How does marijuana affect outcomes after trauma in ICU patients? A propensity-matched analysis

Singer, Matthew M.; Azim, Asad; OʼKeeffe, Terence; Khan, Muhammad Mukhtar; Jain, Arpana; Kulvatunyou, Narong; Gries, Lynn; Jehan, Faisal; Tang, Andrew; Joseph, Bellal

doi:10.1097/ta.0000000000001672

Cited by 19 publications

(18 citation statements)

References 24 publications

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“…7,8 Conversely, a recent statewide analysis demonstrated a pMS to be associated with decreased mortality in adult ICU trauma patients. 9 In support of this finding, multiple clinical studies have shown a pMS screen to have neuroprotective associations, including reduction of cognitive impairment and death following traumatic brain injury (TBI). [10][11][12] Therefore, we hypothesized a pMS to be associated with decreased mortality in all trauma patients, including ICU and younger adult (<40 years old) patient subset groups.…”

Section: Introductionmentioning

confidence: 95%

Marijuana Use Associated with Decreased Mortality in Trauma Patients

Bloom

Grigorian

Schubl

et al. 2022

The American Surgeon

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Background The incidence of trauma patients with a positive marijuana screen (pMS) is increasing but the effects of marijuana on outcomes have varied in previous studies. A recent statewide analysis demonstrated decreased mortality for intensive care unit (ICU) trauma patients with pMS. Thus, we hypothesized a pMS to be associated with a decreased risk of mortality for all trauma patients. Methods The 2017 Trauma Quality Improvement Program (TQIP) database was queried for adult (≥18 years-old) pMS patients, who were compared to patients negative for all drugs and alcohol (nDS). Patients not drug tested or testing positive for drug(s)/alcohol other than marijuana were excluded. Multivariable logistic regression was used to evaluate risk of mortality after controlling for known predictors of mortality including age, sex, injury severity, vital signs, and comorbidities. Additional subgroup analyses were performed for ICU patients and younger adults (<40 years-old). Results From 141 737 tested patients, 23 310 (16.4%) had an isolated pMS. Patients with pMS were younger ( P < .001) but had a similar median injury severity score (ISS) (9, P = .42) compared to nDS patients. On multivariable analysis the associated risk of mortality was lower for pMS (OR .79, .71-.87, P < .001) compared to nDS patients. Subgroups analyses also demonstrated decreased associated risk of mortality for ICU and younger patients (both P < .05). Discussion Patients with a pMS had decreased associated risk of mortality compared to nDS patients, including subgroups of ICU and younger patients. These findings require corroboration with future prospective clinical study and basic science evaluation to ascertain the exact pathophysiologic basis and thereby target potential interventions.

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Section: Introductionmentioning

confidence: 95%

Marijuana Use Associated with Decreased Mortality in Trauma Patients

Bloom

Grigorian

Schubl

et al. 2022

The American Surgeon

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“…reported “a positive marijuana screen is associated with decreased mortality in adult trauma patients admitted to the ICU” and may theoretically provide a neuroprotective effect in the setting of traumatic brain injury (TBI). [3] Abdel Fattah showed similar findings in their 2017 paper where cannabis users with severe injury did show an increased morbidity compared to nondrug users. [4]…”

Section: Discussionmentioning

confidence: 70%

Recreational drugs and outcomes in trauma patients

Fujii

McCague

2019

J Emerg Trauma Shock

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Objective: The objective of the study is to determine if marijuana, methamphetamine, or cocaine is associated with worse outcomes following trauma. Methods: A retrospective cross-sectional study was conducted on 731 trauma patients. Data collected from Natividad Medical Center's trauma registry were used to analyze reports of adult patients from July 1, 2014, to July 1, 2017. Analyzed endpoints were mortality, rates of major trauma, mean Injury Severity Score (ISS), and length of stay (LOS). Results: Odds ratios for mortality contained null value in each group. Odds ratios for suffering major trauma for marijuana and amphetamines were 1.2 and 2.6, respectively. P values for ISS were >0.05 for each group. P values for LOS were >0.05 for marijuana and cocaine and 0.01 for amphetamines. Conclusions: A positive screen for marijuana, amphetamine, or cocaine is not associated with increased mortality for victims of trauma. Amphetamines are associated with higher rates of major trauma and longer LOS. Marijuana is associated with higher rates of major trauma. Cocaine is not associated with the likelihood of suffering major trauma or length of stay.

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“…3,16 Although Singer et al revealed reduced mortality in CB+ trauma patients admitted to the ICU, our study examined overall mortality of all CB+ and CB-trauma activations arriving in the ED and found no difference once controlling for differences in demographics and injury patterns in CB+ and CB-groups. 16 The strengths of our study include the size of the population used, the breadth of patient parameters collected, distribution data on the rates of cannabis associated traumas, chronological data of CB+ results, and the variety of the outcomes used. Weaknesses include the cannabis drug test itself and the potential confounding variable of tobacco smoking (data were not attainable for this retrospective study).…”

mentioning

confidence: 52%

“…In 2014, Nguyen et al found that cannabis was independently associated with survival after traumatic brain injury, and in 2017, Singer et al concluded that a positive screen was associated with decreased mortality in adult trauma patients admitted to the ICU. 15,16 However, potential protective effects of cannabis in trauma patients do not exist uniformly. Jehle et al found a significant increase in the proportion of burn patients who tested positive for cannabis, and those who tested positive had larger burns, longer length of stay, more days spent in the ICU, and a greater number of operations.…”

mentioning

confidence: 99%

Cannabis Use is Associated with Increased Mechanical Ventilation and Polysubstance Use in Trauma Patients

Banks

Biswas

Wong

et al. 2019

The American Surgeon™

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Recent policy changes in California regarding cannabis use underscore the need to study outcomes and prevalence of this drug in trauma. Our study aims to study the prevalence of cannabis use and associations with injury types and outcomes in Los Angeles County trauma patients. Data were reviewed from 21,276 adult patients from a Los Angeles countywide database spanning five years (2012–2016), who underwent urine toxicology testing in the ED after sustaining a traumatic injury. The percentage of trauma patients using marijuana increased from 36 to 43 per cent over the five-year period. On univariate analysis, cannabis-positive patients were significantly younger and more likely male, with lower median systolic blood pressure and heart rate on arrival in the ED. A higher proportion of cannabis users had penetrating trauma, and 48 per cent of cannabis users also tested positive for amphetamines, cocaine, opioids, or Phencyclidine. On multivariate analysis, cannabis was associated with an increase in need for mechanical ventilation after adjusting for age, admission Glasgow Coma Score, gender, polysubstance use, blunt or penetrating mechanism, and Injury Severity Score, and was not associated with increases in mortality or ICU length of stay.

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How does marijuana affect outcomes after trauma in ICU patients? A propensity-matched analysis

Abstract: Prognostic studies, level III.

Cited by 19 publications

References 24 publications

Marijuana Use Associated with Decreased Mortality in Trauma Patients

Marijuana Use Associated with Decreased Mortality in Trauma Patients

Recreational drugs and outcomes in trauma patients

Cannabis Use is Associated with Increased Mechanical Ventilation and Polysubstance Use in Trauma Patients

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