Impact of preexisting opioid use on injury mechanism, type, and outcome

Background: The prevalence of prescription narcotic use in the United States is on the rise. Opioid use and its impact on the management of trauma patients has yet to be thoroughly studied. The aim of this study was to determine the prevalence of preinjury opioid use and its influence on specific outcomes among the trauma patient population.

Methods: A retrospective review of all trauma patients presenting to a level 1 trauma center was performed from January 1, 2010-December 31, 2010. Patients who died within 24 h of presentation and those with incomplete medication data were excluded. Electronic medical record review of history and physical documentation and urine drug screen records were used to determine preinjury opioid status. Preexisting narcotic use, demographic data, injury mechanism and severity, injury type, and outcome variables were analyzed.

Results: A total of 3953 patients met inclusion criteria. Among our sample, 644 (16.3%) were positive for preinjury opioid use. Patients in the preinjury opioid group were older (48 versus 41 y) and more likely to be female (37.9% versus 30.6%). The mechanism of injury was more often falls (32.8% versus 22.0%). Analysis of less severely injured patients (ISS <15) found a significantly increased length of stay (3.7 versus 2.9 d) in the narcotics group. Evaluation of injury type revealed that head injury, abdominal injury, and lower extremity and/or pelvic injuries had significantly increased length of stay.

Conclusions: There is a considerable prevalence of preinjury opioid use in the trauma population. These patients have unique characteristics and causes of injury. Preinjury opioid use is predictive of increased length of stay, with important ramifications for patient care and health care costs.