Stimulant drug misuse in patients presenting to level 1 trauma centres: a retrospective analysis of 80 000 patients in Canada and the United States

Background : Despite increasing global misuse of stimulant drugs, there is a paucity of literature regarding stimulant use among trauma patients. The primary aim of this study was to assess hospital mortality among patients with stimulant intoxication who presented to level 1 trauma centres in Canada and the United States. Secondary outcomes included emergency department mortality, hospital length of stay, and admission to the intensive care unit (ICU). Methods : This is a retrospective analysis of data from the Trauma Quality Improvement Program, including patients presenting emergently to participating level 1 trauma centres from January 2017 to December 2018. We included patients aged 19 to 88 years who had positive toxicology to stimulant drugs or negative toxicology to all drugs. We adjusted for patient demographic factors in the analysis. Results : We included 89 130 patients, with 10 017 patients (11.2%) having a positive screen for stimulants. The mean age in the stimulants cohort was 42.0 years, with a 75.9% male preponderance and mean Injury Severity Score of 9. The control cohort was older, with a mean age of 55 years, and a smaller proportion of males (63.0%, p < 0.001). We found no significant differences between emergency department mortality and length of stay in the ICU after we adjusted for confounders. Patients with stimulants in their system were predicted to spend 1.11 (95% confidence interval 1.09 to 1.13) times as many days in hospital as controls, after we accounted for confounders. Conclusion : Stimulant misuse is a relevant issue in the trauma population, associated with increased hospital length of stay, but no significant difference in mortality. By addressing stimulant intoxication in trauma patients, health care providers can work toward improving patient outcomes and reducing the associated health care burden.