Urine drug screen positive for cocaine and amphetamine is not an adverse risk factor for cardiovascular morbidity or mortality in trauma

Abstract

BackgroundUrine 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.MethodsPatients 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.Results317 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.DiscussionUDS 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 evidenceTherapeutic/care management, level IV.

Opioid-related polysubstance use and its effect on mortality and health resource utilization among trauma patients

“…Elsewhere, while the effect of opioids with polysubstance on mortality has not been explicitly reported, research has shown that results vary regarding the association between stimulant use and mortality (Hadjizacharia et al 2009 ; Neeki et al 2018 ). Satish et al investigated the association of amphetamine and cocaine separately on mortality, showing that cocaine reduced the odds of mortality among trauma patients, while amphetamine did not show any such association (Satish et al 2021 ). As highlighted, though, outcomes vary in the literature (Yeung et al 2013 ; Satish et al 2021 ).…”

“…Satish et al investigated the association of amphetamine and cocaine separately on mortality, showing that cocaine reduced the odds of mortality among trauma patients, while amphetamine did not show any such association (Satish et al 2021 ). As highlighted, though, outcomes vary in the literature (Yeung et al 2013 ; Satish et al 2021 ). Our study stands unique, as it finds no association between the use of opioids and stimulants with mortality.…”

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

“…Another study [ 22 ] recently published used the national trauma database (NTDB) to evaluate the effect of amphetamine and cocaine on mortality. This study evaluated 317,688 patients who underwent urine drug screening in 2017.…”

Perioperative Considerations for Patients Exposed to Psychostimulants

“…However, cocaine and amphetamine have been associated with worsening postoperative complications, such as ventilator associated pneumonia or postoperative infection. 68 Cathinones Clinical signs and symptoms that need to be monitored during the perioperative period include agitation, hypertension, tachycardia, hyperreflexia, seizures, hyponatremia, rhabdomyolysis, and decreased renal function. 42 Like other sympathomimetics, cardiac side effects, including coronary vasospasm, myocardial ischemia, and hypertension, can be present.…”

“…However, cocaine and amphetamine have been associated with worsening postoperative complications, such as ventilator associated pneumonia or postoperative infection. 68…”