Derek Titus^1,2, Areta Kowal-Vern^2,3, John Porter^4,5, Marc R. Matthews^3,5*, Philomene Spadafore⁵, Sydney Vail⁵

Show more
¹ College of Osteopathic Medicine of the Pacific-Northwest, Lebanon, USA.
² Department of Research, Valleywise Health Medical Center, Phoenix, USA.
³ Arizona Burn Center, Valleywise Health Medical Center, Phoenix, USA.
⁴ Department of Physical Medicine & Rehabilitation, Valleywise Health Medical Center, Phoenix, USA.
⁵ Department of Surgery, Valleywise Health Medical Center, Phoenix, USA.
Show less

Abstract: Background: Alcohol and drug screens in trauma patients are endorsed by the American College of Surgeons Committee on Trauma. The objective was to determine the characteristics and frequency of alcohol and poly-drug combinations in patients triaged by Trauma Team Activation (TTA) codes. Methods: A retrospective study of a Level I hospital trauma registry was initiated with 14,972 patients of whom 7028 (47%) were Substance Users (SU). There were 10,369 TTA patients: 5396 (52%) were SU, and 4603 (31%) non-TTA patients, of whom 1632 (35.5%) were SU. Inclusion criteria were: age ≥14 years old, blood alcohol level and Urine Drug Screen (UDS) documentation, Injury Severity Score (ISS), TTA code, hospital charges and Length of Hospitalization (LOS). Statistical analyses were performed with one-way ANOVA, Maximum Likelihood chi squared, and Mann-Whitney U tests. Results: The median ISS was 5 for both groups. TTA patients were younger than non-TTA patients (median 33 years versus 41 years). Mortality was significantly higher for TTA (4.7%) than for non-TTA (0.7%) patients. From 2010-2013 to 2014-2018, all substance users had a significant decrease in alcohol only use (58.0% to 42.0%) with an increase in single drug (42.0% to 58.0%) and poly-drug use (36.9% to 63.1%), p < 0.0001. For all SU patients (TTA and non-TTA), the major single drugs used were opiates (19.9%), cannabinoids (THC) (15.2%), benzodiazepines (7.7%), amphetamines (6.6%), and cocaine (2.5%). The major poly-drugs were: opiates/THC (4.7%), opiates/benzodiazepines (4.6%), THC/amphetamines (3.1%), THC/benzodiazepines (2.2%). Conclusions: By trauma activation code designation, the TTA group had most of the positive alcohol and drug screens in this study. Since the change in mandated opioid prescription practices in 2014, this study showed increased poly-drug use (two to six-drug combinations) in urban trauma patients between 2014-2018. Opioids and cannabinoids continued to be the most frequently used drugs singly and in combinations.

Keywords: Drugs, Alcohol, Trauma

Cite this paper: Titus, D. , Kowal-Vern, A. , Porter, J. , Matthews, M. , Spadafore, P. and Vail, S. (2021) Trauma Activation and Substance Use in an Urban Trauma Center. Surgical Science, 12, 53-66. doi: 10.4236/ss.2021.123008.

References

[1]   London, J.A. and Battistella, F.D. (2007) Testing for Substance Use in Trauma Patients. Are We Doing Enough? The Archives of Surgery, 142, 633-638.
https://doi.org/10.1001/archsurg.142.7.633

[2]   Vitale, S. and van de Mheen, D. (2006) Illicit Drug Use and Injuries: A Review of Emergency Room Studies. Drug and Alcohol Dependence, 82, 1-9.
https://doi.org/10.1016/j.drugalcdep.2005.08.017

[3]   Williams, F.N., Chrisco, L., Strassle, P.D., Laughon, S.L., Sljivic, S., Nurczyk, K., et al. (2020) Bias in Alcohol and Drug Screening in Adult Burn Patients. International Journal of Burns and Trauma, 10, 146-155.

[4]   Dunham, C.M. and Chirichella, T.J. (2012) Trauma Activation Patients: Evidence for Routine Alcohol and Illicit Drug Screening. PLoS ONE, 7, e47999.
https://doi.org/10.1371/journal.pone.0047999

[5]   Langdorf, M.I., Rudkin, S.E., Dellota, K., Fox, J.C. and Munden, S. (2002) Decision Rule and Utility of Routine Urine Toxicology Screening of Trauma Patients. European Journal of Emergency Medicine, 9, 115-121.
https://doi.org/10.1097/00063110-200206000-00003

[6]   The NTDB Annual Report 2010.
https://www.facs.org/~/media/files/quality%20programs/trauma/ntdb/ntdbannualreport2010. ashx

[7]   The NTDB Annual Report 2016.
https://www.facs.org/~/media/files/quality%20programs/trauma/ntdb/ntdb%20annual%20repo rt%202016.ashx

[8]   Warner, E.A., Walker, R.M. and Friedman, P.D. (2003) Should Informed Consent Be Required for Laboratory Testing for Drugs of Abuse in Medical Settings? The American Journal of Medicine, 115, 54-58.
https://doi.org/10.1016/S0002-9343(03)00236-5

[9]   Texas EMS Trauma and Acute Care Foundation (TETAF).
http://tetaf.org/wp-content/uploads/2016/03/trauma-activation-guildelines.pdf

[10]   Ornell, F., Moura, H.F., Scherer, J.N., Pechansky, F., Kessler, F.H.P. and von Diemen, L. (2020) The Covid-19 Pandemic and Its Impact on Substance Use: Implications for Prevention and Treatment. Psychiatry Research, 289, Article ID: 113096.
https://doi.org/10.1016/j.psychres.2020.113096

[11]   Boehnke, K.F., McAfee, J., Ackerman, J.M. and Kruger, D.J. (2020) Medication and Substance Use Increases among People Using Cannabis Medically during the Covid-19 Pandemic. International Journal of Drug Policy, Article ID: 103053.
https://doi.org/10.1016/j.drugpo.2020.103053

[12]   Gossop, M., Stewart, D., Treacy, S. and Marsden, J. (2002) A Prospective Study of Mortality among Drug Misusers during a 4-Year Period after Seeking Treatment. Addiction, 97, 39-47.
https://doi.org/10.1046/j.1360-0443.2002.00079.x

[13]   Riley, E.D., Evans, J.L., Hahn, J.A., et al. (2016) A Longitudinal Study of Multiple Drug Use and Overdose among Young People Who Inject Drugs. American Journal of Public Health, 106, 915-917.
https://doi.org/10.2105/AJPH.2016.303084

[14]   Gudin, J.A., Mogali, S., Jones, J.D. and Comer, S.D. (2013) Risks, Management, and Monitoring of Combination Opioid, Benzodiazepines, and/or Alcohol Use. Postgraduate Medicine, 125, 115-130.
https://doi.org/10.3810/pgm.2013.07.2684

[15]   Gemma, V.A., Chapple, K.M., Goslar, P.W., Israr, S., Petersen, S.R. and Weinberg, J.A. (2018) Crisis under the Radar: Illicit Amphetamine Use Is Reaching Epidemic Proportions and Contributing to Resource Overutilization at a Level I Trauma Center. Journal of Trauma and Acute Care Surgery, 85, 953-959.
https://doi.org/10.1097/TA.0000000000001984

[16]   Cheng, V., Inaba, K., Johnson, M., Byerly, S., Jiang, Y., Matsushima, K., et al. (2016) The Impact of Pre-Injury Controlled Substance Use on Clinical Outcomes Following Trauma. Journal of Trauma and Acute Care Surgery, 81, 913-920.
https://doi.org/10.1097/TA.0000000000001229

[17]   National Trauma Data Bank (NTDB).
https://www.facs.org/quality-programs/trauma/tqp/center-programs/ntdb/ntds/about-ntds

[18]   Erdovan, M., Kureshi, N., Karim, S.A., Tallon, J.M., Asbridge, M. and Green, R.S. (2018) Retrospective Analysis of Alcohol Testing in Trauma Team Activation Patients as a Canadian Tertiary Trauma Centre. BMJ Open, 8, e024190.
https://doi.org/10.1136/bmjopen-2018-024190