Evaluation of the effect of methamphetamine on traumatic injury complications and outcomes

Abstract

BackgroundThis study investigates the impact of methamphetamine use on trauma patient outcomes.MethodsThis retrospective study analyzed patients between 18 and 55 years old presenting to a single trauma center in San Bernardino County, CA who sustained traumatic injury during the 10-year study period (January 1st, 2005 to December 31st, 2015). Routine serum ethanol levels and urine drug screens (UDS) were completed on all trauma patients. Exclusion criteria included patients with an elevated serum ethanol level (> 0 mg/dL). Those who screened positive on UDS for only methamphetamine and negative for cocaine and cannabis (MA(+)) were compared to those with a triple negative UDS for methamphetamine, cocaine, and cannabis (MA(−)). The primary outcome studied was the impact of a methamphetamine positive drug screen on hospital mortality. Secondary outcomes included length of stay (LOS), heart rate, systolic and diastolic blood pressure (SBP and DBP, respectively), and total amount of blood products utilized during hospitalization. To analyze the effect of methamphetamine, age, gender, injury severity score, and mechanism of injury (blunt vs. penetrating) were matched between MA(−) and MA(+) through a propensity matching algorithm.ResultsAfter exclusion, 2538 patients were included in the final analysis; 449 were patients in the MA(+) group and 2089 patients in the MA(−) group. A selection of 449 MA(−) patients were matched with the MA(+) group based on age, gender, injury severity score, and mechanism of injury. This led to a final sample size of 898 patients with 449 patients in each group. No statistically significant change was observed in hospital mortality. Notably, a methamphetamine positive drug screen was associated with a longer LOS (median of 4 vs. 3 days in MA(+) and MA(−), respectively, p < 0.0001), an increased heart rate at the scene (103 vs. 94 bpm for MA(+) and MA(−), respectively, p = 0.0016), and an increased heart rate upon arrival to the trauma center (100 vs. 94 bpm for MA(+) and MA(−), respectively, p < 0.0001). Moreover, the MA(+) group had decreased SBP at the scene compared to the MA(−) group (127 vs. 132 bpm for MA(+) and MA(−), respectively, p = 0.0149), but SBP was no longer statistically different when patients arrived at the trauma center (p = 0.3823). There was no significant difference in DBP or in blood products used.ConclusionMethamphetamine positive drug screens in trauma patients were not associated with an increase in hospital mortality; however, a methamphetamine positive drug screen was associated with a longer LOS and an increased heart rate.

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

“…In general, the effect of pre-injury illicit drug use on outcomes is controversial and the reported results are often contradictory [ 11 , 13 – 16 , 19 , 20 ]. Important factors that can confuse the interpretation of results are inclusion of all illicit drugs in one group, as well as the presence of multiple injuries.…”

Methamphetamine in Orthopaedics

“…In a study of patients in the intensive care unit, Kram et al did not detect a difference in sedation requirements between patients who were acutely intoxicated on stimulants and non-intoxicated patients 72 . However, case studies have indicated that both acute and chronic methamphetamine abuse can alter anesthesia requirements 18,72,73 . Cases of cardiac arrest, refractory hypotension, and severe intraoperative intracranial hypertension due to methamphetamine’s impact on anesthesia requirements have implicated the neurologic effects of methamphetamine 18,73 .…”

“…However, case studies have indicated that both acute and chronic methamphetamine abuse can alter anesthesia requirements 18,72,73 . Cases of cardiac arrest, refractory hypotension, and severe intraoperative intracranial hypertension due to methamphetamine’s impact on anesthesia requirements have implicated the neurologic effects of methamphetamine 18,73 . These studies have contributed to the idea that patients with elevated cortical awareness from acute abuse of methamphetamine may require higher anesthetic doses, but also that catecholamine depletion that is associated with chronic abuse may result in a lower requirement for anesthesia.…”

Methamphetamine and alcohol detection in vehicle‐driver fatalities in South Australia: A 10‐year survey (2008–2018)

“…Methamphetamine (MA), colloquially known as crystal meth, speed, or ice, is a highly addictive illegal drug that is a potent central nervous system psychostimulant that causes deficits in memory, executive functions, information processing, and motor skills (1). It also induces euphoria, aggression, and erratic behavior and has been found on toxicological testing at all ages (2)(3)(4)(5)(6). MA is associated with high dependency rates and its potential for abuse has been linked to overdoses, drug-related crime, and traumatic deaths including vehicle occupant fatalities (7)(8)(9)(10).…”