Singer Matt, Azim Asad, O'Keeffe Terence, Khan Muhammad, Jain Arpana, Kulvatunyou Narong, Gries Lynn, Jehan Faisal, Tang Andrew, Joseph Bellal
From the Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery (M.S., A.A., T. O'K., M.K., A.J., N.K., L.G., F.J., A.T., B.J.), University of Arizona, Tucson, Arizona.
J Trauma Acute Care Surg. 2017 Nov;83(5):846-849. doi: 10.1097/TA.0000000000001672.
In the United States, marijuana abuse and dependence are becoming more prevalent among adult and adolescent trauma patients. Unlike several studies that focus on the effects of marijuana on the outcomes of diseases, our aim was to assess the relationship between a positive toxicology screen for marijuana and mortality in such patients.
A 5-year (2008-2012) analysis of adult trauma patients (older than 18 years old) in Arizona State Trauma Registry. We included patients admitted to the intensive care unit (ICU) with a positive toxicology screen for marijuana. We excluded patients with positive alcohol or other substance screening. Outcome measures were mortality, ventilator days, ICU, and hospital length of stay. We matched patients who tested positive for marijuana (marijuana positive) to those who tested negative (marijuana negative) using propensity score matching in a 1:1 ratio controlling for age, injury severity score, and Glasgow Coma Scale.
We included a total of 28,813 patients, of which 2,678 were matched (1,339, marijuana positive; 1,339, marijuana negative). The rate of positive screening for marijuana was 7.4% (2,127/28,813). Mean age was 31 ± 9 years, and injury severity score was 13 (8-20). There was no difference between the two groups in hospital (6.4 days vs. 5.4 days, p = 0.08) or ICU (3 days vs. 4 days, p = 0.43) length of stay. Of the marijuana-positive patients, 55.3% received mechanical ventilation, while 32% of marijuana-negative patients received mechanical ventilation (p < 0.001). On subanalysis of patients who received mechanical ventilation, the marijuana-positive patients had a higher number of ventilator days (2 days vs. 1 day, p = 0.02) and a lower mortality rate (7.3% vs. 16.1%, p < 0.001) than those who were marijuana negative.
A positive marijuana screen is associated with decreased mortality in adult trauma patients admitted to the ICU. This association warrants further investigation of the possible physiologic effects of marijuana in trauma patients.
Prognostic studies, level III.
在美国，大麻滥用和成瘾在成年及青少年创伤患者中愈发普遍。与多项关注大麻对疾病预后影响的研究不同，我们的目的是评估大麻毒理学筛查呈阳性与这类患者死亡率之间的关系。
对亚利桑那州创伤登记处5年（2008 - 2012年）的成年创伤患者（年龄大于18岁）进行分析。我们纳入了重症监护病房（ICU）收治的大麻毒理学筛查呈阳性的患者。我们排除了酒精或其他物质筛查呈阳性的患者。结局指标为死亡率、呼吸机使用天数、ICU住院时间和住院总时长。我们采用倾向得分匹配法，以1:1的比例将大麻检测呈阳性的患者（大麻阳性）与检测呈阴性的患者（大麻阴性）进行匹配，同时控制年龄、损伤严重程度评分和格拉斯哥昏迷量表。
我们共纳入28,813例患者，其中2,678例进行了匹配（1,339例大麻阳性；1,339例大麻阴性）。大麻筛查阳性率为7.4%（2,127/28,813）。平均年龄为31±9岁，损伤严重程度评分为13（8 - 20）。两组患者的住院时长（6.4天对5.4天，p = 0.08）或ICU住院时长（3天对4天，p = 0.43）无差异。在大麻阳性患者中，55.3%接受了机械通气，而大麻阴性患者中这一比例为32%（p < 0.001）。在对接受机械通气的患者进行亚组分析时，大麻阳性患者的呼吸机使用天数更多（2天对1天，p = 0.02），死亡率更低（7.3%对16.1%，p <
