Background: Alcohol and drug use is known to be a major factor affecting the incidence of traumatic injury.\r\nHowever, the ways in which immediate pre-injury substance use affects patients� clinical care and outcomes\r\nremains unclear. The goal of the present study is to determine the associations between pre-injury use of alcohol\r\nor drugs and patient injury severity, hospital course, and clinical outcome.\r\nMaterials and methods: This study used more than 200,000 records from the National Trauma Data Bank (NTDB),\r\nwhich is the largest trauma registry in the United States. Incidents in the NTDB were placed into one of four\r\nclasses: alcohol related, drug related, alcohol-and-drug related, and substance negative. Logistic regression models\r\nwere used to determine comorbid conditions or treatment complications that were significantly associated with\r\npre-injury substance use. Hospital charges were associated with the presence or absence of drugs and alcohol, and\r\npatient outcomes were assessed using discharge disposition as delimited by the NTDB.\r\nResults: The rates of complications arising during treatment were 8.3, 10.9, 9.9 and 8.6 per one hundred incidents\r\nin the alcohol related, drug related, alcohol-and-drug related, and substance-negative classes, respectively.\r\nRegression models suggested that pre-injury alcohol use is associated with a 15% higher risk of infection, whereas\r\npre-injury drug use is associated with a 30% higher risk of infection. Pre-injury substance use did not appear to\r\nsignificantly impact clinical outcomes following treatment for traumatic injury, however.\r\nConclusion: This study suggests that pre-injury drug use is associated with a significantly higher complication rate.\r\nIn particular, infection during hospitalization is a significant risk for both alcohol and drug related trauma visits, and\r\ndrug-related trauma incidents are associated with increased risk for additional circulatory complications. Although\r\ndrug and alcohol related trauma incidents are not associated with appreciably worse clinical outcomes, patients\r\nexperiencing such complications are associated with significantly greater length of stay and higher hospitalization\r\ncosts. Therefore significant benefits to trauma patients could be gained with enhanced surveillance for pre-injury\r\nsubstance use upon admission to the ED, and closer monitoring for infection or circulatory complications during\r\ntheir period of hospitalization.
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