University of California San Francisco School of Medicine, Department of Surgery, San Francisco, CA; San Francisco General Hospital, Trauma and Acute Care Surgery, San Francisco, CA.
University of California San Francisco School of Medicine, San Francisco, CA. Electronic address: https://twitter.com/SEHernandezz.
Surgery. 2021 Oct;170(4):1249-1254. doi: 10.1016/j.surg.2021.03.003. Epub 2021 Apr 15.
Although death from drug overdose is a leading cause of injury-related death in the United States, its incidence after traumatic incident is unknown. Moreover, little is known about related risk factors. We sought to determine the incidence and characteristics of and risk factors for trauma patients suffering death by acute drug poisoning ("overdose") after hospitalization for a traumatic incident.
We conducted a retrospective chart review of all admitted trauma patients ≥18 y of age at the only level-1 trauma center in our region from 2012 to 2019, matched with unintentional overdose decedents from the California death registry. We assessed associations between demographic and clinical characteristics with risk of overdose death, using cumulative incidence functions and Fine-Gray subdistribution hazard models.
Of 9,860 patients residing in San Francisco, CA, USA, at the time of their trauma activation or admission during the study period, 1,418 died (4.3 per 100 person-years), 107 from unintentional overdose (0.3 per 100 person-years). Overdose decedents were 84% male, 50% white, with a mean age of 48 years at the time of presentation; 20% of deaths occurred within 3 months of hospitalization, and 40% were attributed to a prescription opioid. In multivariate analysis, younger age, male sex, white race, and having undergone a urine drug screening were all associated with subsequent death from overdose.
During a mean 3.4-year follow-up, the mortality rate from overdose among adult patients with traumatic incidents was 0.3/100 person-years. Trauma hospitalization may serve as an opportunity to screen and initiate prevention, harm reduction, and treatment interventions.
尽管药物过量导致的死亡在美国是导致与伤害相关的死亡的主要原因，但创伤事件后其发生率尚不清楚。此外，相关危险因素也知之甚少。我们旨在确定因创伤住院后急性药物中毒（“过量”）导致死亡的创伤患者的发生率、特征和危险因素。
我们对本地区唯一的 1 级创伤中心 2012 年至 2019 年期间所有年龄≥18 岁的入院创伤患者进行了回顾性图表审查，并与加利福尼亚州死亡登记处的非故意药物过量死亡者进行了匹配。我们使用累积发生率函数和 Fine-Gray 亚分布风险模型评估了人口统计学和临床特征与过量死亡风险之间的关联。
在美国加利福尼亚州旧金山市，在研究期间创伤激活或入院时居住在该地区的 9860 名患者中，有 1418 人死亡（每 100 人年 4.3 人），其中 107 人死于非故意药物过量（每 100 人年 0.3 人）。过量死亡者中 84%为男性，50%为白人，就诊时的平均年龄为 48 岁；20%的死亡发生在住院后 3 个月内，40%归因于处方类阿片。多变量分析显示，年龄较小、男性、白种人以及接受尿液药物筛查均与随后因药物过量死亡有关。
在平均 3.4 年的随访期间，创伤患者药物过量死亡率为 0.3/100 人年。创伤住院治疗可能是筛查并启动预防、减少伤害和治疗干预的机会。
