@article{ref1,
title="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",
journal="Journal of clinical neuroscience",
year="2020",
author="Yue, John K. and Phelps, Ryan R. L. and Winkler, Ethan A. and Deng, Hansen and Upadhyayula, Pavan S. and Vassar, Mary J. and Madhok, Debbie Y. and Schnyer, David M. and Puccio, Ava M. and Lingsma, Hester F. and Yuh, Esther L. and Mukherjee, Pratik and Valadka, Alex B. and Okonkwo, David O. and Manley, Geoffrey T.",
volume="ePub",
number="ePub",
pages="ePub-ePub",
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.<br><br>Copyright © 2020. Published by Elsevier Ltd.<p /> <p>Language: en</p>",
language="en",
issn="0967-5868",
doi="10.1016/j.jocn.2020.02.021",
url="http://dx.doi.org/10.1016/j.jocn.2020.02.021"
}