J. Covarrubias1, A. Grigorian1, J. Nahmias1, T. Chin1, S. Schubl1, V. Joe1, M. Lekawa1 1University Of California – Irvine,Department Of Surgery,Orange, CA, USA
Introduction: There is a previously established association between trauma and alcohol, illegal drugs, as well as prescription drugs, all of which can lead to impaired judgement and reaction time resulting in injury. Improved survival in trauma patients with acute alcohol intoxication has been previously reported. The effect of illegal and prescription drugs on mortality is less clear. We hypothesized that alcohol, illegal and prescription drugs are each independently associated with decreased risk of mortality in adult trauma patients.
Methods: The Trauma Quality Improvement Program (2010-2016) was queried for patients screening positive for alcohol, illegal or prescription drugs on admission. These do not include prescription drugs for medical treatment. A multivariable logistic regression model was used to determine risk of mortality.
Results: From 1,299,705 adult patients, 227,995 (17.5%) screened positive for alcohol, 155,437 (12.0%) for illegal drugs and 90,259 (6.9%) for prescription drugs. The alcohol cohort had the highest mortality rate (6.2%), followed by prescription drugs (5.7%) and illegal drugs (5.1%) (p<0.001). After controlling for covariates in an analysis of all adult trauma patients, all three groups had lower risk for mortality: alcohol (OR=0.88, CI=0.84-0.92, p<0.001), illegal drugs (OR=0.80, CI=0.74-0.86, p<0.001), prescription drugs (OR=0.70, CI=0.65-0.76, p<0.001). When stratified by injury severity score (ISS), those screening positive for alcohol or illegal drugs continued to have decreased mortality until an ISS of 50. Patients screening positive for prescription drugs were associated with decreased mortality when ISS>16.
Conclusion: Compared to all trauma patients, those screening positive for alcohol on admission have more than a 10% decreased risk of mortality, those screening positive for illegal drugs have a 20% decreased risk of mortality, and those screening positive for prescription drugs have a 30% decreased risk of mortality. The effect of alcohol and illegal drugs on risk for mortality ceases only when ISS>50. This paradoxical association should be confirmed with future clinical studies, as well as merits basic science research to help identify biochemical or physiologic components conferring a protective effect on survival in trauma patients.