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Crisis under the radar

Illicit amphetamine use is reaching epidemic proportions and contributing to resource overutilization at a Level I trauma center

Gemma, Vincent A., MD; Chapple, Kristina M., PhD; Goslar, Pamela W., PhD; Israr, Sharjeel, MD; Petersen, Scott R., MD; Weinberg, Jordan A., MD

Journal of Trauma and Acute Care Surgery: November 2018 - Volume 85 - Issue 5 - p 953–959
doi: 10.1097/TA.0000000000001984

INTRODUCTION Trauma centers reported illicit amphetamine use in approximately 10% of trauma admissions in the previous decade. From experience at a trauma center located in a southwestern metropolis, our perception is that illicit amphetamine use is on the rise and that these patients utilize in-hospital resources beyond what would be expected for their injuries. The purposes of this study were to document the incidence of illicit amphetamine use among our trauma patients and to evaluate its impact on resource utilization.

METHODS We conducted a retrospective cohort study using 7 consecutive years of data (starting July 2010) from our institution's trauma registry. Toxicology screenings were used to categorize patients into one of three groups: illicit amphetamine, other drugs, or drug-free. Adjusted linear and logistic regression models were used to predict hospital cost, length of stay, intensive care unit admission, and ventilation between drug groups. Models were conducted with combined injury severity (Injury Severity Score [ISS]) and then repeated for ISS of less than 9, ISS 9 to 15, and ISS 16 or greater.

RESULTS Eight thousand five hundred eighty-nine patients were categorized into the following three toxicology groups: 1,255 (14.6%) illicit amphetamine, 2,214 (25.8%) other drugs, and 5,120 (59.6%) drug-free. Illicit amphetamine use increased threefold over the course of the study (from 7.85% to 25.0% of annual trauma admissions). Adjusted linear models demonstrated that illicit amphetamine among patients with ISS of less than 9 was associated with 4.6% increase in hospital cost (p = 0.019) and 7.4% increase in length of stay (p = 0.043). Logistic models revealed significantly increased odds of ventilation across all ISS groups and increased odds of intensive care unit admission when all ISS groups were combined (p = 0.001) and within the group with ISS of less than 9 (p = 0.002).

CONCLUSIONS Hospital resource utilization of amphetamine patients with minor injuries is significant. Trauma centers with similar epidemic growth in proportion of amphetamine patients face a potentially significant resource strain relative to other centers.

LEVEL OF EVIDENCE Prognostic/Epidemiological, level II; Therapeutic, level III.

From the Department of Surgery, Dignity Health–St. Joseph's Hospital and Medical Center, Phoenix, Arizona.

Submitted: February 15, 2018, Revised: May 3, 2018, Accepted: May 8, 2018, Published online: May 22, 2018.

This study was presented at the 48th Annual Meeting of the Western Trauma Association, February 25 to March 2, 2018, in Whistler, British Columbia, Canada.

Address for reprints: Jordan A. Weinberg, MD, Trauma/Acute General Surgery Trauma Administration, St. Joseph's Hospital and Medical Center, 350 W Thomas Rd, Phoenix, AZ 85013; email:

© 2018 Lippincott Williams & Wilkins, Inc.