title: The prevalence and impact of prescription controlled substance use among injured patients at a Level I trauma center.
abstract: BACKGROUND
  There has been increasing attention focused on the epidemic of prescription drug use in the United States, but little is known about its effects in trauma. The purpose of this study was to define the prevalence of prescription controlled substance use among trauma patients and determine its effects on outcome.
  
  
  METHODS
  A retrospective review of all patients admitted to a Level 1 trauma center from January 1, 2011, to December 31, 2011, was performed. Patients dying within 24 hours or without home medication reconciliations were excluded. Data review included preexisting benzodiazepine or narcotic use, sex, age, mechanism of injury, Injury Severity Scores (ISSs), intensive care unit (ICU) and overall length of stay, ventilator days, and overall cost. SAS version 9.3 was used for the analysis, and p ≤ 0.05 was considered significant.
  
  
  RESULTS
  A total of 1,700 patients met inclusion criteria. Of these, 340 (20.0%) were on prescription narcotics and/or benzodiazepines at the time of admission. Patients in the narcotic/benzodiazepine group were significantly older (48 years vs. 43 years) and more likely to be women (43.7% vs. 28.9%). There was no difference in mechanism, ISS, or the presence of head injury between groups. Both ICU length of stay (3.3 days vs. 2.1 days) and total length of stay (7.8 days vs. 6.1 days) were significantly longer in patients on outpatient narcotics and/or benzodiazepines. Excluding severely injured patients, the need for mechanical ventilation was also increased among outpatient controlled substance users (15.8% vs. 11.0%).
  
  
  CONCLUSIONS
  There is a substantial prevalence of preexisting controlled substance use (20%) among patients at our Level 1 trauma center. Preexisting controlled substance use is associated with longer total hospital and ICU stays. Among mildly to moderately injured patients, preinjury controlled substance is also associated with the need for mechanical ventilation.
  
  
  METHODS
  Prognostic study, level III.
authors.affiliation: From the University of Louisville, Louisville, Kentucky.
authors.forename: Robert
authors.initials: R
authors.lastname: Cannon
authors.forename: Matthew
authors.initials: M
authors.lastname: Bozeman
authors.forename: Keith Roy
authors.initials: KR
authors.lastname: Miller
authors.forename: Jason Wayne
authors.initials: JW
authors.lastname: Smith
authors.forename: Brian
authors.initials: B
authors.lastname: Harbrecht
authors.forename: Glen
authors.initials: G
authors.lastname: Franklin
authors.forename: Matthew
authors.initials: M
authors.lastname: Benns
mesh_terms: D000328:Adult; D000367:Age Factors; D001569:Benzodiazepines / Q000627:therapeutic use; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009294:Narcotics / Q000627:therapeutic use; D055553:Prescription Drugs / Q000009:adverse effects / Q000627:therapeutic use*; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012737:Sex Factors; D014193:Trauma Centers / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000150:complications / Q000453:epidemiology*
chemical_list: D009294:Narcotics; D055553:Prescription Drugs; D001569:Benzodiazepines