1
|
Lau G, Ang JY, Kim N, Gabbe BJ, Mitra B, Dietze PM, Reeder S, Beck B. Approaches and reporting of alcohol and other drug testing for injured patients in hospital-based studies: A systematic review. Drug Alcohol Rev 2024; 43:897-926. [PMID: 38316529 DOI: 10.1111/dar.13816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 12/18/2023] [Accepted: 01/02/2024] [Indexed: 02/07/2024]
Abstract
ISSUE Hospital alcohol and/or other drug (AOD) testing is important for identifying AOD-related injuries; however, testing methods vary. This systematic review aimed to examine biological AOD testing methods from hospital-based studies of injured patients and quantify what proportion reported key information on those testing methods. APPROACH Observational studies published in English from 2010 onwards involving biological AOD testing for injured patients presenting to hospital were included. Studies examining single injury causes were excluded. Extracted data included concentration thresholds for AOD detection (e.g., lower limits of detection, author-defined cut-offs), test type (e.g., immunoassay, breathalyser) and approach (e.g., routine, clinical discretion), timing of testing, sample type and the proportion of injured cases tested for AODs. KEY FINDINGS Of 83 included studies, 76 measured alcohol and 37 other drugs. Forty-nine studies defined blood alcohol concentration thresholds (ranging from 0 to 0.1 g/100 mL). Seven studies defined concentration thresholds for other drugs. Testing approach was reported in 39/76 alcohol and 18/37 other drug studies. Sample type was commonly reported (alcohol: n = 69/76; other drugs: n = 28/37); alcohol was typically measured using blood (n = 60) and other drugs using urine (n = 20). Studies that reported the proportion of cases tested (alcohol: n = 53/76; other drugs: n = 28/37), reported that between 0% and 89% of cases were not tested for alcohol and 0% and 91% for other drugs. Timing of testing was often unreported (alcohol: n = 61; other drugs: n = 30). IMPLICATIONS AND CONCLUSION Variation in AOD testing methods alongside incomplete reporting of those methods limits data comparability and interpretation. Standardised reporting of testing methods will assist AOD-related injury surveillance and prevention.
Collapse
Affiliation(s)
- Georgina Lau
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jia Y Ang
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Nayoung Kim
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Health Data Research UK, Swansea University Medical School, Swansea University, Swansea, UK
| | - Biswadev Mitra
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Australia
| | - Paul M Dietze
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
- National Drug Research Institute, Curtin University, Perth, Australia
| | - Sandra Reeder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, Australia
| | - Ben Beck
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| |
Collapse
|
2
|
Khadka S, Bardes JM, Al-Mamun MA. Opioid-related polysubstance use and its effect on mortality and health resource utilization among trauma patients. Inj Epidemiol 2023; 10:54. [PMID: 37872616 PMCID: PMC10594664 DOI: 10.1186/s40621-023-00459-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/30/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Pre-injury opioid use is common, but the effects of opioid-related polysubstance use on mortality and health resources utilization (HRU) have not been investigated yet. The objective of this study was to investigate the effects of opioid-related polysubstance use on mortality and HRU among patients in trauma centres in the US. METHODS We conducted a retrospective cross-sectional study using the US National Trauma Databank from the year 2017 to 2019. Patients (≥ 18 years of age) who tested positive for opioids were included. Patients were analysed based on the number of substances used (i.e., opioids only, two substances (opioids + 1 substance), and three or more than three substances (opioids + ≥ 2 substances)), and polysubstance by type (i.e., opioids only, opioids and alcohol, opioids and stimulants, opioids and benzodiazepine, and other combinations). Multivariate logistic regression was used to determine the association between polysubstance use, mortality and HRU (i.e., need for hospital admission, ICU, and mechanical ventilation). RESULTS Both polysubstance by number and type analyses showed that opioid-related polysubstance use was not significantly associated with mortality compared to opioids only. The odds of hospital admission were higher among the opioids and benzodiazepines group (OR 1.15, 95% CI 1.06-1.24, p < 0.01). The need for ICU was magnified using benzodiazepines and stimulants with opioids (OR 1.44, 95% CI 1.27-1.63, p < 0.01) when compared to the opioids only group. CONCLUSION Opioid-related pre-injury polysubstance use was associated with higher HRU in trauma patients. The evidence can be used by policymakers and practitioners to improve patient outcomes in trauma centers.
Collapse
Affiliation(s)
- Safalta Khadka
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, 26505, USA.
| | - James M Bardes
- Division of Trauma, Acute Care Surgery and Critical Care, Department of Surgery, West Virginia University, Morgantown, WV, 26505, USA
| | - Mohammad A Al-Mamun
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, 26505, USA
| |
Collapse
|
3
|
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.
Collapse
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.
| |
Collapse
|
4
|
Jakob DA, Lewis M, Benjamin ER, Haltmeier T, Schnüriger B, Exadaktylos AK, Demetriades D. Pre-injury stimulant use in isolated severe traumatic brain injury: effect on outcomes. Eur J Trauma Emerg Surg 2023; 49:1683-1691. [PMID: 36066583 PMCID: PMC9446589 DOI: 10.1007/s00068-022-02095-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/19/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of this study was to assess the impact of pre-injury stimulant use (amphetamine, cocaine, methamphetamine and/or ecstasy) on outcomes after isolated severe traumatic brain injury (TBI). METHODS Retrospective 2017 TQIP study, including adult trauma patients (≥16 years old) who underwent drug and alcohol screening on admission and sustained an isolated severe TBI (head AIS ≥3). Patients with significant extracranial trauma (AIS ≥3) were excluded. Epidemiological and clinical characteristics, procedures and outcome variables were collected. Patients with isolated stimulant use were matched 1:1 for age, gender, mechanism of injury, head AIS and overall comorbidities, with patients with negative toxicology and alcohol screen. Outcomes in the two groups were compared with univariable and multivariable regression analysis. RESULTS 681 patients with isolated TBI and stimulant use were matched with 681 patients with negative toxicology and alcohol screen. The incidence of hypotension and CGS <9 was similar in the two groups. In multivariable regression analysis, stimulant use was not independently associated with mortality (OR 0.95, 95% CI 0.61-1.49). However, stimulant use was associated with longer hospital length of stay (HLOS) (RC 1.13, 95%CI 1.03-1.24). CONCLUSION Pre-injury stimulant use is common in patients admitted for severe TBI, but was not independently associated with mortality when compared to patients with negative toxicology. However, stimulant use was associated with a significant longer HLOS.
Collapse
Affiliation(s)
- Dominik Andreas Jakob
- Division of Trauma and Surgical Critical Care, Department of Surgery, Los Angeles County, University of Southern California Medical Center, University of Southern California, Los Angeles, CA 90033 USA
- Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, Freiburgstrasse 16C, 3010 Bern, Switzerland
| | - Meghan Lewis
- Division of Trauma and Surgical Critical Care, Department of Surgery, Los Angeles County, University of Southern California Medical Center, University of Southern California, Los Angeles, CA 90033 USA
| | - Elizabeth Robinson Benjamin
- Division of Trauma and Acute Care Surgery, Department of Surgery, Grady Health System, Emory University, Atlanta, GA 30327 USA
| | - Tobias Haltmeier
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Beat Schnüriger
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Demetrios Demetriades
- Division of Trauma and Surgical Critical Care, Department of Surgery, Los Angeles County, University of Southern California Medical Center, University of Southern California, Los Angeles, CA 90033 USA
| |
Collapse
|
5
|
Satish S, Freeman C, Culhane J. Urine drug screen positive for cocaine and amphetamine is not an adverse risk factor for cardiovascular morbidity or mortality in trauma. Trauma Surg Acute Care Open 2021; 6:e000749. [PMID: 34514174 PMCID: PMC8383867 DOI: 10.1136/tsaco-2021-000749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 08/03/2021] [Indexed: 02/04/2023] Open
Abstract
Background Urine drug screening (UDS) is a component of trauma workup and of perioperative risk evaluation. Illicit stimulant use has been associated with cardiovascular complications. This study investigates the impact of stimulant use and its interaction with surgery on cardiovascular complications in trauma patients. Methods Patients were identified from the 2017 National Trauma Data Bank. Univariate and multivariate analyses were used to evaluate the effect of amphetamine and cocaine on mortality, myocardial infarction (MI), and stroke. We evaluated three subsets: all screened patients, those who underwent surgery, and those whose surgery was immediate. Significance was tested with χ2 test for categorical variables, Student’s t-test for continuous variables, and logistic regression for multivariate analysis. Results 317 688 (32.1%) patients underwent UDS. Multivariate analysis showed protective association between cocaine and mortality OR 0.9 (p=0.028). Cocaine was a non-significant predictor of MI and stroke: OR 0.63 (p=0.065) and 0.91 (p=0.502), respectively. Amphetamine was a non-significant predictor of mortality, MI, and stroke: OR 0.97 (p=0.405), 0.80 (p=0.283), and 1.02 (p=0.857), respectively. On univariate analysis, amphetamine showed a protective association with MI for all screened patients: relative risk (RR) 0.58 (p=0.005), and for surgical patients: RR 0.58 (p=0.019). Amphetamine showed a protective association with mortality for all three subsets: RR 0.83 (p<0.001), 0.78 (p<0.001), and 0.71 (p<0.001), respectively. Cocaine showed a protective association with MI for all screened patients: RR 0.45 (p=0.001), and for surgical patients: RR 0.44 (p=0.005). Cocaine showed a protective association with mortality for all three subsets: RR 0.76 (p<0.001), 0.71 (p<0.001), and 0.63 (p<0.001), respectively. Discussion UDS positive for cocaine or amphetamine is not an adverse risk factor in trauma, including trauma patients who underwent surgery. The apparent protective effects of illicit drugs warrant further investigation. Level of evidence Therapeutic/care management, level IV.
Collapse
Affiliation(s)
| | - Carl Freeman
- Trauma, Saint Louis University, Saint Louis, Missouri, USA
| | - John Culhane
- Trauma, Saint Louis University, Saint Louis, Missouri, USA
| |
Collapse
|
6
|
Vices-paradox in trauma: Positive alcohol and drug screens associated with decreased mortality. Drug Alcohol Depend 2021; 226:108866. [PMID: 34216867 DOI: 10.1016/j.drugalcdep.2021.108866] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Improved survival in trauma patients with acute alcohol intoxication has been previously reported. The effect of illegal and controlled substances on mortality is less clear. We hypothesized that alcohol, illegal and controlled substances are each independently associated with lower odds of mortality in adult trauma patients. METHODS The Trauma Quality Improvement Program (2010-2016) was queried for patients screening positive for alcohol, illegal or controlled substances on admission. A multivariate logistic regression analysis was used to determine odds of mortality. A similar analysis was used after stratification by injury severity scale (ISS). RESULTS From 1,299,705 adult patients, 660,135 were screened for substance use. Of these patients, 497,872 were male, 227,995 (34.5 %) screened positive for alcohol, 155,437 (23.5 %) for illegal substances and 90,259 (13.7 %) for controlled substances. Mortality rate was 6.2 % with alcohol, 5.1 % with illegal substances, and 5.7 % with controlled substances compared to 8.0 % with no substance use (p < 0.001). After controlling for covariates, all groups had lower odds of mortality: alcohol (OR = 0.88, CI = 0.84-0.92, p < 0.001), illegal substances (OR = 0.83, CI = 0.77-0.90, p < 0.001), controlled substances (OR = 0.72, CI = 0.67-0.79, p < 0.001). When stratified by ISS, alcohol and illegal substances continued to be associated with decreased mortality until ISS 50. Controlled substances were associated with decreased mortality when ISS > 16. CONCLUSION Patients positive for alcohol, illegal or controlled substances have 12 %, 17 %, and 28 % decreased odds of mortality, respectively. This paradoxical association should be confirmed with future clinical studies and merits basic science research to identify biochemical or physiological components conferring a protective effect on survival in trauma patients.
Collapse
|
7
|
Shymon SJ, Arthur D, Keeling P, Rashidi S, Kwong LM, Andrawis JP. Current illicit drug use profile of orthopaedic trauma patients and its effect on hospital length of stay. Injury 2020; 51:887-891. [PMID: 32145902 DOI: 10.1016/j.injury.2020.02.077] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 02/15/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The purpose of this study was to investigate the prevalence of illicit drug use among patients admitted with traumatic orthopaedic injuries and to determine its effect on hospital length of stay (LOS). We hypothesized that patients with pre-injury drug use would have a longer hospital LOS compared to those who do not use drugs. METHODS We conducted a retrospective cohort study at our level 1 urban trauma center of patients admitted with traumatic orthopaedic injuries between 2013 and 2015 with urine toxicology screening. We collected demographic and hospital LOS data from chart review. RESULTS Of 611 patients, over half (55%) had a positive drug screen: marijuana (41%), amphetamine (19%), cocaine (7%), and/or PCP (2%). The highest incidence of drug use was in males under 19 years of age (81%). Patients with any drug use had a longer hospital LOS compared to those who did not use drugs (8.3 vs. 6.3 days; p = 0.03). Patients who used amphetamines had a longer hospital LOS than those patients who did not (9.5 vs. 6.9 days; p = 0.01). CONCLUSION Compared to the orthopaedic trauma population two decades ago, the current population using illicit drugs is younger (<30 years) with an increased preference for amphetamine and marijuana and a decreased preference for cocaine. Pre-injury drug use was associated with a longer hospital LOS in patients with a traumatic orthopaedic injury. Knowledge of the current trends in illicit drug use amongst orthopaedic trauma patients could facilitate medical decision-making regarding clinical care and optimizing resource utilization in this complex population of individuals.
Collapse
Affiliation(s)
| | - D'Ann Arthur
- Harbor-UCLA Medical Center, Torrance, CA, United States
| | | | - Sara Rashidi
- Harbor-UCLA Medical Center, Torrance, CA, United States
| | - Louis M Kwong
- Harbor-UCLA Medical Center, Torrance, CA, United States
| | | |
Collapse
|
8
|
Nikova AS, Karakasi MV, Pavlidis P, Birbilis T, Dimitrov I. Does Nationality Matter for the Gunshot Brain Injury? Ten-Year Retrospective Observational Cadaveric Comparative Study for Gunshot TBI between Greece and Bulgaria. Korean J Neurotrauma 2019; 15:95-102. [PMID: 31720262 PMCID: PMC6826088 DOI: 10.13004/kjnt.2019.15.e34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 04/09/2019] [Accepted: 09/20/2019] [Indexed: 11/15/2022] Open
Abstract
Objective Penetrating brain trauma (PBT) caused by gunshot is one of the most lethal traumatic brain injuries (TBIs) and its management and confrontation is of great importance. Methods The authors searched retrospectively the archives from 2 similar autonomous laboratories of forensic science and toxicology in the Balkan peninsula for a 10-year period of time and included only fatal penetrating brain injuries. Results The study is conducted in 61 cadavers with gunshot PBT. All of the cadavers were victims of suicide attempt. The most common anatomical localization on the skull were the facial bones, followed by skull base, temporal and parietal bone, conducting a trajectory of the gunshot. Additional findings were atherosclerosis of the blood vessels and chronic diseases such as chronic obstructive pulmonary disease, cancer and fatty liver. Conclusion PBI has a high mortality rate. There are factors and findings from the collected data differing between the 2 aforementioned nations. Either way, better preventative measures, gun control and healthcare system are highly necessary.
Collapse
Affiliation(s)
- Alexandrina S Nikova
- Department of Neurosurgery, Democritus University of Thrace, Alexandroupolis, Greece
| | - Maria-Valeria Karakasi
- Department of Forensic Science and Toxicology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Pavlos Pavlidis
- Department of Forensic Science and Toxicology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Theodossios Birbilis
- Department of Neurosurgery, Democritus University of Thrace, Alexandroupolis, Greece
| | - Ivaylo Dimitrov
- Department of Forensic Science and Toxicology, "Stamen Iliev" Regional Hospital, Montana, Bugaria
| |
Collapse
|
9
|
Abstract
Objective: The objective of the study is to determine if marijuana, methamphetamine, or cocaine is associated with worse outcomes following trauma. Methods: A retrospective cross-sectional study was conducted on 731 trauma patients. Data collected from Natividad Medical Center's trauma registry were used to analyze reports of adult patients from July 1, 2014, to July 1, 2017. Analyzed endpoints were mortality, rates of major trauma, mean Injury Severity Score (ISS), and length of stay (LOS). Results: Odds ratios for mortality contained null value in each group. Odds ratios for suffering major trauma for marijuana and amphetamines were 1.2 and 2.6, respectively. P values for ISS were >0.05 for each group. P values for LOS were >0.05 for marijuana and cocaine and 0.01 for amphetamines. Conclusions: A positive screen for marijuana, amphetamine, or cocaine is not associated with increased mortality for victims of trauma. Amphetamines are associated with higher rates of major trauma and longer LOS. Marijuana is associated with higher rates of major trauma. Cocaine is not associated with the likelihood of suffering major trauma or length of stay.
Collapse
Affiliation(s)
- Quinn Fujii
- Department of Surgery, Touro University, Vallejo, California, USA
| | | |
Collapse
|
10
|
The impact of pre-injury controlled substance use on clinical outcomes after trauma. J Trauma Acute Care Surg 2017; 81:913-920. [PMID: 27537515 DOI: 10.1097/ta.0000000000001229] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND A disproportionately high percentage of trauma patients use controlled substances, and they often co-ingest multiple drugs. Previous studies have evaluated the effect of individual drugs on clinical outcomes after trauma. However, the impact of all drugs included in a comprehensive screening panel has not yet been compared in a single cohort of patients. METHODS All trauma patients who underwent urine drug screens after admission to the LAC + USC Medical Center (January 2008-June 2015) were identified retrospectively. Univariable and multivariable regression analyses determined the significance of all drugs tested in the hospital's standard toxicology screen (amphetamine, barbiturate, benzodiazepine, cocaine, opiate, phencyclidine) on clinical outcomes. RESULTS A total of 10,166 patients who underwent admission toxicology screening were identified. Although 5,621 patients had completely negative screens, 3,292 patients tested positive for only one drug and 1,253 patients tested for multiple drugs. Univariable analysis indicated that patients who tested positive for multiple drugs had higher rates of operative intervention (p < 0.001), longer hospital stay (p < 0.001), and longer ICU stays (p < 0.001). Multivariable analysis indicated that phencyclidine was associated with higher rates of mortality (p = 0.025) whereas amphetamine was associated with lower rates of mortality (p = 0.012). Higher rates of operative intervention were observed in patients testing positive for amphetamine (p < 0.001), benzodiazepine (p < 0.001), or opiate (p < 0.001). Benzodiazepine use was associated with higher rates of mechanical ventilation (p < 0.001), but use of amphetamines (p = 0.021) or opiates (p < 0.001) was associated with lower rates. CONCLUSIONS Pre-injury use of amphetamine, barbiturate, benzodiazepine, cocaine, opiate, and PCP has a significant and variable impact on clinical outcomes after trauma. Comparing the relative effect of each drug class can help clinicians risk-stratify all trauma patients, including those who test positive for multiple substances. LEVEL OF EVIDENCE Epidemiologic study, level III.
Collapse
|
11
|
Tardif PA, Moore L, Boutin A, Dufresne P, Omar M, Bourgeois G, Bonaventure PL, Kuimi BLB, Turgeon AF. Hospital length of stay following admission for traumatic brain injury in a Canadian integrated trauma system: A retrospective multicenter cohort study. Injury 2017; 48:94-100. [PMID: 27839794 DOI: 10.1016/j.injury.2016.10.042] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 10/18/2016] [Accepted: 10/28/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Traumatic brain injury (TBI) is the leading cause of disability in children and young adults and costs CAD$3 billion annually in Canada. Stakeholders have expressed the urgent need to obtain information on resource use for TBI to improve the quality and efficiency of acute care in this patient population. We aimed to assess the components and determinants of hospital and ICU LOS for TBI admissions. METHODS We performed a retrospective multicenter cohort study on 11,199 adults admitted for TBI between 2007 and 2012 in an inclusive Canadian trauma system. Our primary outcome measure was index hospital LOS (admission to the hospital with the highest designation level). Index LOS was compared to total LOS (all consecutive admissions related to the injury). Expected LOS was calculated by matching TBI admissions to all-diagnosis hospital admissions by age, gender, and year of admission. LOS determinants were identified using multilevel linear regression. RESULTS Geometric mean total LOS was 1day longer than geometric mean index LOS (12.6 versus 11.7 days). Observed index and ICU LOS were respectively 4.2days and 2.5days longer than that expected according to all-diagnosis admissions. The six most important determinants of LOS were discharge destination, severity of concomitant injuries, extracranial complications, GCS, TBI severity, and mechanical ventilation, accounting for 80% of explained variation. CONCLUSIONS Results of this multicenter retrospective cohort study suggest that hospital and ICU LOS for TBI admissions are 56% and 119% longer than expected according to all-diagnosis admissions, respectively. In addition, hospital LOS is underestimated when only the index visit is considered and is largely influenced by discharge destination and extracranial complications, suggesting that improvements could be achieved with better discharge planning and interventions targeting prevention of in-hospital complications. This study highlights the importance of considering TBI patients as a distinct population when allocating resources or planning quality improvement interventions.
Collapse
Affiliation(s)
- Pier-Alexandre Tardif
- CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Université Laval, Québec (QC), Canada; Department of Social and Preventative Medicine, Université Laval, Québec (QC), Canada.
| | - Lynne Moore
- CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Université Laval, Québec (QC), Canada; Department of Social and Preventative Medicine, Université Laval, Québec (QC), Canada.
| | - Amélie Boutin
- CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Université Laval, Québec (QC), Canada; Department of Social and Preventative Medicine, Université Laval, Québec (QC), Canada.
| | - Philippe Dufresne
- CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Université Laval, Québec (QC), Canada; Department of Social and Preventative Medicine, Université Laval, Québec (QC), Canada.
| | - Madiba Omar
- CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Université Laval, Québec (QC), Canada; Department of Social and Preventative Medicine, Université Laval, Québec (QC), Canada.
| | - Gilles Bourgeois
- Institut National d'Excellence en Santé et en Services Sociaux, Montréal, Québec, Canada.
| | - Paule Lessard Bonaventure
- CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Université Laval, Québec (QC), Canada; Department of Neurological Sciences, Division of Neurosurgery, Université Laval, Québec (QC), Canada.
| | - Brice Lionel Batomen Kuimi
- CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Université Laval, Québec (QC), Canada.
| | - Alexis F Turgeon
- CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Université Laval, Québec (QC), Canada; Department of Anesthesiology, Division of Critical Care Medicine, Université Laval, Québec (QC), Canada.
| |
Collapse
|
12
|
Scheff SW, Ansari MA. Natural Compounds as a Therapeutic Intervention following Traumatic Brain Injury: The Role of Phytochemicals. J Neurotrauma 2016; 34:1491-1510. [PMID: 27846772 DOI: 10.1089/neu.2016.4718] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
There has been a tremendous focus on the discovery and development of neuroprotective agents that might have clinical relevance following traumatic brain injury (TBI). This type of brain injury is very complex and is divided into two major components. The first component, a primary injury, occurs at the time of impact and is the result of the mechanical insult itself. This primary injury is thought to be irreversible and resistant to most treatments. A second component or secondary brain injury, is defined as cellular damage that is not immediately obvious after trauma, but that develops after a delay of minutes, hours, or even days. This injury appears to be amenable to treatment. Because of the complexity of the secondary injury, any type of therapeutic intervention needs to be multi-faceted and have the ability to simultaneously modulate different cellular changes. Because of diverse pharmaceutical interactions, combinations of different drugs do not work well in concert and result in adverse physiological conditions. Research has begun to investigate the possibility of using natural compounds as a therapeutic intervention following TBI. These compounds normally have very low toxicity and have reduced interactions with other pharmaceuticals. In addition, many natural compounds have the potential to target numerous different components of the secondary injury. Here, we review 33 different plant-derived natural compounds, phytochemicals, which have been investigated in experimental animal models of TBI. Some of these phytochemicals appear to have potential as possible therapeutic interventions to offset key components of the secondary injury cascade. However, not all studies have used the same scientific rigor, and one should be cautious in the interpretation of studies using naturally occurring phytochemical in TBI research.
Collapse
Affiliation(s)
- Stephen W Scheff
- Sanders-Brown Center on Aging, University of Kentucky , Lexington, Kentucky
| | - Mubeen A Ansari
- Sanders-Brown Center on Aging, University of Kentucky , Lexington, Kentucky
| |
Collapse
|
13
|
Rumalla K, Reddy AY, Mittal MK. Association of Recreational Marijuana Use with Aneurysmal Subarachnoid Hemorrhage. J Stroke Cerebrovasc Dis 2016; 25:452-60. [DOI: 10.1016/j.jstrokecerebrovasdis.2015.10.019] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 10/22/2015] [Indexed: 10/22/2022] Open
|