title: Suicides, homicides, and unintentional injury deaths after trauma center discharge: cocaine use as a risk factor.
abstract: BACKGROUND
  : To study whether trauma center patients with positive toxicology findings for cocaine-positive (COC+) are at a higher risk for suicide, homicide, and unintentional injury death after discharge than cocaine-negative (COC+) trauma patients.
  
  
  METHODS
  : Patients admitted between July 1983 and June 1995 and discharged alive from a level I trauma center were prospectively followed up for 1.5 years to 14.5 years. The occurrence of suicide, homicide, and unintentional injury death was explored in relation to COC+ status at admission using Cox proportional hazards methodology. Models included possible confounders. Interactions with each of the main effects were explored.
  
  
  RESULTS
  : Of the 27,399 admissions, 21,500 had urine COC toxicology testing performed and were included in the study. COC was positive in 11.4% of the studied population. COC+ patients were significantly younger, with 72% of COC+ versus 43% of COC- in the 25 to 44 years age group. COC+ patients were more likely to be men, positive for alcohol, and intentional injury victims. COC+ status was not associated with subsequent suicide. Furthermore, the COC+ status association with subsequent homicide became nonsignificant after adjusting for confounders. Unadjusted COC+ status was associated with unintentional injury death (odds ratio = 1.65 [1.14-2.40]). Interactions were found in the association with unintentional injury death such that COC+ status tripled the odds of injury death (odds ratio = 2.75 [1.58-4.78]) among the alcohol-negative patients within the 25 to 45 years age group.
  
  
  CONCLUSIONS
  : COC+ trauma patients are at an increased risk of subsequent unintentional injury death after discharge from a trauma center. Suicide and homicide occurrence seems to be unaffected.
authors.affiliation: National Study Center for Trauma and Emergency Medical Systems, 110 South Paca Street, 4th Floor, Baltimore, MD 21201, USA. gabyryb@pol.net
authors.forename: Gabriel E
authors.initials: GE
authors.lastname: Ryb
authors.forename: Carnell C
authors.initials: CC
authors.lastname: Cooper
authors.forename: Patricia C
authors.initials: PC
authors.lastname: Dischinger
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Kufera
authors.forename: Kimberly M
authors.initials: KM
authors.lastname: Auman
authors.forename: Carl A
authors.initials: CA
authors.lastname: Soderstrom
mesh_terms: D000059:Accidents / Q000401:mortality*; D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D019970:Cocaine-Related Disorders / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D006708:Homicide / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D010351:Patient Discharge; D012307:Risk Factors; D013405:Suicide / Q000706:statistics & numerical data*; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000401:mortality*; D055815:Young Adult