Background: Intravenous contrast media-enhanced computed tomography is vitally important in the early identification of traumatic injuries. Contrast media, however, has the propensity to promote nephrotoxicity. Age, injury severity score, renal dysfunction, and hypotension upon presentation are factors associated with contrast-associated acute kidney injury in current trauma literature. This study endeavors to expand upon these findings and evaluate the relationship between traumatic injuries and contrast-associated acute kidney injury. Methods: This is a retrospective cohort study conducted at a Level 1 Trauma Center between January 2005 and August 2013. Patients identified by the institution's Trauma Registry were divided into two groups: contrast-associated acute kidney injury-positive and negative based on previously published definitions. Results: The analysis consisted of 831 intensive care patients; 161 contrast-associated acute kidney injury-positive and 670 contrast-associated acute kidney injury-negative. Logistic regression using significant findings from univariate comparisons between the study groups indicated that genitourinary (OR ¼ 2.859, 95% CI 1.587-5.152, p ¼ 0.000), arterial injuries (OR ¼ 2.464, 95% CI 1.294-4.690, p ¼ 0.006), and concomitant exposure to medications that are potentially nephrotoxic or alter renal hemodynamics (OR ¼ 1.483, 95% CI 1.018-2.158, p ¼ 0.040) were independent risk factors for contrast-associated acute kidney injury. Increasing revised trauma score (OR ¼ 0.874, 95% CI 0.790-0.966, p ¼ 0.009) and fluid administration prior to contrast (OR ¼ 0.445, 95% CI 0.301-0.656, p ¼ 0.000) were independently associated with decreased risk of contrast-associated acute kidney injury. Conclusion: The risk of contrast-associated acute kidney injury increases with escalating injury severity. Unless contraindicated, fluids should be administered prior to contrast, and concomitant exposure to agents that may increase the potential for contrast-associated acute kidney injury should be limited. These practices are increasingly important in patients presenting with arterial or genitourinary trauma.

matched-control study evaluated dronabinol as an adjunct therapy for acute pain management in burn patients that used marijuana as an outpatient. The control group was comprised of patients who did not receive dronabinol nor had a history of marijuana use. Patients were matched in a 1:1 fashion based on age, sex, weight, length of intubation, and total burn surface area. The primary outcome was the amount of opioids used per day over the first 14 days of admission. Secondary outcomes included other pharmacologic interventions, mean pain scores, and length of stay. Results: Thirty-two patients who met inclusion criteria for the dronabinol group were matched to 32 control patients. Baseline demographics were statistically similar between groups. Mean total burn surface area was 13.3% and 12.7% in the dronabinol and control groups, respectively. The dronabinol and control groups used a median of 56.3 mg (IQR 44.8-72.7) and 43.2 mg (IQR 30.3-60) of IV morphine equivalents (EQs), respectively (p=0.02). The dronabinol group used a median of 1.58 mg (IQR 0.8-2.3) lorazepam EQs per day vs. 0.7 mg (IQR 0.4-1.5) in the control group (p=0.006). The dronabinol group used more antiemetics, ketorolac, and ketamine. There were no differences in mean pain scores or length of stay. Conclusions: Patients in the dronabinol group required greater amounts of analgesic, anxiolytic, and antiemetic medications. Causality remains unknown. Future studies consisting entirely of patients that use marijuana are warranted to more accurately assess the benefit of cannabinoid supplementation in acute pain management.