The Effects of Stimulant Drugs on Outcomes from Traumatic Injury: A National TQIP Analysis

Introduction: Stimulant drug use is associated with adverse outcomes in traumatic injury. We investigated the association of stimulant drug positivity on trauma outcomes, predicting that mortality and healthcare utilization would be increased.

Methods: We analyzed 2017-2021TQIP data including trauma patients ≥18 years. We defined stimulant drug positivity as admission urine toxicology positive for cocaine, amphetamine, methamphetamine, or MDMA. Unadjusted analyses and adjusted analyses were performed. Primary outcomes included mortality and length of stay (LOS).

Results: Among 4.9 million patients, 269,950 (5.5%) were positive for stimulants. Compared to controls, stimulant-positive patients were more often male (75.1% vs. 57.8%, p<0.001), more severely injured (injury severity score, ISS >15: 24.8% vs. 16.1%, p<0.001), and had longer lengths of stay (7.9 vs. 6.3 days, p<0.001). In adjusted analyses, overall mortality was lower among stimulant positive patients (OR 0.91, p<0.001) but the combination of ISS>15 and stimulant positivity increased mortality (OR: 1.82, p<0.001). LOS varied if patients underwent procedures, with most significant increases among patients undergoing tracheostomy and gastrostomy (Figure 1). Among stimulant positive patients, penetrating injury increased the odds of mortality compared to blunt injury (OR: 4.27, p<0.001).

Conclusions: The lower overall mortality among stimulant positive patients has been attributed to the “Vices Paradox”, where substances are associated with vasoconstrictive effects. However, the mortality increase in stimulant positive patients with ISS>15 and increased LOS suggest this patient population remains high risk. Protocolized management of this complex group can help improve procedural safety, reduce healthcare utilization, and reduce adverse outcomes.