SLR - January 2012 - Ruth Devadas
Reference: Cowperthwaite M, Burnett M: Treatment course and outcomes following drug and alcohol-related traumatic injuries; Journal of Trauma Management & Outcomes 2011, 5:3
Scientific Literature Review
Reviewed by: Ruth Devadas, DPM
Residency Program: Botsford Hospital
Podiatric Relevance:
Some podiatric emergencies are due to drug or alcohol related trauma, and this article provides unique information with respect to pre- and post-operative assessment of these patients.
Methods:
The National Trauma Data Bank database was used to review complete entries of trauma from 770 trauma centers from around the United States. Injury incidents were included if the presence or absence of both drugs and alcohol on admission to the emergency department was recorded. Injuries were not included in the study if the patient’s alcohol and drug status was not determined on admission.
Injuries were placed into 4 categories: 1- alcohol related and drug absent, 2- drug related and alcohol absent, 3- alcohol and drug related, 4- substance negative where no reported use of drugs or alcohol use pre-injury. Inclusion criteria included: age at least 16, injury severity score (ISS) must be between 0-75, gender must be limited to either male or female. Pre-existing co-morbidities were used to test whether the substance abusing population was significantly less healthy than the trauma population on whole. Complications were used to test the significance of hospital course with pre-injury substance abuse. Complications included: DVT, cardiac arrest and renal failure.
Results:
Demographically, males were more frequently involved in substance abuse trauma when compared to females. Drugs and alcohol were more likely to occur in the same trauma incident for males versus females. With respect to the ISS (injury severity score), severe injuries were associated with drug or alcohol related injuries. With respect to pre-existing co-morbidities, there was no significant data on whether the trauma would occur in a population with more co-morbidities and substance abuse. 80% of the reported comorbid conditions were not significantly associated with pre-injury drug or alcohol use. With respect to complications, 80% of complications involving infections were associated with alcohol abuse, 50% with drug usage and 71% for a combination of substance abuse. It was determined that pre-injury substance abuse increased the risk of infection by 15-30%. 42% of complications involving circulatory conditions (ex: DVT) were associated with drug abuse. Incidentally it was noted that patients with pre-injury substance abuse had longer hospital stays, generally due to the various complications (most commonly infection or circulatory related).
Conclusions:
This study suggests that pre-injury drug use is associated with a significantly higher complication rate. In particular, infection during hospitalization is a significant risk for both alcohol and drug related trauma injuries. In addition, drug-related trauma incidents are associated with increased risk for circulatory complications. Drug and alcohol related trauma patients experiencing complications are associated with significantly greater length of hospitalization. Therefore, it could be beneficial to survey for pre-injury substance use upon admission to the ED, and closer monitoring for infection or circulatory complications during their period of hospitalization