Alcohol and other illicit drug use has been linked to poorer outcomes in trauma, including burn injuries. Routine admission blood and urine toxicology screens are not indicative of long-term use or dependence but may predict increased morbidity and/or mortality. Our objective was to analyze the effects of positive drug screens and alcohol levels at admission for patients admitted to a tertiary care burn center.
Single-site, retrospective, non-randomized, observational cohort study. Patients were identified using Institutional Burn Center registry and linked to the clinical and administrative data. Adult (≥18 years old) patients admitted with a burn injury with or without an inhalation injury between January 1, 2005 and December 31, 2015 were eligible for inclusion. Demographics, length of stay (LOS), cost, and mortality were evaluated.
Three thousand two hundred ninety-nine patients were tested for drugs (amphetamine, cocaine, and marijuana) and/or alcohol. Fifty-six percent of patients tested positive for at least one substance. The most prevalent drug was marijuana at 29% of study population, followed by alcohol, cocaine, and then amphetamine. Patients who tested positive for marijuana and amphetamine were younger than those that tested positive for alcohol, cocaine, or with negative toxicology screens (35 years of age compared to 42 years of age). Patients who tested positive for marijuana had shorter ICU lengths of stay, hospital LOS, and total ventilator days compared to all other groups, including those testing negative for drugs or alcohol. The average hospital cost for patients testing positive for marijuana was $82,400 compared to $102,518 for patients testing positive for cocaine, $133,976 for amphetamine, $154,656 for alcohol and $90,583 for those with negative drug and alcohol screens. Mortality was 4% for patients with positive cocaine and amphetamine screens, as well as those testing negative for drugs and alcohol. Mortality was 8% for those positive for alcohol and 1% for patients with positive marijuana screens.
In our patient cohort, marijuana use appears to be protective in acute burn admissions, despite classic teaching that illicit drug use leads to poorer outcomes. Age as well as advances in critical care and surgical management may be responsible for overcoming effects of these substances.
Applicability of Research to Practice
These findings help to determine if an immune phenotype is protective in marijuana users who sustain a burn injury.