Highlights
- •Emergency department toxicology screen (tox+) is an indicator of active substance use.
- •Tox+ confounds neurologic assessment and is a risk factor for poor outcomes after TBI.
- •Tox+ is associated with prior substance use history and prior TBIs.
- •Tox+ is associated with increased hospital admissions in CT-negative TBI.
- •Tox+ is associated with PTSD and psychiatric symptoms at 6-months postinjury.
Abstract
Substance use is commonly associated with traumatic brain injury (TBI). We investigate
associations between active substance use, peri-injury factors, and outcome after
TBI across three U.S. Level I trauma centers. TBI subjects from the prospective Transforming
Research and Clinical Knowledge in Traumatic Brain Injury Pilot (TRACK-TBI Pilot)
with Marshall computed tomography (CT) score 1–3, no neurosurgical procedure/operation,
and admission urine toxicology screen (tox+/−) were extracted. Associations between
tox+/−, comorbidities, hospital variables, and six-month functional (GOSE) and neuropsychiatric
(PCL-C, BSI18, RPQ-13, SWLS) outcomes were analyzed. Multivariable regression was
performed for associations significant on univariate analysis with odds ratios (mOR)
presented. Significance assessed at p < 0.05. In 133 subjects, tox+/tox− were 29.1%/72.9%.
Tox+ was younger (35.5/43.6-years, p = 0.018), trended toward male sex (80.6%/63.9%,
p = 0.067), was associated with history of seizures (27.8%/10.3%, p = 0.012), self-reported
substance use (44.4%/17.5%, p = 0.001), prior TBI (58.8%/34.1%, p = 0.009), GCS < 15
(69.4%/48.4%, p = 0.031) and blood alcohol level >0.08-mg/dl (55.6%/30.8%, p = 0.022).
In CT-negative subjects, tox+ was associated with increased hospital admission (95.7%/66.7%,
p = 0.034). At six-months, tox+ was associated with screening positive for post-traumatic
stress disorder (PCL-C: 40.0%/15.9%; mOR = 8.24, p = 0.022) and psychiatric symptoms
(BSI18: 40.0%/14.3%, mOR = 11.06, p = 0.023). Active substance use in TBI may confound
GCS assessment, triage to higher level of care, and be associated with increased six-month
neuropsychiatric symptoms. Substance use screening should be integrated into standard
emergency/acute care TBI protocols to optimize management and resource utilization.
Clinicians should be vigilant in providing education, counselling, and follow-up for
TBI patients with substance use.
Keywords
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Article info
Publication history
Published online: March 12, 2020
Accepted:
February 10,
2020
Received:
December 31,
2019
Identification
Copyright
© 2020 Published by Elsevier Ltd.
