Toxicology Screening in Urban Trauma Patients

Sloan, Edward P.; Zalenski, Robert J.; Smith, Robert F.; Sheaff, Charles M.; Chen, Edwin H.; Keys, Niko; Crescenzo, Marc; Barrett, John; Berman, Eleanor

doi:10.1097/00005373-198912000-00011

Cited by 91 publications

(5 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The higher rate of trauma observed for cocaine versus methamphetamine users in our study has been reported in past trauma-based studies [24,31,[77][78][79]. In addition, we found the coingestion of ethanol was significantly higher for cocaine than methamphetamine users.…”

Section: Discussionsupporting

confidence: 81%

Cocaine Versus Methamphetamine Users in the Emergency Department: How Do They Differ?

Richards¹,

Tabish²,

Wang³

et al. 2017

J Alcohol Drug Depend

View full text Add to dashboard Cite

Background: Stimulant use disorder is a worldwide problem. Users present to the ED for diverse reasons including trauma, chest and abdominal pain, altered mental status, stroke, suicidality, and skin infection. Objective: To determine what differences exist between stimulant users. Methods: We compared Stimulant users presenting to an urban ED Level I trauma center over a 3-month period with toxicology screens positive for cocaine and/or methamphetamine. Results: Of 718 subjects (465 male, 253 female), 610 (85%) were positive for methamphetamine, 80 (11%) cocaine, and 28 (4%) both. Significant racial differences existed, but not for age, gender, and insurance status. Ethanol co-ingestion was higher for cocaine users, otherwise no significant differences were detected for laboratory values and maximum heart rate, and systolic/diastolic blood pressure. For presenting complaint, the proportion of cocaine users was higher for trauma and lower for altered level of consciousness than other subgroups. There was no significant difference in proportion of subjects admitted to the hospital, but cocaine users had a higher rate of elopement and were placed on 72-h psychiatric holds and/or transferred to inpatient psychiatric facilities at a significantly lower rate than the other subgroups. Conclusion: Cocaine users were more likely to present with trauma, elope from the ED, and have alcohol intoxication. Methamphetamine users were more likely to be Caucasian, have altered level of consciousness, be placed on psychiatric holds, or transferred to inpatient psychiatric facilities. These differences may be explained by regional preferences, socialization, personality types, and the unique neuropsychopharmacological differences between cocaine and methamphetamine.

show abstract

Section: Discussionsupporting

confidence: 81%

Cocaine Versus Methamphetamine Users in the Emergency Department: How Do They Differ?

Richards¹,

Tabish²,

Wang³

et al. 2017

J Alcohol Drug Depend

View full text Add to dashboard Cite

show abstract

“…In our trauma region, prehospital fluid administration frequently does not exceed a volume of 1,000 ml, which might explain the absent relationship between pre-hospital fluid administration and coagulopathy in our patient population. Additionally, our data confirmed that alcohol intoxication is a common finding in patients with isolated TBI and suggested that alcohol intoxication is associated with a lower incidence of coagulopathy as compared to non-intoxicated patients [28]. …”

Section: Discussionsupporting

confidence: 77%

“…Despite the higher volume of fluid administration in patients with isolated TBI-associated coagulopathy as compared to subjects without hemostatic disorders, this was no predictor of patient outcome. Recent findings suggest that pre-hospital fluids exceeding 2,000 ml may independently be associated with coagulopathy in patients with isolated blunt TBI [28]. In our trauma region, prehospital fluid administration frequently does not exceed a volume of 1,000 ml, which might explain the absent relationship between pre-hospital fluid administration and coagulopathy in our patient population.…”

Section: Discussionmentioning

confidence: 75%

Acute and delayed mild coagulopathy are related to outcome in patients with isolated traumatic brain injury

et al. 2011

View full text Add to dashboard Cite

IntroductionThe relationship between isolated traumatic brain injury (TBI) associated coagulopathy and patient prognosis frequently lacks information regarding the time course of coagulation disorders throughout the post-traumatic period. This study was conducted to assess the prevalence and time course of post-traumatic coagulopathy in patients with isolated TBI and the relationship of these hemostatic disorders with outcome.MethodsThe local Human Subjects Committee approved the study. We retrospectively studied the medical records of computed tomography (CT)-confirmed isolated TBI patients with an extracranial abbreviated injury scale (AIS) <3 who were primarily referred to a Level 1 trauma centre in Amsterdam (n = 107). Hemostatic parameters including activated partial thromboplastin time (aPTT), prothrombin time (PT), platelet count, hemoglobin, hematocrit, glucose, pH and lactate levels were recorded throughout a 72-hour period as part of a routine standardized follow-up of TBI. Coagulopathy was defined as a aPPT >40 seconds and/or a PTT in International Normalized Ratio (INR) >1.2 and/or a platelet count <120*109/l.ResultsPatients were mostly male, aged 48 ± 20 years with a median injury severity score of 25 (range 20 to 25). Early coagulopathy as diagnosed in the emergency department (ED) occurred in 24% of all patients. The occurrence of TBI-related coagulopathy increased to 54% in the first 24 hours post-trauma. In addition to an increased age and disturbed pupillary reflex, both coagulopathy upon ED arrival and during the first 24 hours post-trauma provided an independent prognostic factor for unfavorable outcome (odds ratio (OR) 3.75 (95% CI 1.07 to 12.51; P = 0.04) and OR 11.61 (2.79 to 48.34); P = 0.003).ConclusionsOur study confirms a high prevalence of early and delayed coagulopathy in patients with isolated TBI, which is strongly associated with an unfavorable outcome. These data support close monitoring of hemostasis after TBI and indicate that correction of coagulation disturbances might need to be considered.

show abstract

“…The majority of our study collective consists of young, male patients. This coincides with the characterization of the risk profile of injured, alcoholized patients that can also be found in other studies [18,19].…”

Section: Discussionsupporting

confidence: 91%

Alcohol and trauma: the influence of blood alcohol levels on the severity of injuries and outcome of trauma patients - a retrospective analysis of 6268 patients of the TraumaRegister DGU®

Brockamp

Böhmer

Lefering

et al. 2021

Scand J Trauma Resusc Emerg Med

View full text Add to dashboard Cite

Background Blood alcohol level (BAL) has previously been considered as a factor influencing the outcome of injured patients. Despite the well-known positive correlation between alcohol-influenced traffic participation and the risk of accidents, there is still no clear evidence of a positive correlation between blood alcohol levels and severity of injury. The aim of the study was to analyze data of the TraumaRegister DGU® (TR-DGU), to find out whether the blood alcohol level has an influence on the type and severity of injuries as well as on the outcome of multiple-trauma patients. Methods Datasets from 11,842 trauma patients of the TR-DGU from the years 2015 and 2016 were analyzed retrospectively and 6268 patients with a full dataset and an AIS ≥ 3 could be used for evaluation. Two groups were formed for data analysis. A control group with a BAL = 0 ‰ (BAL negative) was compared to an alcohol group with a BAL of ≥0.3‰ to < 4.0‰ (BAL positive). Patients with a BAL > 0‰ and < 0.3‰ were excluded. They were compared with regard to various preclinical, clinical and physiological parameters. Additionally, a subgroup analysis with a focus on patients with a traumatic brain injury (TBI) was performed. A total of 5271 cases were assigned to the control group and 832 cases to the BAL positive group. 70.3% (3704) of the patients in the control group were male. The collective of the control group was on average 5.7 years older than the patients in the BAL positive group (p < .001). The control group showed a mean ISS of 20.3 and the alcohol group of 18.9 (p = .007). In terms of the injury severity of head, the BAL positive group was significantly higher on average than the control group (p < 0.001), whereas the control group showed a higher AIS to thorax and extremities (p < 0.001). The mean Glasgow Coma Scale (GCS) was 10.8 in the BAL positive group and 12.0 in the control group (p < 0.001). Physiological parameters such as base excess (BE) and International Normalized Ratio (INR) showed reduced values for the BAL positive group. However, neither the 24-h mortality nor the overall mortality showed a significant difference in either group (p = 0.19, p = 0.14). In a subgroup analysis, we found that patients with a relevant head injury (AIS: Abbreviated Injury Scale head ≥3) and positive BAL displayed a higher survival rate compared to patients in the control group with isolated TBI (p < 0.001). Conclusions This retrospective study analyzed the influence of the blood alcohol level in severely injured patients in a large national dataset. BAL positive patients showed worse results with regard to head injuries, the GCS and to some other physiological parameters. Finally, neither the 24-h mortality nor the overall mortality showed a significant difference in either group. Only in a subgroup analysis the mortality rate in BAL negative patients with TBI was significantly higher than the mortality rate of BAL positive patients with TBI. This mechanism is not yet fully understood and is discussed controversially in the literature.

show abstract

Toxicology Screening in Urban Trauma Patients

Cited by 91 publications

References 0 publications

Cocaine Versus Methamphetamine Users in the Emergency Department: How Do They Differ?

Cocaine Versus Methamphetamine Users in the Emergency Department: How Do They Differ?

Acute and delayed mild coagulopathy are related to outcome in patients with isolated traumatic brain injury

Alcohol and trauma: the influence of blood alcohol levels on the severity of injuries and outcome of trauma patients - a retrospective analysis of 6268 patients of the TraumaRegister DGU®

Contact Info

Product

Resources

About