DRUG AND ALCOHOL-USE IN ORTHOPEDIC TRAUMA PATIENTS - A PROSPECTIVE-STUDY

Alcohol has been shown to confound the initial assessment of trauma vi ctims, and cocaine is associated with numerous medical and anesthetic complications. A prospective study was performed to determine the prev alence of alcohol and illicit drug use in orthopedic trauma patients a t an inner-city teaching hospital. All patients admitted to the orthop edic service during a 2-year period (January 1993 to December 1994) we re prospectively studied. Patients <14 years old were excluded. Blood alcohol levels were determined, and the urine was screened for cocaine , opiates, marijuana, barbiturates, amphetamines, benzodiazepines, and phencyclidine. Demographic data and a medical history were obtained. Seven hundred sixty-six patients met the study parameters. Of these, 6 28 (82%) had complete drug and alcohol screens available for review. T he data were then sorted by diagnosis, mechanism of injury, type of in jury (closed versus open), length of inpatient stay, age, sex, and rac e, and a statistical analysis was performed. The overall incidence of positive drug or alcohol tests was 56%. Twenty-four percent of patient s tested positive for two or more drugs, and 9% for three or more. Alc ohol (25%) was the most commonly detected drug, followed by cocaine (2 2%) and marijuana (21%). The highest incidence of drug use was found i n males and in those ages 31-40 years. Hospital stay averaged 1.3 days longer in patients with positive screens. Patients with tibia fractur es or open fractures, and those injuries sustained by gunshot, alterca tion, or pedestrian versus motor vehicle accident had the highest inci dence of positive screens. These data show that drug-using patients ha ve more severe orthopedic injuries (i.e., open fractures) and require longer hospitalizations. We conclude that drug and alcohol use is wide spread in patients presenting with orthopedic injuries and we make rec ommendations regarding treatment of these patients. The majority of or thopedic trauma resources in this setting is devoted to treating intox icated patients. Drug and alcohol use is a major social problem and ma y have an adverse effect on patient care.