Department of Pharmacology, Division of Laboratory Medicine, Oslo University Hospital, Oslo, Norway.
Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.
Scand J Trauma Resusc Emerg Med. 2021 Aug 28;29(1):125. doi: 10.1186/s13049-021-00939-6.
The use of psychoactive prescription drugs is associated with increased risk of traumatic injury, and has negative impact on clinical outcome in trauma patients. Previous studies have focused on specific drugs or subgroups of patients. Our aim was to examine the extent of psychoactive drug dispensing prior to injury in a comprehensive population of trauma patients.
The Oslo University Hospital Trauma Registry provided data on all trauma patients admitted to the trauma centre between 2005 and 2014. We linked the data to Norwegian Prescription Database data from 2004. Opioids, benzodiazepines, z-hypnotics, gabapentinoids, and centrally acting sympathomimetics dispensed during the year before trauma of each patient were identified. We determined the pre-trauma annual prevalence of dispensing and mean annual cumulative defined daily doses (DDD) for each drug class, and compared results with corresponding figures in the general population, using standardised ratios. For each drug class, dispensing 14 days preceding trauma was analysed in patients sustaining severe injury and compared with patients sustaining non-severe injury.
12,713 patients (71% male) were included. Median age was 36 years. 4891 patients (38%) presented with severe injury (Injury Severity Score > 15). The ratio between annual prevalence of dispensed prescriptions for trauma patients and the general population, adjusted for age and sex, was 1.5 (95% confidence interval 1.4-1.6) for opioids, 2.1 (2.0-2.2) for benzodiazepines, 1.7 (1.6-1.8) for z-hypnotics, 1.9 (1.6-2.2) for gabapentinoids, and 1.9 (1.6-2.2) for centrally acting sympathomimetics. Compared with the general population, mean annual cumulative DDD of opioids and benzodiazepines dispensed to trauma patients were more than two and three times as high, respectively, in several age groups below 70 years. The prevalence of dispensing 14 days pre-trauma was higher in severely injured patients for opioids, benzodiazepines, and z-hypnotics compared with patients without severe injury.
Our results support previous findings that the prevalence of psychoactive drug use is high among trauma patients. In terms of both frequency and amounts, the pre-injury dispensing of psychoactive drugs to trauma patients supersedes that of the general population, especially in younger patients.
使用精神活性处方药物与创伤性损伤的风险增加有关，并对创伤患者的临床结果产生负面影响。以前的研究集中在特定药物或特定患者群体上。我们的目的是在一个全面的创伤患者人群中检查受伤前精神活性药物的使用程度。
奥斯陆大学医院创伤登记处提供了 2005 年至 2014 年期间收治到创伤中心的所有创伤患者的数据。我们将这些数据与 2004 年挪威处方数据库的数据进行了关联。确定了每位患者创伤前一年中开具的阿片类药物、苯二氮䓬类药物、Z 类催眠药、加巴喷丁类药物和中枢作用拟交感神经药的数量。我们确定了每个药物类别在创伤前的年度流行率和平均每年累积的限定日剂量（DDD），并使用标准化比值与一般人群中的相应数字进行了比较。对于每个药物类别，我们分析了在严重受伤的患者和非严重受伤的患者中，创伤前 14 天的药物使用情况。
共纳入 12713 名患者（71%为男性）。中位年龄为 36 岁。4891 名患者（38%）表现为严重损伤（损伤严重程度评分>15）。调整年龄和性别后，创伤患者与普通人群之间年度处方配药率的比值为 1.5（95%置信区间 1.4-1.6）阿片类药物，2.1（2.0-2.2）苯二氮䓬类药物，1.7（1.6-1.8）Z 类催眠药，1.9（1.6-2.2）加巴喷丁类药物和 1.9（1.6-2.2）中枢作用拟交感神经药。与普通人群相比，70 岁以下多个年龄组中，创伤患者开阿片类药物和苯二氮䓬类药物的年累积 DDD 分别是普通人群的两倍和三倍以上。与无严重损伤的患者相比，严重损伤患者的阿片类药物、苯二氮䓬类药物和 Z 类催眠药的 14 天前配药率更高。
我们的结果支持以前的发现，即精神活性药物的使用在创伤患者中很普遍。就频率和数量而言，创伤患者的精神活性药物的开方量超过了普通人群，尤其是在年轻患者中。
