W. Wilson1, S. O’Mara1,2, J. Opalek2, U. Pandya1,2 1Ohio University,Heritage College Of Osteopathic Medicine,Athens, OH, USA 2Grant Medical Center,Trauma Services,Columbus, OH, USA
Introduction: The prevalence of prescription narcotic use in the U.S. is on the rise. Opioid use and its impact on the management of trauma patients has yet to be thoroughly studied. The aim of this study is to determine the prevalence of pre-injury opioid use and its influence on specific outcomes amongst the trauma patient population.
Methods: A retrospective review of all trauma patients presenting to a Level I Trauma Center was performed from January 1, 2010 to December 31, 2010. Patients who died within 24 hours of presentation and those with incomplete medication data were excluded. Electronic medical record review of history and physical documentation and urine drug screen records were used to determine pre-injury opioid status. Pre-existing narcotic use, demographic data, injury mechanism and severity, injury type, and outcome variables were analyzed.
Results:A total of 3953 patients met inclusion criteria. Among our sample, 644 (16.3%) were positive for pre-injury opioid use. Patients in the pre-injury opioid group were older (48 years vs. 41 years) and more likely to be female (37.9% vs. 30.6%). The mechanism of injury was more often falls (32.8% vs. 22.0%). Patients on narcotics were more likely to be admitted (82.6% vs. 77.4 %) despite having overall lower injury severity. Analysis of less severely injured patients (ISS < 15) found a significantly increased length of stay (3.7 days vs. 2.9 days) in the narcotics group. Evaluation of injury type revealed that head injury, abdominal injury and lower extremity/pelvic injuries were predictive of increased length of stay in these patients.
Conclusion:There is a considerable prevalence of pre-injury opioid use in the trauma population. These patients have unique characteristics and causes of injury. Pre injury opioid use is predictive of increased hospital admission rate and increased length of stay, with important ramifications for patient care and health care costs.
