Cocaine use in trauma: the vices-paradox revisited.

Humans Adolescent Adult Wounds, Gunshot Cocaine-Related Disorders / complications Substance-Related Disorders / complications Cocaine / adverse effects Ethanol Stroke / complications Myocardial Infarction / complications

Journal

Surgery
ISSN: 1532-7361
Titre abrégé: Surgery
Pays: United States
ID NLM: 0417347

Informations de publication

Date de publication:
10 2023
Historique:
received: 25 04 2023
revised: 02 06 2023
accepted: 18 06 2023
medline: 18 9 2023
pubmed: 27 7 2023
entrez: 26 7 2023
Statut: ppublish

Résumé

The "vices-paradox" describes the paradoxical association between illicit substance use and decreased mortality risk in trauma patients. Cocaine's vasoconstrictive effects may decrease hemorrhage but also increase the risk of thromboembolic complications. To clarify the effects of cocaine use on trauma patients, we compared the risk of mortality and thromboembolic complications in patients screening positive for cocaine with those screening negative. We searched the Trauma Quality Improvement Program database to identify patients 18 years and over who had presented with a drug and alcohol screen on admission between 2017 and 2019. After excluding all patients who had tested positive for alcohol and substances other than cocaine, we then compared the clinical outcomes of patients who were positive and negative for cocaine use. Of the 312,553 patients identified, 11,942 (3.82%) had tested positive for cocaine. Cocaine users were significantly more likely to present with stab (8.0% vs 3.1%) or gunshot wounds (8.0% vs 3.0%) but had lower rates of mortality (3.6% vs 4.7%), myocardial infarction (0.1% vs 0.2%,) and cerebrovascular accident (0.3% vs 0.4%,). After controlling for covariates, the risk of death, myocardial infarction, and cerebrovascular accident did not significantly differ between cocaine and non-cocaine users. Trauma patients positive for cocaine have similar risks of death and thromboembolic complications and so have a similar prognosis to patients negative for all drugs or alcohol, indicating that the "vices-paradox" does not apply to cocaine use. However, these patients more commonly present after penetrating trauma, suggesting cocaine use in hazardous environments.

Sections du résumé

BACKGROUND
The "vices-paradox" describes the paradoxical association between illicit substance use and decreased mortality risk in trauma patients. Cocaine's vasoconstrictive effects may decrease hemorrhage but also increase the risk of thromboembolic complications. To clarify the effects of cocaine use on trauma patients, we compared the risk of mortality and thromboembolic complications in patients screening positive for cocaine with those screening negative.
METHODS
We searched the Trauma Quality Improvement Program database to identify patients 18 years and over who had presented with a drug and alcohol screen on admission between 2017 and 2019. After excluding all patients who had tested positive for alcohol and substances other than cocaine, we then compared the clinical outcomes of patients who were positive and negative for cocaine use.
RESULTS
Of the 312,553 patients identified, 11,942 (3.82%) had tested positive for cocaine. Cocaine users were significantly more likely to present with stab (8.0% vs 3.1%) or gunshot wounds (8.0% vs 3.0%) but had lower rates of mortality (3.6% vs 4.7%), myocardial infarction (0.1% vs 0.2%,) and cerebrovascular accident (0.3% vs 0.4%,). After controlling for covariates, the risk of death, myocardial infarction, and cerebrovascular accident did not significantly differ between cocaine and non-cocaine users.
CONCLUSION
Trauma patients positive for cocaine have similar risks of death and thromboembolic complications and so have a similar prognosis to patients negative for all drugs or alcohol, indicating that the "vices-paradox" does not apply to cocaine use. However, these patients more commonly present after penetrating trauma, suggesting cocaine use in hazardous environments.

Identifiants

DOI: 10.1016/j.surg.2023.06.024 PMID: 37495463
pubmed: 37495463
pii: S0039-6060(23)00406-3
doi: 10.1016/j.surg.2023.06.024
pii:
doi:

Substances chimiques

Cocaine I5Y540LHVR
Ethanol 3K9958V90M

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

1056-1062

Informations de copyright

Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.

Auteurs

A Bhullar (A)

Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine Medical Center, Orange, CA.

J Nahmias (J)

Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine Medical Center, Orange, CA.

A Kong (A)

Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine Medical Center, Orange, CA.

L Swentek (L)

Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine Medical Center, Orange, CA.

T Chin (T)

Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine Medical Center, Orange, CA.

M Schellenberg (M)

Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine Medical Center, Orange, CA.

A Grigorian (A)

Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine Medical Center, Orange, CA. Electronic address: arigori@hs.uci.edu.

Articles similaires

[Redispensing of expensive oral anticancer medicines: a practical application].

Lisanne N van Merendonk, Kübra Akgöl, Bastiaan Nuijen
1.00
Humans Antineoplastic Agents Administration, Oral Drug Costs Counterfeit Drugs

Smoking Cessation and Incident Cardiovascular Disease.

Jun Hwan Cho, Seung Yong Shin, Hoseob Kim et al.
1.00
Humans Male Smoking Cessation Cardiovascular Diseases Female

Evaluation of Low-Value Services Across Major Medicare Advantage Insurers and Traditional Medicare.

Ciara Duggan, Adam L Beckman, Ishani Ganguli et al.
1.00
Humans United States Aged Cross-Sectional Studies Medicare Part C

Effectiveness of Virtual Yoga for Chronic Low Back Pain: A Randomized Clinical Trial.

Hallie Tankha, Devyn Gaskins, Amanda Shallcross et al.
1.00
Humans Yoga Low Back Pain Female Male

Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Cocaine use in trauma: the vices-paradox revisited.
questionsmedicales.fr › Personnes › Tranches d'âge › Adolescent › Cocaine use in trauma: the vices-paradox revisited.
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Cocaine use in trauma: the vices-paradox revisited.
questionsmedicales.fr › Plaies et blessures › Plaies pénétrantes › Plaies par arme à feu › Cocaine use in trauma: the vices-paradox revisited.
questionsmedicales.fr › Troubles mentaux › Troubles liés à une substance › Troubles liés à la cocaïne › Cocaine use in trauma: the vices-paradox revisited.
questionsmedicales.fr › Troubles mentaux › Troubles liés à une substance › Cocaine use in trauma: the vices-paradox revisited.
questionsmedicales.fr › Composés hétérocycliques › Composés hétérocycliques, cycle ponté › Tropanes › Cocaïne › Cocaine use in trauma: the vices-paradox revisited.
questionsmedicales.fr › Composés chimiques organiques › Alcools › Éthanol › Cocaine use in trauma: the vices-paradox revisited.
questionsmedicales.fr › Maladies cardiovasculaires › Maladies vasculaires › Angiopathies intracrâniennes › Accident vasculaire cérébral › Cocaine use in trauma: the vices-paradox revisited.
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Nécrose › Infarctus › Infarctus du myocarde › Cocaine use in trauma: the vices-paradox revisited.