment for severity of illness, age, and chronic comorbidities (p = 1.0). CONCLUSION Cannabinoid-use disorders were present in 0.8% of ICU admissions in our region and were associated with increased ICU length of stay. Further studies are needed to examine cannabinoids as contributors to and modifiers of critical illness.
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Affiliation(s)
- Laura Renger
- Department of Intensive Care Services, Royal Brisbane and Womens Hospital, Brisbane, Queensland, Australia.
| | - Jayesh Dhanani
- Department of Intensive Care Services, Royal Brisbane and Womens Hospital, Brisbane, Queensland, Australia; Faculty of Medicine, University of Queensland Centre for Clinical Research, Brisbane, Queensland, Australia
| | - Elissa Milford
- Department of Intensive Care Services, Royal Brisbane and Womens Hospital, Brisbane, Queensland, Australia; Faculty of Medicine, University of Queensland Centre for Clinical Research, Brisbane, Queensland, Australia
| | - Alexis Tabah
- Faculty of Medicine, University of Queensland Centre for Clinical Research, Brisbane, Queensland, Australia; Queensland University of Technology (QUT), Brisbane, Queensland, Australia; Intensive Care Unit, Redcliffe Hospital, Metro North Hospital and Health Services, Queensland, Australia
| | - Kiran Shekar
- Faculty of Medicine, University of Queensland Centre for Clinical Research, Brisbane, Queensland, Australia; Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Mahesh Ramanan
- Faculty of Medicine, University of Queensland Centre for Clinical Research, Brisbane, Queensland, Australia; Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, Queensland, Australia; Intensive Care Unit, Caboolture Hospital, Metro North Hospital and Health Services, Queensland, Australia; Critical Care Division, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Kevin B Laupland
- Department of Intensive Care Services, Royal Brisbane and Womens Hospital, Brisbane, Queensland, Australia; Queensland University of Technology (QUT), Brisbane, Queensland, Australia
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Aryan N, Grigorian A, Matsushima K, Schellenberg M, Nahmias J, Emigh B, Inaba K. Mechanisms of Injury in Adolescent Trauma Patients With a Positive Marijuana Screen. Am Surg 2023; 89:5565-5569. [PMID: 36878692 DOI: 10.1177/00031348231157807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
BACKGROUND Marijuana use among adolescents may have increased after its legalization in the United States. An association between violence and marijuana use in adults has been demonstrated in previous reports. We hypothesized that adolescent trauma patients presenting with a positive marijuana screen (pMS) are more likely to have been injured by gunfire or knives and will have more severe injuries overall, compared to patients with a negative marijuana screen (nMS). METHODS The 2017 Trauma Quality Improvement Program database was queried for adolescent (13-17 years old) pMS patients and compared to adolescents who tested negative for all substance/alcohol. Patients with positive polysubstance/alcohol were excluded. RESULTS From 8257 adolescent trauma patients, 2060 (24.9%) had a pMS with a higher rate of males in the pMS group (76.3% vs 64.3%, P < .001). The pMS group presented more frequently after gun (20.3% vs 7.9%, P < .001) or knife trauma (5.7% vs 3.0%, P < .001) and less frequently after falls (8.9% vs 15.6%, P < .001) and bicycle collisions (3.3% vs 4.8%, P = .002). The rate of serious thoracic injury (AIS ≥3) was higher for pMS patients (16.7% vs 12.0%, P < .001), and more pMS patients required emergent operation (14.9% vs 10.6%, P < .001). DISCUSSION In our adolescent patient population, one quarter tested positive for marijuana. These patients are more likely to be injured by guns and/or knives suffering serious injuries, and often require immediate operative intervention. A marijuana cessation program for adolescents can help improve outcomes in this high-risk patient group.
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Affiliation(s)
- Negaar Aryan
- Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, University of California Irvine School of Medicine, Orange, CA, USA
| | - Areg Grigorian
- Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, University of California Irvine School of Medicine, Orange, CA, USA
- Department of Surgery, Division of Trauma and Surgical Critical Care, University of Southern California, Los Angeles, CA, USA
| | - Kazuhide Matsushima
- Department of Surgery, Division of Trauma and Surgical Critical Care, University of Southern California, Los Angeles, CA, USA
| | - Morgan Schellenberg
- Department of Surgery, Division of Trauma and Surgical Critical Care, University of Southern California, Los Angeles, CA, USA
| | - Jeffry Nahmias
- Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, University of California Irvine School of Medicine, Orange, CA, USA
| | - Brent Emigh
- Department of Surgery, Division of Trauma and Critical Care, Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Kenji Inaba
- Department of Surgery, Division of Trauma and Surgical Critical Care, University of Southern California, Los Angeles, CA, USA
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Bhullar A, Nahmias J, Kong A, Swentek L, Chin T, Schellenberg M, Grigorian A. Cocaine use in trauma: the vices-paradox revisited. Surgery 2023; 174:1056-1062. [PMID: 37495463 DOI: 10.1016/j.surg.2023.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/02/2023] [Accepted: 06/18/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND The "vices-paradox" describes the paradoxical association between illicit substance use and decreased mortality risk in trauma patients. Cocaine's vasoconstrictive effects may decrease hemorrhage but also increase the risk of thromboembolic complications. To clarify the effects of cocaine use on trauma patients, we compared the risk of mortality and thromboembolic complications in patients screening positive for cocaine with those screening negative. METHODS We searched the Trauma Quality Improvement Program database to identify patients 18 years and over who had presented with a drug and alcohol screen on admission between 2017 and 2019. After excluding all patients who had tested positive for alcohol and substances other than cocaine, we then compared the clinical outcomes of patients who were positive and negative for cocaine use. RESULTS Of the 312,553 patients identified, 11,942 (3.82%) had tested positive for cocaine. Cocaine users were significantly more likely to present with stab (8.0% vs 3.1%) or gunshot wounds (8.0% vs 3.0%) but had lower rates of mortality (3.6% vs 4.7%), myocardial infarction (0.1% vs 0.2%,) and cerebrovascular accident (0.3% vs 0.4%,). After controlling for covariates, the risk of death, myocardial infarction, and cerebrovascular accident did not significantly differ between cocaine and non-cocaine users. CONCLUSION Trauma patients positive for cocaine have similar risks of death and thromboembolic complications and so have a similar prognosis to patients negative for all drugs or alcohol, indicating that the "vices-paradox" does not apply to cocaine use. However, these patients more commonly present after penetrating trauma, suggesting cocaine use in hazardous environments.
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Affiliation(s)
- A Bhullar
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine Medical Center, Orange, CA
| | - J Nahmias
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine Medical Center, Orange, CA
| | - A Kong
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine Medical Center, Orange, CA
| | - L Swentek
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine Medical Center, Orange, CA
| | - T Chin
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine Medical Center, Orange, CA
| | - M Schellenberg
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine Medical Center, Orange, CA
| | - A Grigorian
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine Medical Center, Orange, CA.
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Ahmed N, Kuo YH. Impact of cannabis on outcome in patients following traumatic injury. Injury 2023; 54:110808. [PMID: 37268530 DOI: 10.1016/j.injury.2023.05.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 04/27/2023] [Accepted: 05/10/2023] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Outcomes of trauma patients who tested positive for cannabis at the time of admission showed variable results. Sample size and research methodology that was used in prior studies may have resulted in the conflict. The purpose of the study was to evaluate the impact of cannabis use on outcomes in trauma patients using national data. Our hypothesis was that the use of cannabis will impact outcomes. METHODS The trauma quality improvement program (TQIP) Participant Use File (PUF) database of the calendar years 2017 and 2018 were accessed for the study. All trauma patients aged 12 years old and above who were tested for cannabis at the time of initial evaluation were included in the study. Variables included in the study were: race, sex, injury severity score (ISS), Glasgow Coma Scale (GCS) Score, Abbreviated Injury Scale (AIS) score of different body regions and comorbidities. Excluded from the study were all patients who were not tested for cannabis or tested for cannabis but were also tested positive for alcohol and other drugs and those suffering from mental conditions. Propensity matched analysis was performed. The outcome of interest was overall in-hospital mortality and complications. RESULTS Propensity matched analysis created 28,028 pairs. The analysis showed no significant difference in-hospital mortality between cannabis positive and cannabis negative groups (3.2% vs. 3.2%). The median length of hospital stay in both groups was not significantly different (4 [IQR: 3-8] vs. 4 [IQR: 2-8] days). No significant difference was found between the two groups regarding hospital complications except in pulmonary embolism (PE) with 0.1% less incidence of PE in the cannabis positive group compared to the cannabis negative group (0.4 vs. 0.5%). The incidence of DVT was identical in both groups (0.9% vs. 0.9%). CONCLUSION Cannabis was not associated with overall in-hospital mortality or morbidity. There was a slight decrease in the incidence of PE in the cannabis positive group.
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Affiliation(s)
- Nasim Ahmed
- Division of Trauma & Surgical Critical Care, Jersey Shore University Medical Center, Neptune NJ, USA; Hackensack Meridian School of Medicine, Nutley, NJ, USA.
| | - Yen-Hong Kuo
- Office of Research Administration, Jersey Shore University Medical Center, Neptune, NJ, USA
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Grigorian A, Martin M, Schellenberg M, Emigh B, Nahmias J, Matsushima K, Lewis M, Inaba K. Methamphetamine use associated with gun and knife violence: A matched cohort analysis. Surg Open Sci 2023; 13:71-74. [PMID: 37187917 PMCID: PMC10176051 DOI: 10.1016/j.sopen.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/24/2023] [Accepted: 04/24/2023] [Indexed: 05/17/2023] Open
Abstract
Introduction There may be an association between violence and methamphetamine use. We hypothesized that trauma patients screening positive for methamphetamines are more likely to present after penetrating trauma and have increased mortality. Methods The 2017-2019 TQIP was used to 1:2 match methamphetamine (meth+) patients to patients testing negative for all drugs (meth-). Patients with polysubstance/alcohol use were excluded. Bivariate and logistic regression analyses were performed. Results The rate of methamphetamine use was 3.1 %. After matching, there was no difference in vitals, injury severity score, sex, and comorbidities between cohorts (all p > 0.05). Compared to meth-, the meth+ group was more commonly sustained penetrating trauma (19.8 % vs. 9.2 %, p < 0.001) with stab-wounds being the most common penetrating mechanism (10.5 % vs. 4.5 %, p < 0.001). The meth+ group more commonly underwent surgery immediately from the emergency department (ED) (20.3 % vs. 13.3 %, p < 0.001). The associated risk of death in the ED was higher for the meth+ group (OR 2.77, CI 1.45-5.28, p = 0.002), however, the risk was similar for patients that were admitted or received an operation (p = 0.065). Conclusion Trauma patients using methamphetamine more commonly presented after gun or knife violence and required immediate surgical intervention. They also have increased associated risk of death in the ED. Given these serious findings, a multidisciplinary approach in helping curtail the worsening epidemic of methamphetamine use appears warranted as it is related to penetrating trauma and outcomes. Level of evidence IV.
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Affiliation(s)
- Areg Grigorian
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
- Corresponding author at: Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine Medical Center, 3200 Chapman Ave #6200, Orange, CA, USA.
| | - Matthew Martin
- University of Southern California, Department of Surgery, Los Angeles, CA, USA
| | - Morgan Schellenberg
- University of Southern California, Department of Surgery, Los Angeles, CA, USA
| | - Brent Emigh
- Warren Alpert Medical School at Brown University, Department of Surgery, Division of Trauma and Critical Care, Providence, RI, USA
| | - Jeffry Nahmias
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - Kazuhide Matsushima
- University of Southern California, Department of Surgery, Los Angeles, CA, USA
| | - Meghan Lewis
- University of Southern California, Department of Surgery, Los Angeles, CA, USA
| | - Kenji Inaba
- University of Southern California, Department of Surgery, Los Angeles, CA, USA
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