TY - JOUR
T1 - Substance use on admission toxicology screen is associated with peri-injury factors and six-month outcome after traumatic brain injury
T2 - A TRACK-TBI Pilot study
AU - Yue, John K.
AU - Phelps, Ryan R.L.
AU - Winkler, Ethan A.
AU - Deng, Hansen
AU - Upadhyayula, Pavan S.
AU - Vassar, Mary J.
AU - Madhok, Debbie Y.
AU - Schnyer, David M.
AU - Puccio, Ava M.
AU - Lingsma, Hester F.
AU - Yuh, Esther L.
AU - Mukherjee, Pratik
AU - Valadka, Alex B.
AU - Okonkwo, David O.
AU - Manley, Geoffrey T.
N1 - Publisher Copyright:
© 2020
PY - 2020/5
Y1 - 2020/5
N2 - 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.
AB - 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.
KW - Functional outcome
KW - Level of care
KW - Neuropsychiatric outcome
KW - Risk factors
KW - Substance use
KW - Toxicology
KW - Traumatic brain injury
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UR - http://www.scopus.com/inward/citedby.url?scp=85081917549&partnerID=8YFLogxK
U2 - 10.1016/j.jocn.2020.02.021
DO - 10.1016/j.jocn.2020.02.021
M3 - Article
C2 - 32173156
AN - SCOPUS:85081917549
SN - 0967-5868
VL - 75
SP - 149
EP - 156
JO - Journal of Clinical Neuroscience
JF - Journal of Clinical Neuroscience
ER -