Substance use on admission toxicology screen is associated with peri-injury factors and six-month outcome after traumatic brain injury: A TRACK-TBI Pilot study

John K. Yue, Ryan R.L. Phelps, Ethan A. Winkler, Hansen Deng, Pavan S. Upadhyayula, Mary J. Vassar, Debbie Y. Madhok, David M. Schnyer, Ava M. Puccio, Hester F. Lingsma, Esther L. Yuh, Pratik Mukherjee, Alex B. Valadka, David O. Okonkwo, Geoffrey T. Manley

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)149-156
Number of pages8
JournalJournal of Clinical Neuroscience
Volume75
DOIs
StatePublished - May 2020
Externally publishedYes

Keywords

  • Functional outcome
  • Level of care
  • Neuropsychiatric outcome
  • Risk factors
  • Substance use
  • Toxicology
  • Traumatic brain injury

ASJC Scopus subject areas

  • Surgery
  • Neurology
  • Clinical Neurology
  • Physiology (medical)

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