Evaluation of the effect of methamphetamine on traumatic injury complications and outcomes

Abstract Background This study investigates the impact of methamphetamine use on trauma patient outcomes. Methods This retrospective study analyzed patients between 18 and 55 years old presenting to a single trauma center in San Bernardino County, CA who sustained traumatic injury during the 10-year study period (January 1st, 2005 to December 31st, 2015). Routine serum ethanol levels and urine drug screens (UDS) were completed on all trauma patients. Exclusion criteria included patients with an elevated serum ethanol level (> 0 mg/dL). Those who screened positive on UDS for only methamphetamine and negative for cocaine and cannabis (MA(+)) were compared to those with a triple negative UDS for methamphetamine, cocaine, and cannabis (MA(−)). The primary outcome studied was the impact of a methamphetamine positive drug screen on hospital mortality. Secondary outcomes included length of stay (LOS), heart rate, systolic and diastolic blood pressure (SBP and DBP, respectively), and total amount of blood products utilized during hospitalization. To analyze the effect of methamphetamine, age, gender, injury severity score, and mechanism of injury (blunt vs. penetrating) were matched between MA(−) and MA(+) through a propensity matching algorithm. Results After exclusion, 2538 patients were included in the final analysis; 449 were patients in the MA(+) group and 2089 patients in the MA(−) group. A selection of 449 MA(−) patients were matched with the MA(+) group based on age, gender, injury severity score, and mechanism of injury. This led to a final sample size of 898 patients with 449 patients in each group. No statistically significant change was observed in hospital mortality. Notably, a methamphetamine positive drug screen was associated with a longer LOS (median of 4 vs. 3 days in MA(+) and MA(−), respectively, p < 0.0001), an increased heart rate at the scene (103 vs. 94 bpm for MA(+) and MA(−), respectively, p = 0.0016), and an increased heart rate upon arrival to the trauma center (100 vs. 94 bpm for MA(+) and MA(−), respectively, p < 0.0001). Moreover, the MA(+) group had decreased SBP at the scene compared to the MA(−) group (127 vs. 132 bpm for MA(+) and MA(−), respectively, p = 0.0149), but SBP was no longer statistically different when patients arrived at the trauma center (p = 0.3823). There was no significant difference in DBP or in blood products used. Conclusion Methamphetamine positive drug screens in trauma patients were not associated with an increase in hospital mortality; however, a methamphetamine positive drug screen was associated with a longer LOS and an increased heart rate

Efficacy and Safety of Tranexamic Acid in Prehospital Traumatic Hemorrhagic Shock: Outcomes of the Cal-PAT Study

Introduction: The California Prehospital Antifibrinolytic Therapy (Cal-PAT) study seeks to assess thesafety and impact on patient mortality of tranexamic acid (TXA) administration in cases of trauma-inducedhemorrhagic shock. The current study further aimed to assess the feasibility of prehospital TXA administrationby paramedics within the framework of North American emergency medicine standards and protocols.Methods: This is an ongoing multi-centered, prospective, observational cohort study with a retrospectivechart-review comparison. Trauma patients identified in the prehospital setting with signs of hemorrhagicshock by first responders were administered one gram of TXA followed by an optional second one-gram doseupon arrival to the hospital, if the patient still met inclusion criteria. Patients administered TXA make up theprehospital intervention group. Control group patients met the same inclusion criteria as TXA candidates andwere matched with the prehospital intervention patients based on mechanism of injury, injury severity score,and age. The primary outcomes were mortality, measured at 24 hours, 48 hours, and 28 days. Secondaryoutcomes measured included the total blood products transfused and any known adverse events associatedwith TXA administration.Results: We included 128 patients in the prehospital intervention group and 125 in the control group.Although not statistically significant, the prehospital intervention group trended toward a lower 24-hourmortality rate (3.9% vs 7.2% for intervention and control, respectively, p=0.25), 48-hour mortality rate (6.3%vs 7.2% for intervention and control, respectively, p=0.76), and 28-day mortality rate (6.3% vs 10.4% forintervention and control, respectively, p=0.23). There was no significant difference observed in knownadverse events associated with TXA administration in the prehospital intervention group and control group. Areduction in total blood product usage was observed following the administration of TXA (control: 6.95 units;intervention: 4.09 units; p=0.01).Conclusion: Preliminary evidence from the Cal-PAT study suggests that TXA administration may be safe inthe prehospital setting with no significant change in adverse events observed and an associated decreaseduse of blood products in cases of trauma-induced hemorrhagic shock. Given the current sample size, astatistically significant decrease in mortality was not observed. Additionally, this study demonstrates thatit may be feasible for paramedics to identify and safely administer TXA in the prehospital setting