Current illicit drug use profile of orthopaedic trauma patients and its effect on hospital length of stay

Shymon, Stephen; Arthur, D'Ann; Keeling, Peyton; Rashidi, Sara Fanati; Kwong, Louis M.; Andrawis, John P.

doi:10.1016/j.injury.2020.02.077

Cited by 13 publications

(16 citation statements)

References 18 publications

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“…Only a few studies examined secondary outcomes in trauma patients who were under the influence of pre-injury stimulants. In line with our findings, most of these studies reported that pre-injury stimulant use was associated with a longer hospital LOS [13,19,23,24].…”

Section: Discussionsupporting

confidence: 92%

Pre-injury stimulant use in isolated severe traumatic brain injury: effect on outcomes

Jakob

Lewis

Benjamin

et al. 2022

Eur J Trauma Emerg Surg

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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.

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Section: Discussionsupporting

confidence: 92%

Pre-injury stimulant use in isolated severe traumatic brain injury: effect on outcomes

Jakob

Lewis

Benjamin

et al. 2022

Eur J Trauma Emerg Surg

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“…Previous studies have shown that methamphetamine-positive patients have approximately the same risk for an ICU admission when compared to the methamphetamine-negative patient, while others put this group at a slightly higher risk [ 1 , 4 ]. Pre-injury drug use has also been associated with longer hospital stays by Shymon et al, but they did not study if there was a delay in surgical intervention for that patient population [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

Methamphetamine Intoxication and Perioperative Complications Following Orthopaedic Surgical Procedures

Murray¹,

Mansy²,

Lackey³

et al. 2021

Cureus

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“…In an initial single-site level I trauma center study, over half of consecutively sampled injured trauma survivors displayed a lifetime alcohol or drug use disorder 14. Subsequent investigations have also documented high frequencies of opioid, stimulant, and cannabis use comorbidity among hospitalized injury survivors 15–17. A recent investigation conducted at three trauma center sites found that 30% of trauma patients screened positive for one or more psychoactive drugs, including methamphetamine, opioids, phencyclidine, methylenedioxymethamphetamine (ecstasy), cannabinoids, tricyclic antidepressants, benzodiazepines and barbiturates 15.…”

Section: Introductionmentioning

confidence: 99%

“…One investigation found that trauma survivors with psychoactive drug use were more likely to be younger, have a lower income and education level, and have a history of tobacco and substance use 15. Other single-site investigations have found that trauma survivors of younger age, Caucasian race and male sex were more likely to be suffering from alcohol and drug use comorbidity 16 17. Additionally, an investigation of the Canadian Hospitals Injury Reporting and Prevention Program found that alcohol and drug use were more frequently associated with intentional injuries compared with unintentional injuries; the investigation also found that trauma survivors presenting with alcohol and drug use were more likely to be younger and male 18…”

Section: Introductionmentioning

confidence: 99%

Post-traumatic stress disorder (PTSD) symptoms and alcohol and drug use comorbidity at 25 US level I trauma centers

Nguyen

Whiteside

Bulger

et al. 2022

Trauma Surg Acute Care Open

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BackgroundQuestions regarding the extent to which post-traumatic stress disorder (PTSD) is comorbid with alcohol and drug use are particularly germane in an era when the American College of Surgeons Committee on Trauma (ACS-COT) is considering policy requiring screening, intervention and/or referral services for patients presenting with psychological sequalae of traumatic injury. Literature review revealed few multisite trauma-center-based investigations that have assessed the association between PTSD symptoms and alcohol and drug use comorbidities in injured patients.MethodsThis investigation was a secondary analysis of baseline data collected prior to randomization in a 25-site trauma center pragmatic clinical trial. All 635 patients included in the investigation had elevated PTSD symptom levels at the time of trauma center admission. Self-report questionnaire screening, laboratory toxicology results, and electronic health record data were combined to assess the frequencies of alcohol, stimulant (i.e., amphetamine and cocaine), opioid and marijuana use comorbidities for injured patients. Logistic regression was used to assess the associations between demographic and injury characteristics and alcohol and drug use comorbidity.ResultsThe frequency of patients with one or more alcohol or substance use comorbidity was between 62% and 79%. Over 50% of patients were positive for one or more alcohol or cannabis comorbidity. Approximately 26% of patients were positive for stimulants and 10% for opioid comorbidity.DiscussionThis multisite investigation suggests that between 62% and 79% of hospitalized injury survivors with elevated PTSD symptoms have one or more alcohol or drug use comorbidity. Orchestrated ACS-COT policy and trauma center service delivery development should incorporate the key finding that a substantial majority of patients with high levels of psychological distress (eg, elevated PTSD symptoms) may have alcohol and drug use comorbidities.Level of evidenceLevel II (epidemiological investigation of untreated controls from a multisite randomized clinical trial)Trial registration numberNCT02655354.

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Current illicit drug use profile of orthopaedic trauma patients and its effect on hospital length of stay

Cited by 13 publications

References 18 publications

Pre-injury stimulant use in isolated severe traumatic brain injury: effect on outcomes

Pre-injury stimulant use in isolated severe traumatic brain injury: effect on outcomes

Methamphetamine Intoxication and Perioperative Complications Following Orthopaedic Surgical Procedures

Post-traumatic stress disorder (PTSD) symptoms and alcohol and drug use comorbidity at 25 US level I trauma centers

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