Session III - Polytrauma

Thurs, 10/20/05 Polytrauma, Paper #9, 4:04 pm

Toxicology Screening in Orthopaedic Trauma Patients Predicting Duration of Prescription Opioid Use

Gene M. Massey, BS1; Heather N. Dodds, BA2; Craig S. Roberts, MD1; Timothy J. Servoss, MA; Richard D. Blondell, MD; (n-all authors)
1Department of Orthopaedic Surgery, University of Louisville,
Louisville, Kentucky, USA;
2School of Medicine and Department of Family & Community Medicine, University of Buffalo, Buffalo, New York, USA

Purpose: Half of all trauma victims have a pre-existing history of alcohol or drug abuse. Many of these patients have positive toxicology screening on admission. Patients suffering high-energy fractures may require opioids for pain relief during recovery. he purpose of this study was to determine whether the results of screening with urine and serum toxicology are predictive of opioid use following hospital discharge among orthopaedic trauma patients hospitalized with high-energy fractures.

Methods: A retrospective cohort study of 50 patients with high-energy fractures was conducted to determine if toxicology screening tests upon admission can predict subsequent opioid use. Data were collected from clinical records and a statewide electronic database of prescription records. The mean age, gender mix, racial mix, hospital length-of-stay, and injury severity did not differ significantly between those who had positive toxicology and those with negative toxicology. Positive toxicology screens were defined by the presence of illicit drugs, controlled substances, or a blood alcohol concentration (BAC) >50 gm/dL. Opioid analgesics were quantified by converting actual dosages into milligrams of oral morphine equivalents (ME mg). Data analyses were performed with the Statistical Package for the Social Sciences (SPSS) Version 12.0 (SPSS, Inc, Chicago, IL, 2003), using logarithmic transformations, odds ratios, independent samples t-tests, and effect sizes.

Results: 36 patients (72%) presented with positive toxicology and 14 (28%) presented with negative toxicology. No significant difference in the average opiate dose, ISS, GCS and hospital length-of-stay was found between the two groups. Patients with positive toxicology used more total opioids (730 ME mg versus 364 ME mg; p=0.04), and were more likely to still be using opioids on the last day of the 3rd, 4th, 5th, and 6th month.


Conclusion/Significance: Positive toxicology screening results at the time of admission to the hospital following high-energy orthopaedic trauma is a useful prognostic indicator for prescription opioid drug use beyond 2 months from the time of hospital discharge. These patients are at risk for prolonged opiate use during the initial 6 months after discharge.

If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.