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; TRACK-TBI Investigators

doi:10.1016/j.jocn.2020.02.021

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

J Clin Neurosci. 2020 May:75:149-156. doi: 10.1016/j.jocn.2020.02.021. Epub 2020 Mar 12.

Authors

Affiliations

¹ Department of Neurosurgery, University of California San Francisco, San Francisco, CA, USA; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA.
² Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
³ Department of Neurosurgery, University of California San Diego, San Diego, CA, USA.
⁴ Department of Emergency Medicine, University of California San Francisco, San Francisco, CA, USA.
⁵ Department of Psychology, University of Texas in Austin, Austin, TX, USA.
⁶ Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands.
⁷ Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA; Department of Radiology, University of California San Francisco, San Francisco, CA, USA.
⁸ Department of Neurosurgery, Virginia Commonwealth University, Richmond, VA, USA.
⁹ Department of Neurosurgery, University of California San Francisco, San Francisco, CA, USA; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA. Electronic address: [email protected].

PMID: 32173156
DOI: 10.1016/j.jocn.2020.02.021

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: Functional outcome; Level of care; Neuropsychiatric outcome; Risk factors; Substance use; Toxicology; Traumatic brain injury.

MeSH terms

Adult
Age Factors
Blood Alcohol Content
Brain Injuries, Traumatic / diagnostic imaging
Brain Injuries, Traumatic / etiology*
Emergency Service, Hospital
Female
Hospitalization
Humans
Male
Mass Screening / methods*
Middle Aged
Pilot Projects
Sex Factors
Substance-Related Disorders / complications*
Tomography, X-Ray Computed
Toxicology / methods*
Trauma Centers
Treatment Outcome

Substances

Blood Alcohol Content