Toxicology Screening in Urban Trauma Patients

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Abstract
Although toxicology screening is often used when treating trauma patients, its utility and significance remain controversial. Data from 623 toxicology screens performed in urban trauma center patients with mental status alterations are reported. The study patients were predominantly black and male, with a mean age of 32 (± 22) years. Overall, 86% of screens were positive. Substances of abuse, including ethanol, were noted in 525 (84%) of urine toxicology screens. Ethanol, cannabinoids, and cocaine were the drugs most commonly found in urine, with positivity noted in 53%, 37%, and 34% of screens. Serum analysis was 44% positive, with ethanol noted in 41% of patients. In blacks, the odds ratio of illicit drug use before trauma ranged from 1.9 to 4.2 (p < 0.005), and in those aged 17 to 40 years, the odds ratio for illicit urine drugs ranged from 4.7 to 16.8 (p < 0.001). In patients older than 40 years, the odds of a positive serum ethanol level were 1.7 times greater than in younger patients, and a level above 300 mg% was 3.8 times more likely in this age group (p < 0.001). When serum ethanol was detected, the odds ratio of a head injury was 1.4 relative to patients without serum ethanol (p < 0.06), and the odds ratio for abdominal injury was 1.6 for patients with serum ethanol (p < 0.03). The odds of a TS < 12 were 1.8 (p < 0.05), and the odds of a GCS < 12 were 3.3 (p < 0.001) with ethanol levels > 100 mg%. Toxicology screen data predicted neither overall ISS data nor the need for an emergent airway, laparotomy, or a neurosurgical procedure. Despite these limitations, we conclude that syndrome-specific toxicology screens, especially ethanol levels, are useful in urban trauma patients.

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