title: Pre-injury neuro-psychiatric medication use, alone or in combination with cardiac medications, may affect outcomes in trauma patients.
abstract: BACKGROUND
  Recent review of older (≥45-years-old) patients admitted to our trauma center showed that more than one-third were using neuro-psychiatric medications (NPMs) prior to their injury-related admission. Previously published data suggests that use of NPMs may increase patients' risk and severity of injury. We sought to examine the impact of pre-injury NPM use on older trauma patients' morbidity and mortality.
  
  
  METHODS
  Retrospective record review included medication regimen characteristics and NPM use (antidepressants-AD, antipsychotics-AP, anxiolytics-AA). Hospital morbidity, mortality, and 90-day survival were examined. Comparisons included regimens involving NPMs, further focusing on their interactions with various cardiac medications (beta blocker - BB; angiotensin-converting enzyme inhibitor/angiotensin receptor blocker - ACE/ARB; calcium channel blocker - CCB).
  
  
  RESULTS
  712 patient records were reviewed (399 males, mean age 63.5 years, median ISS 8). 245 patients were taking at least 1 NPM: AD (158), AP (35), or AA (108) before injury. There was no effect of NPM monotherapy on hospital mortality. Patients taking ≥3 NPMs had significantly lower 90-day survival compared to patients taking ≤2 NPMs (81% for 3 or more NPMs, 95% for no NPMs, and 89% 1-2 NPMs, P < 0.01). Several AD-cardiac medication (CM) combinations were associated with increased mortality compared to monotherapy with either agent (BB-AD 14.7% mortality versus 7.0% for AD monotherapy or 4.8% BB monotherapy, P < 0.05). Combinations of ACE/ARB-AA were associated with increased mortality compared to ACE/ARB monotherapy (11.5% vs 4.9, P = 0.04). Finally, ACE/ARB-AD co-administration had higher mortality than ACE/ARB monotherapy (13.5% vs 4.9%, P = 0.01).
  
  
  CONCLUSIONS
  Large proportion of older trauma patients was using pre-injury NPMs. Several regimens involving NPMs and CMs were associated with increased in-hospital mortality. Additionally, use of ≥3 NPMs was associated with lower 90-day survival.
authors.forename: J R
authors.initials: JR
authors.lastname: Wisler
authors.forename: A N
authors.initials: AN
authors.lastname: Springer
authors.forename: K
authors.initials: K
authors.lastname: Hateley
authors.forename: X M
authors.initials: XM
authors.lastname: Mo
authors.forename: D C
authors.initials: DC
authors.lastname: Evans
authors.forename: C H
authors.initials: CH
authors.lastname: Cook
authors.forename: A T
authors.initials: AT
authors.lastname: Gerlach
authors.forename: C V
authors.initials: CV
authors.lastname: Murphy
authors.forename: D S
authors.initials: DS
authors.lastname: Eiferman
authors.forename: S M
authors.initials: SM
authors.lastname: Steinberg
authors.forename: S D
authors.initials: SD
authors.lastname: Bergese
authors.forename: T J
authors.initials: TJ
authors.lastname: Papadimos
authors.affiliation: Department of Research & Innovation, St Luke's University Health Network, Bethlehem, Pennsylvania, USA.
authors.forename: S P
authors.initials: SP
authors.lastname: Stawicki
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000401:mortality; D015601:Injury Severity Score; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy* / Q000401:mortality; D008875:Middle Aged; D019338:Polypharmacy; D012189:Retrospective Studies; D014947:Wounds and Injuries / Q000150:complications* / Q000453:epidemiology
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors