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Cocaine Use in Trauma: Effect on Injuries and Outcomes

Hadjizacharia, Pantelis MD; Green, Donald J. MD; Plurad, David MD; Chan, Linda S. PhD; Law, Jennifer MS; Inaba, Kenji MD; Demetriades, Demetrios MD, PhD, FACS

Journal of Trauma and Acute Care Surgery: February 2009 - Volume 66 - Issue 2 - p 491-494
doi: 10.1097/TA.0b013e3181622b9b
Original Articles

Background: It has been reported that cocaine is associated with trauma patients at epidemic proportions. However, the injury patterns, complications, and mortality in cocaine test-positive trauma patients are not well known.

Methods: Retrospective review of all trauma patients with toxicology screen at a Level I trauma center between January 2002 and December 2005. A total of 1,096 patients were positive for cocaine but no other substances of abuse or alcohol. Nine hundred eighty-five patients of these cocaine test-positive patients were matched to a pool of 4,846 toxicology test-negative patients admitted during the same period with respect to age (≤18, 19–55, >55 years), gender, mechanism (blunt, penetrating), Injury Severity Score (ISS <16, 16–25, >25), head Abbreviated Injury Score (AIS <3, ≥3), chest AIS (<3, ≥3), abdominal AIS (<3, ≥3), and extremity AIS (<3, ≥3). Matched pairs of binary outcomes were analyzed using McNemars, and continuous data were tested using the Wilcoxon signed-ranks test.

Results: The two groups had similar injury patterns and there was no difference in surgical procedures between cocaine test-positive and toxicology test-negative patients. Overall, there was no difference in mortality between the cocaine and test-negative patients (6.5% vs. 6.2%; p = 0.81), or between cocaine and test-negative patients with an ISS <16 (1.4% vs. 1.5%; p = 1.00), ISS 16 to 25 (13% vs. 12%; p = 1.00), and ISS >25 (59% vs. 54%; p = 0.70). The overall incidence of complications was 4% in cocaine patients and 3.6% in test-negative patients (p = 0.72), although the incidence of pneumonia was significantly higher in the cocaine test-positive patients (p = 0.04).

Conclusion: Cocaine abuse in trauma patients is concerning. This study did not show a difference in mortality or length of intensive care unit stay between cocaine positive and negative patients. However, there was a significantly higher incidence of pneumonia in cocaine positive patients. Implementation of effective prevention strategies may help reduce cocaine related victims of trauma.

From the Division of Trauma and Surgical Intensive Care, Department of Surgery, University of Southern California, Los Angeles, California.

Submitted for publication July 6, 2007.

Accepted for publication November 14, 2007.

Address for reprints: Demetrios Demetriades, MD, PhD, FACS, 1200 N. State Street, Room 1105, Los Angeles, CA 90033; email:

© 2009 Lippincott Williams & Wilkins, Inc.