Trauma, Critical Care, and General Surgery Services, St. Elizabeth Youngstown Hospital, 1044 Belmont Ave., St. Elizabeth Youngstown Hospital, Youngstown, OH 44501, United States.
Trauma, Critical Care, and General Surgery Services, St. Elizabeth Youngstown Hospital, 1044 Belmont Ave., St. Elizabeth Youngstown Hospital, Youngstown, OH 44501, United States.
Injury. 2023 May;54(5):1334-1341. doi: 10.1016/j.injury.2023.01.048. Epub 2023 Jan 29.
Unlike prior guidelines for a positive toxicology screen, the 2022 national trauma data bank dictionary requires the exclusion of postinjury drugs. We aimed to (1) investigate the proportion of drugs in the toxicology screen that were given postinjury; (2) determine preinjury toxicology-positive associations with smoking, psychiatric, and drug abuse histories in an activation patient (ACT-Pt) cohort; and (3) explore whether ACT-Pt varied toxicology testing rates would produce similar preinjury toxicology-positive results.
In this retrospective study, the historic parent database included consecutive trauma center admissions where toxicology testing was discretionary. A supplementary electronic medical record audit of ACT-Pts age 18-60 years assessed smoking, psychiatric, and drug abuse histories. Subsequently, ACT-Pt age 18-100 years testing was encouraged by attending surgeons and, later routine testing was implemented.
Of 2,076 patients in the historic parent database, discretionary toxicology testing occurred in 23.9% (n = 496) and the positive proportion was 58.9% (n = 292). However, 23.6% (n = 69) of the positive screens had the drug given postinjury. The preinjury positive-toxicology proportion was 45.0% (223/496). Preinjury toxicology positivity was greater in ACT-Pts age 18-60 years (52.3%) than in other patients (activations >60 years of age or consultations) (33.7%; p < 0.0001; odds ratio [OR] = 2.2). Smoking, psychiatric, and drug abuse histories were more common in ACT-Pts age 18-60 years preinjury toxicology-positive patients (74.4%, 51.3%, and 98.7%) than in negative patients (36.6%, 25.2%, and 25.2%; p < 0.0001). In ACT-Pts age 18-100 years, when compared to historic discretionary testing (32.7%), testing was increased with encouraged testing (62.1%; p < 0.0001; OR = 3.4) and routine testing (73.1%; p < 0.0001; OR = 5.6). ACT-Pt preinjury toxicology positivity was similar for historic discretionary (47.9%), encouraged (57.6%), and routine (51.3%) (p = 0.3670) testing. The meta-analytic toxicology-positive proportion for the three testing strategies was 49.8%.
Substantial toxicology-positive findings are due to postinjury drug administration. Toxicology positivity is associated with ACT-Pts age 18-60 years and smoking, psychiatric, and drug abuse histories. ACT-Pt age 18-100 years preinjury toxicology positivity is 50% and does not vary with different testing proportions and strategies.
与之前的阳性毒理学筛查指南不同，2022 年国家创伤数据库词典要求排除伤后用药。我们旨在：(1) 调查毒理学筛查中伤后用药的比例；(2) 在激活患者（ACT-Pt）队列中确定伤前毒理学阳性与吸烟、精神科和药物滥用史的关联；(3) 探讨 ACT-Pt 不同的毒理学检测率是否会产生类似的伤前毒理学阳性结果。
在这项回顾性研究中，历史母数据库包括毒理学检测是选择性的连续创伤中心入院。对年龄在 18-60 岁的 ACT-Pt 进行补充电子病历审核，评估吸烟、精神科和药物滥用史。随后，由主治外科医生鼓励对年龄在 18-100 岁的 ACT-Pt 进行检测，之后实施常规检测。
在历史母数据库的 2076 名患者中，选择性毒理学检测的比例为 23.9%（n=496），阳性比例为 58.9%（n=292）。然而，23.6%（n=69）的阳性筛查结果显示药物是伤后给予的。伤前毒理学阳性比例为 45.0%（n=496）。ACT-Pt 年龄在 18-60 岁的患者伤前毒理学阳性比例（52.3%）高于其他患者（激活时间超过 60 岁或咨询）（33.7%；p<0.0001；比值比[OR]=2.2）。在伤前毒理学阳性的 ACT-Pt 年龄在 18-60 岁的患者中，吸烟、精神科和药物滥用史更为常见（74.4%、51.3%和 98.7%），而非阴性患者（36.6%、25.2%和 25.2%；p<0.0001）。在 ACT-Pt 年龄在 18-100 岁的患者中，与历史选择性检测（32.7%）相比，鼓励检测（62.1%；p<0.0001；OR=3.4）和常规检测（73.1%；p<0.0001；OR=5.6）增加了检测。ACT-Pt 年龄在 18-60 岁的患者伤前毒理学阳性率在历史选择性（47.9%）、鼓励性（57.6%）和常规性（51.3%）检测时相似（p=0.3670）。三种检测策略的毒理学阳性比例的荟萃分析结果为 49.8%。
大量的毒理学阳性发现是由于伤后用药。毒理学阳性与 ACT-Pt 年龄在 18-60 岁和吸烟、精神科和药物滥用史有关。ACT-Pt 年龄在 18-100 岁的伤前毒理学阳性率为 50%，与不同的检测比例和策略无关。
