B. E. Love1, K. Inaba1, K. Matsushima1, D. Clark1, M. Lewis1, D. Demetriades1, A. Strumwasser1 1LAC+USC Medical Center,Acute Care Surgery,Los Angeles, CA, USA
Introduction: Stimulant use has multiple physiologic effects. In traumatic brain injury patients, these effects include clouding the physical and neurologic exam. The effects of stimulant use on in-hospital outcomes for patients with traumatic brain injury has been largely unexamined in the current literature.
Methods: We performed a retrospective chart review of all adult patients with traumatic brain injury admitted to our Level I trauma center in Los Angeles from March 2008 to May of 2017. Only patients with urine drug screens performed on admission were included in the study. Patients tested for methamphetamines, cocaine, and PCP were selected for analysis. All patients with alcohol and other depressants were excluded from the study. Patients that died within the first 48 hours of admission (n = 276) were excluded. In-hospital interventions, outcomes, and ICU complications were collected and analyzed.
Results: A total of 1,946 patients met inclusion criteria for the study. Methamphetamines were the most commonly found stimulant (88%). Table 1 demonstrates patient demographics and ICU outcomes. As can be seen in Table 2, patients that tested positive for stimulants tended to be younger and had longer ICU courses with longer ventilator days. More patients that tested positive for stimulants were intubated in the emergency department. The stimulant group also had more ICU complications during their hospitalization (39% vs 24%), though mortality was slightly better in the stimulant group (9% vs 13%). None of the stimulant patients developed ARDS during their hospital course, while 9 (0.5%) in the stimulant negative group did.
Conclusion: Stimulant use in patients with traumatic brain injury are associated with slightly improved survival, but more in-hospital complications. The absence of ARDS from the stimulant group might be due to the more aggressive, early intubation in the emergency department, explained by increased combativeness and the lower GCS upon presentation. This suggests a possible protective effect of early intubation in patients with stimulants and traumatic brain injury. Further study on stimulants is needed to better parse their effects on patients with varying injury patterns.