Clinical characteristics and outcomes of methamphetamine-associated intracerebral hemorrhage

Swor, Dionne E.; Maas, Matthew B.; Walia, Sandeep; Bissig, David; Liotta, Eric M.; Naidech, Andrew M.; Ng, Kwan

doi:10.1212/wnl.0000000000007666

Cited by 24 publications

(24 citation statements)

References 25 publications

(38 reference statements)

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“…The observed age disparities in patients with Meth-ICH versus Non-Meth-ICH were consistent with previous reports 18,19 .…”

Section: Discussionsupporting

confidence: 92%

“…It demonstrates that methamphetamine is an important risk factor for ICH in young males, smokers, Hispanic and White populations in Southern California. The rate of Meth-ICH was 9% in our large cohort, as compared to 13% and 16.4% reported previously 18,19 . Of note, of the 645 patients who denied history of methamphetamine use, only 379 patients (58.8%) had a UDS and 29 (7.7%) were urine positive for amphetamine.…”

Section: Discussioncontrasting

confidence: 55%

“…Of note, our findings are significantly different from what was previously reported. Swor et al showed that patients with Meth-ICH had significantly longer LOS in the ICU (10 ± 8 vs 5 ± 5 days) and hospital (18 ± 27 vs 8 ± 8 days) than Non-Meth-ICH 19 . They also showed higher mortality rates (29% vs 34%), as compared to our study (18% vs 25%).…”

Section: Discussionmentioning

confidence: 99%

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Clinical characteristics and outcomes of methamphetamine-associated versus non-methamphetamine intracerebral hemorrhage

Zhu

Osman

Stradling

et al. 2020

Sci Rep

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Methamphetamine use has emerged as a risk factor for intracerebral hemorrhage (ICH). We aim to investigate the clinical characteristics and outcomes of methamphetamine-associated ICH (Meth-ICH) versus Non-Meth-ICH. Patients with ICH between January 2011 and December 2017 were studied. Meth-ICH and Non-Meth-ICH were defined by history of abuse and urine drug screen (UDS). The clinical features of the 2 groups were explored. Among the 677 consecutive patients, 61 (9.0%) were identified as Meth-ICH and 350 as Non-Meth ICH. Meth-ICH was more common in Hispanics (14.6%) and Whites (10.1%) as compared to Asians (1.2%). Patients with Meth-ICH were more often younger (51.2 vs. 62.2 years, p < 0.001), male (77.0% vs. 61.4.0%, p < 0.05), and smokers (44.3% vs. 13.4%, p < 0.001). Non-Meth-ICH was more likely to have history of hypertension (72.61% v. 59%, p < 0.05) or antithrombotic use (10.9% vs. 1.6%, p < 0.05). There was no significant difference in clinical severity, hospital length of stay (LOS), rate of functional independence (29.5% vs. 25.7%, p = 0.534), or mortality (18.0% vs. 24.6%, p = 0.267) between the 2 groups. Methamphetamine use was not an independent predictor of poor outcome. Despite difference in demographics, Meth-ICH is similar to Non-Meth ICH in hospital course and outcome. MethodsThis is a retrospective observational study. It was approved by the University of California Irvine Institutional Review Board (IRB) and the Ethics Committee. Informed consents were waived as part of the IRB approval. All methods in the study were performed in accordance with the relevant guidelines and regulations.Consecutive patients with spontaneous ICH at the University of California Irvine Comprehensive Stroke Center between January 1, 2011 and December 31, 2017 were identified by searching electronic medical records and the prospectively maintained American Heart Association (AHA)-Get With The Guidelines (GWTG)-Stroke Registry. ICH from cerebral aneurysm, arteriovenous malformation, brain tumors, coagulopathy, or trauma were excluded. Patients with Meth-ICH were identified by recorded history of methamphetamine use or a positive urine drug screen (UDS) at the time of admission. The UDS was performed using EMIT II Plus Amphetamines assay (1,000 ng/mL cutoff) with a sensitivity and specificity of 94.3% and 93.3%, respectively 21 . Those with a positive UDS while taking trazodone, Adderall, bupropion, or labetalol within 2 weeks of admission were excluded due to potential false-positive result 22 . Patients with no history of methamphetamine use and a negative UDS were included in Non-Meth-ICH group. Patients who denied history of drug abuse but had no UDS were excluded from the comparison analysis. All ICH patients were initially managed in the dedicated Neuroscience ICU with standard ICH order-set and clinical pathway by board-certified neurointensivists.The following information was abstracted from chart review and the AHA GWTG-Stroke Registry: age, gender, race, past medical history, the highest blood pressure (BP) lev...

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“…The observed age disparities in patients with Meth-ICH versus Non-Meth-ICH were consistent with previous reports 18,19 .…”

Section: Discussionsupporting

confidence: 92%

Section: Discussioncontrasting

confidence: 55%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Clinical characteristics and outcomes of methamphetamine-associated versus non-methamphetamine intracerebral hemorrhage

Zhu

Osman

Stradling

et al. 2020

Sci Rep

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“…Nowadays patients presenting to the emergency department (ED) with methamphetamine-related complaints are of a wide age range with 18% older than 45 [ 17 ]. ED visits for methamphetamine associated complaints are increasing nationwide, particularly in the Pacific Rim [ 5 , 6 , 8 – 10 ],…”

Section: Discussionmentioning

confidence: 99%

“…Its use is associated with cerebrovascular toxicity, both directly via damage to the endothelial lining and indirectly through potent sympathomimetic activity [ 3 , 4 ]. Both chronic and acute use may lead to intracerebral hemorrhage (ICH), with previous studies reporting these patients faring worse [ 4 – 6 ]. Our previous study, looking at outcomes between methamphetamine and non-methamphetamine associated ICH, revealed no difference in ICH severity, length of stay (LOS), and functional outcome, which may be attributed to dedicated care in a neurological intensive care unit (ICU), something not available at all hospitals [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Intracerebral hemorrhage: who gets tested for methamphetamine use and why might it matter?

et al. 2020

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Background Methamphetamine use is an emerging risk factor for intracerebral hemorrhage (ICH). The aim of this study was to investigate the use of urine drug screen (UDS) for identifying methamphetamine-associated ICH. Methods This is a retrospective, single-center study of consecutive patients hospitalized with spontaneous ICH from January 2013 to December 2017. Patients were divided into groups based on presence of UDS. The characteristics of patients with and without UDS were compared. Factors associated with getting UDS were explored using multivariable analyses. Results Five hundred ninety-six patients with ICH were included. UDS was performed in 357 (60%), and positive for methamphetamine in 44 (12.3%). In contrast, only 19 of the 357 patients (5.3%) had a documented history of methamphetamine use. Multivariable analysis demonstrated that patients screened with UDS were more likely to be younger than 45 (OR, 2.24; 95% CI, 0.26–0.78; p = 0.004), male (OR, 1.65; 95% CI, 0.44–0.84; p = 0.003), smokers (OR, 1.74; 95% CI, 1.09–2.77; p < 0.001), with history of methamphetamine use (OR, 10.48; 95% CI, 2.48–44.34; p < 0.001), without diabetes (OR 1.47; 95% CI, 0.471–0.975; p = 0.036), not on anticoagulant (OR, 2.20; 95% CI, 0.26–0.78; p = 0.004), with National Institutes of Health Stroke Scale (NIHSS) > 4 (OR, 1.92; 95%CI, 1.34–2.75; p < 0.001), or require external ventricular drain (EVD) (OR, 1.63; 95%CI, 1.07–2.47; p = 0.021. There was no significant difference in race (p = 0.319). Reported history of methamphetamine use was the strongest predictor of obtaining a UDS (OR,10.48). Five percent of patients without UDS admitted history of use. Conclusion UDS identified 12.3% of ICH patients with methamphetamine use as compared to 5.3% per documented history of drug use. There was no racial bias in ordering UDS. However, it was more often ordered in younger, male, smokers, with history of methamphetamine use, without diabetes or anticoagulant use.

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Imaging of Spontaneous Intracranial Hemorrhage

Zamora

Castillo

2021

Atlas of Emergency Imaging From Head-to-Toe

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Clinical characteristics and outcomes of methamphetamine-associated intracerebral hemorrhage

Cited by 24 publications

References 25 publications

Clinical characteristics and outcomes of methamphetamine-associated versus non-methamphetamine intracerebral hemorrhage

Clinical characteristics and outcomes of methamphetamine-associated versus non-methamphetamine intracerebral hemorrhage

Intracerebral hemorrhage: who gets tested for methamphetamine use and why might it matter?

Imaging of Spontaneous Intracranial Hemorrhage

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