Valley Orthopedic Surgery Residency Modesto, CA, United States.
Valley Orthopedic Surgery Residency Modesto, CA, United States.
Injury. 2021 Mar;52(3):478-480. doi: 10.1016/j.injury.2021.02.008. Epub 2021 Feb 7.
Pain management in trauma patients can be difficult due to their varied injuries and presence or absence of illicit substances in their systems. Additionally, trauma patients have variable lengths of stay. Limiting length of stay to what is medically necessary and preventing long-term dependence on narcotic medications are important in trauma patient care.
We performed a retrospective review of 385 consecutive trauma activations at a Level II trauma center with urine toxicology screens from 2015. Main outcome measures recorded were urine toxicology results, average daily morphine milligram equivalents (MME), length of stay (LOS), injury severity score (ISS). We also recorded patient demographic information. Statistical analysis compared outcomes and demographics between trauma patients with positive urine toxicology screens to those with negative screens. Significance was set at p < 0.05.
Positive urine toxicology screens were present in 230/385 (59.7%) patients. The median (interquartile range (IQR)) daily MME usage in the positive urine toxicology group was 25.2 (12.0-48.6) versus 12.4 (2.5-27.5) for those with a negative drug screen (p < 0.001). Median LOS was 3 (1-6) days versus 2 (1-4) days for the positive and negative groups, respectively (p = 0.004). There were no differences in age, gender distribution, or ISS between the two groups. Subgroup analysis showed urine toxicology positive for opiates, benzodiazepines, and tetrahydrocannabinol (THC) were associated with increased daily MME. Benzodiazepines and amphetamines were associated with increased LOS.
This study identifies a positive toxicology screening as a risk factor for increased narcotic demands and longer length of stay in trauma patients. These findings may assist in developing treatment plans and setting expectations in this population. This information can also lead to proactive interventions aimed at minimizing narcotic use and shortening LOS in this population.
由于创伤患者的伤势各异，体内是否存在非法物质也存在差异，因此疼痛管理可能较为困难。此外，创伤患者的住院时间长短不一。限制住院时间以符合医学需要并防止长期依赖麻醉药物对于创伤患者的护理非常重要。
我们对一家二级创伤中心的 385 例连续创伤激活病例进行了回顾性研究，这些病例均进行了尿液毒理学检测。记录的主要结果包括尿液毒理学结果、平均每日吗啡毫克当量（MME）、住院时间（LOS）、损伤严重程度评分（ISS）。我们还记录了患者的人口统计学信息。对尿液毒理学检测阳性和阴性患者的结果和人口统计学数据进行了比较。p 值小于 0.05 被认为具有统计学意义。
在 385 例患者中，有 230 例（59.7%）尿液毒理学检测呈阳性。在阳性尿液毒理学组中，每日 MME 使用率中位数（四分位距（IQR））为 25.2（12.0-48.6），而在阴性药物检测组中为 12.4（2.5-27.5）（p<0.001）。阳性组和阴性组的 LOS 中位数分别为 3（1-6）天和 2（1-4）天（p=0.004）。两组在年龄、性别分布或 ISS 方面均无差异。亚组分析显示，阿片类药物、苯二氮䓬类药物和四氢大麻酚（THC）的尿液毒理学阳性与每日 MME 增加有关。苯二氮䓬类药物和安非他命与 LOS 延长有关。
本研究确定阳性毒理学筛查是创伤患者增加麻醉需求和延长住院时间的危险因素。这些发现可能有助于制定该人群的治疗计划和设定预期。这些信息还可以促使针对该人群实施积极干预措施，以尽量减少麻醉药物的使用和缩短 LOS。
