A. Jordan1, P. Salen2, T. R. Wojda1, M. S. Cohen2, A. Hasani3, J. Luster3, H. Stankewicz2, S. P. Stawicki1 1St. Luke’s University Health Network,Department Of Surgery,Bethlehem, PENNSYLVANIA, USA 2St. Luke’s University Health Network,Department Of Emergency Medicine,Bethlehem, PENNSYLVANIA, USA 3Temple University,Department Of Surgery,Philadelpha, PA, USA
Introduction: Polysubstance abuse, defined as any combination of multiple drugs or at least one drug and alcohol, is a major public health problem. In addition to the negative impact on health and well-being of substance users, alcohol and/or drug abuse can be associated with significant trauma burden. The aim of this study was to determine if serum alcohol (EtOH) levels on initial trauma evaluation correlate with the simultaneous presence of other substances of abuse. We hypothesized that polysubstance use would be significantly more common among patients who presented to our trauma center with blood alcohol content (BAC) >0.10%.
Methods: A retrospective audit of trauma registry (August 1998 to June 2015) was performed. Abstracted data included patient demographics, BAC determinations, all available formal determinations of urine/serum drug screening, injury mechanism and severity information, Glasgow coma scale (GCS) assessments, and 30-day mortality. Stratification of BAC was based on the 0.10% cut-off. Statistical comparisons were performed using Fisher’s exact testing and Chi-square testing, with significance set at α=0.05.
Results: We analyzed 488 patients (76.3% male, mean age 38.7 years). Median GCS was 15 (IQR 14-15). Median ISS was 9 (IQR 5-17). Overall 30-day mortality was 2.7%, with no difference between elevated (>0.10) and normal (<0.10) EtOH groups. For the overall study sample, the median BAC was 0.10% (IQR 0-0.13). There were 284 (58.2%) patients with BAC <0.10% and 204 (41.8%) patients with BAC >0.10%. The two groups were similar in terms of mechanism of injury (both, >95% blunt).
A total of 245 patients underwent formal “tox-screen” evaluations. Of those, 31 (12.7%) were positive for marijuana, 18 (7.35%) were positive for cocaine, 28 (11.4%) for opioids, and 32 (13.1%) for benzodiazepines. Patients with BAC >0.10% on initial evaluation were significantly more likely to also have polysubstance use (e.g., EtOH + additional substance) than patients with BAC <0.10% (53/220 [24.1%] versus 16/25 [64.0%], p<0.002, Table). Among polysubstance users, BAC >0.10% was significantly associated with opioid and cocaine use (Table).
Conclusion: This study confirms that a significant proportion of trauma victims with an admission BAC >0.10% present with evidence of polysubstance use. Patients with BAC >0.10% were more likely to test positive for drugs of abuse (e.g., cocaine and opioids) than patients with BAC <0.10%. Our findings support the need for routine substance abuse screening in the presence of EtOH intoxication, with focus on primary identification, appropriate clinical management, and early polysubstance abuse intervention.
