Association of benzodiazepines, opioids and tricyclic antidepressants use and falls in trauma patients: Conditional effect of age

Introduction The relationship between benzodiazepines, opioids and tricyclic antidepressants and trauma is of great importance because of increased consumption and the growing evidence of a positive association among older adults. The objective of this study was to determine the effect size of the association between the consumption of psychotropic medications /opioids and falls in patients who have suffered trauma by studying the role of other variables in this relationship. Method From 2011 to 2016, the presence of benzodiazepines, opioids and tricyclic antidepressants and other drugs in 1060 patients admitted for trauma at a level I trauma hospital was analysed. Multivariate models were used to measure the adjusted effect size of the association between consumption of benzodiazepines, opioids and tricyclic antidepressants and falls, and the effect of age on this association was studied. Results A total of 192 patients tested positive for benzodiazepines, opioids and tricyclic antidepressants, with same-level falls being the most frequent mechanism of injury in this group (40.1%), with an odds ratio of 1.96 (1.40–2.75), p < 0.001. Once other covariates were introduced, this association was not observed, leaving only age, gender (woman) and, to a lesser extent, sensory conditions as variables associated with falls. Age acted as an effect modifier between benzodiazepines, opioids and tricyclic antidepressants and falls, with significant effect sizes starting at 51.9 years of age. Conclusions The association between the consumption of benzodiazepines, opioids and tricyclic antidepressants and falls in patients admitted for trauma is conditioned by other confounding variables, with age being the most influential confounding variable.The members of the GISyC group (SCG, CFA and ESM) are funded by “Programa Operativo FEDER Extremadura (2014-2020) y Fondo Europeo Desarrollo Regional (FEDER) Grant number: GR18146. This work was supported by 4IE+ project (0499_4IE_PLUS_4_E) funded by the Interreg V-A España-Portugal (POCTEP) 2014- 2020 program

Association between the detection of alcohol, illicit drugs and/or psychotropic medications/ opioids in patients admitted due to trauma and trauma recidivism: A cohort study

To quantify the association between the presence and type of drug detected and trauma recidivism in a cohort of patients admitted due to trauma. The incidence rate of TR was 10.94 cases per 100 patient-years in the group of patients negative for substances and 27.99 per 100 patient-years in positive patients. The survival curves show very significant differences in cumulative recurrence-free survival between the groups (Log Rank: p<0.001). Both the aHRR and the aIRR estimates show an increased risk of re-injury due to alcohol consumption (aIRR: 2.33 (1.72±3.15), p<0.001), cannabis use (aIRR: 1.87 (1.09±3.20), p = 0.022) and polydrug use (aIRR: 2.34 (1.80±3.04), p<0.001). The presence of alcohol and/or illicit drugs in these patients doubles the risk of trauma recidivismThis work was supported by the Dirección General de Tráfico, Spain [grant number: 0100DGT22389

Efecto de las drogas alucinógenas, estimulantes y depresoras del sistema nervioso central sobre la gravedad de la lesión en pacientes ingresados por traumatismos

Objective: The effect of drugs other than alcohol on severity of trauma remains unclear. Pooled data analyses in previous studies that grouped substances with opposite effects on the central nervous system (CNS) may have masked the influence of substances on injury severity. The aim was to analyze the effect of stimulant, hallucinogenic and depressant drugs other than alcohol on injury severity in trauma patients. Methods: The presence of alcohol, stimulant drugs (cocaine, amphetamines and methamphetamines), depressant drugs (benzodiazepines, opiates, methadone and barbiturates) and hallucinogenic drugs (THC and PCP) was analyzed in 1187 patients between 16 and 70 years old admitted to a trauma hospital between November 2012 and June 2015. Injury severity was determined prospectively as the Injury Severity Score. A multivariate analysis was used to quantify the strength of association between exposure to substances and trauma severity, using the presence of alcohol as a stratification variable. Results: Drugs other than alcohol were found in 371 patients (31.3%): 32 (2.7%) stimulants, 186 (15.3%) depressants, 78 (6.6%) hallucinogenics and 75 (5.6%) polydrug use. The presence of CNS depressant substances was associated with increased injury severity only in patients also exposed to alcohol, with an adjusted odds ratio of 4.63 (1.37-15.60) for moderate injuries and 7.83 (2.53-24.21) for severe. Conclusion: CNS depressant drugs had a strong influence on injury severity in patients who screened positive for alcohol consumption.Objetivo: No está claro qué efecto tienen las drogas distintas del alcohol sobre la gravedad de los traumatismos. Los análisis incluidos en estudios previos, que agrupan sustancias con efectos opuestos sobre el sistema nervioso central (SNC), pueden haber enmascarado la influencia de estas sobre la gravedad. El objetivo fue analizar el efecto de las drogas alucinógenas, estimulantes y depresoras del SNC, diferentes del alcohol, sobre la gravedad de las lesiones en pacientes ingresados por traumatismos. Métodos: Se analizó la presencia de alcohol, drogas estimulantes (cocaína, anfetaminas y metanfetaminas), depresoras (benzodiacepinas, opiáceos, metadona y barbitúricos) y alucinógenas (THC y PCP) en 1187 pacientes de entre 16 y 70 años de edad ingresados por traumatismo de noviembre de 2012 a junio de 2015. La gravedad del traumatismo se determinó prospectivamente mediante la Injury Severity Score. Se cuantificó la fuerza de la asociación entre la exposición a sustancias y la gravedad del traumatismo mediante un análisis multivariante, utilizando la presencia de alcohol como variable de estratificación. Conclusión: Las drogas depresoras del SNC tuvieron una fuerte influencia en la gravedad del traumatismo en los pacientes que además presentaban resultados positivos para consumo de alcohol.This work was supported by the Dirección General de Tráfico, Spain [No. 0100DGT22389] and the Consejería de Salud, Junta de Andalucía, Spain [No. PI-0691-2013]

El efecto del consumo del alcohol, las drogas ilícitas y los psicofármacos sobre la reincidencia y la gravedad de los traumatismos: Propuesta de una estrategia de prevención

En 2011 se llevó a cabo en el Hospital de Traumatología de Granada la implantación de un proyecto de prevención, mediante el cribado sistemático de sustancias, en pacientes ingresados por traumatismos, para la realización de una intervención motivacional breve. Mediante el registro de pacientes creado por el proyecto se llevó a cabo esta Tesis Doctoral con los objetivos de: 1) describir a los pacientes del registro; 2) cuantificar la fuerza de asociación entre el tipo de sustancias detectadas y su historial de traumatismos previos; 3) analizar la asociación de las drogas según su efecto en el sistema nervioso central sobre la gravedad; 4) estimar y comparar la reincidencia de nuevos traumatismos en los pacientes positivos y negativos a sustancias; 5) y estimar la efectividad de la intervención motivacional breve en la reducción de la reincidencia de traumatismos.Tesis Univ. Granada.m Programa de doctorado en Medicina Clínica y Salud PúblicaLa realización de esta Tesis Doctoral ha sido en parte posible gracias a la financiación obtenida por la Dirección General de Tráfico (Proyecto: “Asistencia técnica para la implementación de una intervención Motivacional en accidentes asociados con el alcohol y las drogas. Ref.0100DGT22389”) y por la Consejería de Salud de la Junta de Andalucía (Proyecto: “Efectividad de una Intervención Breve en el tratamiento de pacientes admitidos por un accidente de tráfico relacionado con el consumo de drogas. Ref. PI-0691-2013”)