Trauma Outcomes in Methamphetamine-positive Patients vs Matched Methamphetamine-negative Controls in a Central Valley California Trauma Center

Abstract

Aim and objective: Our objective was to determine whether patients presenting as activated traumas to a trauma center serving a high methamphetamine (meth) prevalence region differed in outcomes based on whether they tested positive vs negative for methamphetamine at the time of presentation. Materials and methods: A case-control design was used to examine the trauma outcomes among patients who tested meth-positive vs matched controls. The trauma outcomes evaluated were needed for laparotomy, rate of inpatient admission, rate of ICU admission, hospital length of stay, ICU length of stay, ventilation status, ventilation time, injury severity score, and mortality. Propensity score matching was used to match meth-positive cases and comparison cases on sex, age (in years), race, primary financial resources to pay for the visit, presentation time, and the county where s/he lived at the time of presentation. Results: Meth-positive patients and matched comparison cases did not differ in the need for laparotomy. Meth-positive patients experienced a longer hospital stay ( p = 0.011), longer duration of ventilator use ( p = 0.05), and a higher injury severity score ( p < 0.001). Positive cases were more likely than matched comparison cases to be admitted to the ICU ( p < 0.001) and to be placed on mechanical ventilation ( p < 0.001). Meth- positive patients had a marginally significantly higher rate of inpatient admission ( p = 0.066). No significant difference was found between the two groups in mortality rate at discharge and length of ICU stays. Conclusion: Meth positivity is notably associated with an increased injury severity score on presentation. If meth use is known or suspected before arrival, trauma resources should be mobilized appropriately to prepare for a severe traumatic injury. The fact that meth positivity increases the likelihood of ICU admission and ventilator use, with increased hospital length of stay and increased ventilator time, indicates that meth positivity in trauma patients places a large burden on hospital staffing and resources.