Division of Trauma and Surgical Critical Care, Department of Surgery, Los Angeles County, University of Southern California Medical Center, University of Southern California, Los Angeles, CA, 90033, USA.
Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, Freiburgstrasse 16C, 3010, Bern, Switzerland.
Eur J Trauma Emerg Surg. 2023 Aug;49(4):1683-1691. doi: 10.1007/s00068-022-02095-7. Epub 2022 Sep 6.
The aim of this study was to assess the impact of pre-injury stimulant use (amphetamine, cocaine, methamphetamine and/or ecstasy) on outcomes after isolated severe traumatic brain injury (TBI).
Retrospective 2017 TQIP study, including adult trauma patients (≥16 years old) who underwent drug and alcohol screening on admission and sustained an isolated severe TBI (head AIS ≥3). Patients with significant extracranial trauma (AIS ≥3) were excluded. Epidemiological and clinical characteristics, procedures and outcome variables were collected. Patients with isolated stimulant use were matched 1:1 for age, gender, mechanism of injury, head AIS and overall comorbidities, with patients with negative toxicology and alcohol screen. Outcomes in the two groups were compared with univariable and multivariable regression analysis.
681 patients with isolated TBI and stimulant use were matched with 681 patients with negative toxicology and alcohol screen. The incidence of hypotension and CGS <9 was similar in the two groups. In multivariable regression analysis, stimulant use was not independently associated with mortality (OR 0.95, 95% CI 0.61-1.49). However, stimulant use was associated with longer hospital length of stay (HLOS) (RC 1.13, 95%CI 1.03-1.24).
Pre-injury stimulant use is common in patients admitted for severe TBI, but was not independently associated with mortality when compared to patients with negative toxicology. However, stimulant use was associated with a significant longer HLOS.
本研究旨在评估创伤性脑损伤（TBI）患者受伤前使用兴奋剂（安非他命、可卡因、甲基苯丙胺和/或摇头丸）对结局的影响。
回顾性 2017 年 TQIP 研究，纳入成人创伤患者（≥16 岁），入院时进行药物和酒精筛查，并发生孤立性严重 TBI（头部 AIS≥3）。排除有明显颅外创伤（AIS≥3）的患者。收集流行病学和临床特征、程序和结局变量。对孤立性兴奋剂使用者按年龄、性别、损伤机制、头部 AIS 和总体合并症进行 1:1 匹配，匹配阴性毒理学和酒精筛查的患者。对两组患者进行单变量和多变量回归分析比较结局。
681 例孤立性 TBI 伴兴奋剂使用患者与 681 例阴性毒理学和酒精筛查患者相匹配。两组患者低血压和 CGS<9 的发生率相似。多变量回归分析显示，兴奋剂使用与死亡率无关（OR 0.95，95%CI 0.61-1.49）。然而，兴奋剂使用与住院时间延长相关（RC 1.13，95%CI 1.03-1.24）。
在因严重 TBI 入院的患者中，受伤前使用兴奋剂很常见，但与阴性毒理学患者相比，死亡率无显著差异。然而，兴奋剂使用与显著延长的住院时间相关。
