title: Patients with detectable cocaethylene are more likely to require intensive care unit admission after trauma.
abstract: Cocaethylene (CE) is a toxic metabolite that is formed after simultaneous consumption of cocaine and ethanol. This potent stimulant is more toxic than cocaine and has a longer half-life. The deleterious hemodynamic and cardiovascular effects of CE have been proven in animal models. The aim of this study is to assess the impact of CE on clinical outcomes after trauma. We prospectively enrolled adult (≥13 years) trauma patients requiring admission. Predictor variables were age, sex, mechanism of injury, Injury Severity Score, base deficit, and toxicology groups (ethanol alone, cocaine alone, CE, and none). The outcomes examined were mortality, intensive care unit (ICU) admission, and length of hospital stay (LOS). We used nonparametric tests to compare continuous variables and χ² test to compare categorical data. We constructed a logistic regression to identify variables that could predict mortality and ICU admission. We enrolled 417 patients (74% male; 70% blunt injury; median age, 40 [range, 13-95]; overall mortality, 2.2%). Urine toxicology and serum ethanol level screens classified patients into the following groups: 13.4% ethanol only, 4.1% cocaine only, 8.9% CE, and 46% none. Mortality and LOS were not statistically different among the groups. In logistic regression analysis, none of the variables were statistically significant in predicting mortality. However, the presence of CE significantly increased the likelihood of ICU admission (odds ratio, 5.9; 95% confidence interval, 1.6-22). The presence of detectable CE in the urine does not increase the mortality or LOS in trauma patients requiring admission but does increase the likelihood of ICU admission.
authors.affiliation: Department of Emergency Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY 11203, USA.
authors.forename: Sage E
authors.initials: SE
authors.lastname: Wiener
authors.forename: Darrell
authors.initials: D
authors.lastname: Sutijono
authors.forename: Cynthia H
authors.initials: CH
authors.lastname: Moon
authors.forename: Ramanand A
authors.initials: RA
authors.lastname: Subramanian
authors.forename: Jim
authors.initials: J
authors.lastname: Calaycay
authors.forename: Julie I
authors.initials: JI
authors.lastname: Rushbrook
authors.forename: Shahriar
authors.initials: S
authors.lastname: Zehtabchi
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000009:adverse effects / Q000097:blood; D016009:Chi-Square Distribution; D003042:Cocaine / Q000031:analogs & derivatives* / Q000097:blood; D019970:Cocaine-Related Disorders / Q000097:blood / Q000150:complications*; D003422:Critical Care / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D012737:Sex Factors; D018709:Statistics, Nonparametric; D014947:Wounds and Injuries / Q000150:complications* / Q000401:mortality / Q000628:therapy; D055815:Young Adult
chemical_list: C066444:cocaethylene; D003042:Cocaine