Swanson Sophia M, Sise C Beth, Sise Michael J, Sack Daniel I, Holbrook Troy Lisa, Paci Gabrielle M
Division of Trauma, Scripps Mercy Hospital, San Diego, California, USA.
J Trauma. 2007 Sep;63(3):531-7. doi: 10.1097/TA.0b013e318074d3ac.
Methamphetamine (METH) use is associated with high-risk behavior and serious injury. The aim of this study was to assess the impact of METH use in trauma patients on a Level I trauma center to guide prevention efforts.
A retrospective registry-based review of 4,932 consecutive trauma patients who underwent toxicology screening at our center during a 3-year period (2003-2005). This sample represented 76% of all trauma patients seen during this interval.
From the first half of 2003 to the second half of 2005, overall use of METH increased 70% (p < 0.001), surpassing marijuana as the most common illicit drug used by the trauma population. Other illicit drug use did not significantly change during this interval. METH-positive patients were more likely to have a violent mechanism of injury (47.3% vs. 26.3%, p < 0.001), with 33% more assaults (p < 0.01), 96% more gunshot wounds (p < 0.001), and 158% more stab wounds (p < 0.001). They were more likely to have attempted suicide (4.8% vs. 2.6%, p < 0.01), to have had an altercation with law enforcement (1.8% vs. 0.3%, p < 0.001), or been the victim of domestic violence (4.4% vs. 2.1%, p < 0.001). METH users had a higher mean Injury Severity Score (11.2 vs. 10.0, p < 0.01), were 62% more likely to receive mechanical ventilation (p < 0.001), and 53% more likely to undergo an operation (p < 0.001). They were more prone to leave against medical advice (4.9% vs. 2.1%, p < 0.001) and 113% more likely to die from their injuries (6.4% vs. 3.0%, p < 0.001). The average cost of care per METH user was 9% higher than that for nonusers, and METH users were more likely to be unfunded than nonusers (47.6% vs. 23.1%, p < 0.001). The annual uncompensated cost of care of METH users increased 70% during the study period to $1,477,108 in 2005.
METH use in trauma patients increased significantly and was associated with adverse outcomes and a significant financial burden on our trauma center. Evidence-based prevention efforts must be a priority for trauma centers to help stop the scourge of METH.
使用甲基苯丙胺（冰毒）与高风险行为及严重伤害相关。本研究旨在评估在一级创伤中心中，创伤患者使用冰毒的影响，以指导预防工作。
对在3年期间（2003 - 2005年）于我们中心接受毒理学筛查的4932例连续创伤患者进行基于登记处的回顾性研究。该样本占此期间所有创伤患者的76%。
从2003年上半年到2005年下半年，冰毒的总体使用率增长了70%（p < 0.001），超过大麻成为创伤人群中最常用的非法药物。在此期间，其他非法药物的使用情况没有显著变化。冰毒检测呈阳性的患者更有可能有暴力致伤机制（47.3%对26.3%，p < 0.001），袭击事件多33%（p < 0.01），枪伤多96%（p < 0.001），刺伤多158%（p < 0.001）。他们更有可能曾试图自杀（4.8%对2.6%，p < 0.01），与执法部门发生过争执（1.8%对0.3%，p < 0.001），或成为家庭暴力的受害者（4.4%对2.1%，p < 0.001）。冰毒使用者的平均损伤严重度评分更高（11.2对10.0，p < 0.01），接受机械通气的可能性高62%（p < 0.001），接受手术的可能性高53%（p < 0.001）。他们更倾向于擅自离院（4.9%对2.1%，p < 0.001），因伤死亡的可能性高113%（6.4%对3.0%，p < 0.001）。每位冰毒使用者的平均护理费用比非使用者高9%，冰毒使用者比非使用者更有可能没有资金来源（47.6%对23.1%，p < 0.001）。在研究期间，冰毒使用者每年的未补偿护理费用增长了70%，到2005年达到1477108美元。
创伤患者中冰毒的使用显著增加，且与不良后果及给我们创伤中心带来的重大经济负担相关。基于证据的预防工作必须成为创伤中心的首要任务，以帮助遏制冰毒的危害。
