Increased incidence of complications in trauma patients cointoxicated with alcohol and other drugs

Background: Alcohol and drug intoxication is prevalent in trauma patients. Although intoxication and cointoxication can have a range of physiologic effects, their implications for clinical management are unclear. The current investigation aims to assess the effects of alcohol and substance use as well as the interaction between these two states on outcomes and in-hospital complications. Methods: All trauma patients with an Injury Severity Score (ISS) >= 12 during a 5-year period who were tested for both alcohol and other drugs were included. Alcohol-positive, drug-positive, and both-positive patients were compared with patients who tested negative. Logistic regression analysis was performed controlling for age and ISS to assess the relative contribution of intoxication or cointoxication in determining clinical outcomes and in-hospital complications. Results: For alcohol-positive and drug-positive patients, intoxication status did not appear to influence outcomes. However, cointoxicated individuals were found to have an increased incidence of complications overall (odds ratio [OR] = 2.06), an increased incidence of pneumonia specifically (OR = 3.34) and an increased incidence of the requirement for mechanical ventilation (OR = 2.37). Conclusions: Cointoxication with alcohol and other drugs is a risk factor for increased in-hospital complications.