Outcomes in traumatic brain injury for patients presenting on antiplatelet therapy.

An increasing number of patients are presenting to trauma units with head injuries on antiplatelet therapy (APT). The influence of APT on these patients is poorly defined. This study examines the outcomes of patients on APT presenting to the hospital with blunt head trauma (BHT). Registries of two Level I trauma centers were reviewed for patients older than 40 years of age from January 2008 to December 2011 with BHT. Patients on APT were compared with control subjects. Primary outcome measures were in-hospital mortality, intracranial hemorrhage (ICH), and need for neurosurgical intervention (NI). Hospital length of stay (LOS) was a secondary outcome measure. Multivariate analysis was used and adjusted models included antiplatelet status, age, Injury Severity Score (ISS), and Glasgow coma scale (GCS). Patients meeting inclusion criteria and having complete data (n = 1547) were included in the analysis; 422 (27%) patients were taking APT. Rates of ICH, NI, and in-hospital mortality of patients with BHT in our study were 45.4, 3.1, and 5.8 per cent, respectively. Controlling for age, ISS, and GCS, there was no significant difference in ICH (odds ratio [OR], 0.84; 95% confidence interval [CI], 0.61 to 1.16), NI (OR, 1.26; 95% CI, 0.60 to 2.67), or mortality (OR, 1.79; 95% CI, 0.89 to 3.59) associated with APT. Subgroup analysis revealed that patients with ISS 20 or greater on APT had increased in-hospital mortality (OR, 2.34; 95% CI, 1.03 to 5.31). LOS greater than 14 days was more likely in the APT group than those in the non-APT group (OR, 1.85; 95% CI, 1.09 to 3.12). The effects of antiplatelet therapy in patients with BHT aged 40 years and older showed no difference in ICH, NI, and in-hospital mortality.

Comparison of Objective Screening and Self-Report for Alcohol and Drug Use in Traumatically Injured Patients.

Alcohol and drug use is prevalent in trauma patients. Concerns over the validity of self-reporting drug use could make non laboratory screening problematic. This study sought to validate patient self-report of substance use against objective screening to determine the reliability of self-report in trauma patients. Patients admitted to either the Trauma or Burn services who were at least 18 years old were screened for alcohol and drug use with validated screening tools. Exclusion criteria were altered mental status, non English speaking, inability to answer questions for other reasons, under police custody, or admission for < 24 hours. Results from admission Blood Alcohol Concentration BAC and Urine Drug Screen UDS were also collected and compared to self-reported use to determine its reliability. Alcohol use was queried in 128 patients, 101 of whom had a BAC drawn. Of those 101, 34 (33.7%) had a BAC > 0 mg%. Alcohol Use Disorder Identification Test AUDIT screening revealed 13 (12.9%) patients who were self-reported non drinkers, none of which had a BAC > 0 mg%. Drug use was queried in 133 patients, 93 of whom had a UDS. A positive was found in 26 (28.0%) of the patients, only 12 (46.2%) of whom reported drug use in the past year. Though substance use in trauma patients is prevalent, self-report screening techniques for drugs may be inadequate at determining those patients whom could benefit from brief interventions while in the hospital. Further investigation is needed to determine the discrepancy between alcohol and drug use screening in trauma patients and more acceptable means of drug use discussion.