Toxicological screening in trauma

Objectives-To determine the prevalence and patterns of alcohol and drug use in patients with major trauma. Methods-Consecutive trauma patient enrolment, 24 hours a day, was envisaged with anonymised patient data on gender, age band, and mechanism of injury collected. The study group had surplus plasma quantitatively analysed for e thanol concentration, and urine samples were initially screened, via immuno assay, for opiates, cannabinoids, amphetamines, benzodiazepines, cocaine, a nd methadone. Confirmation and specification of individual positive results was then performed using thin layer or gas-liquid chromatography. Drugs of treatment given in the resuscitation room, if subsequently detected in the urine samples, were excluded from the final results. Results-There were 116 eligible trauma patients assessed and treated in the resuscitation room over a six month period, of which 93 (80%) were enrolle d. Altogether 27% of this trauma population had plasma ethanol concentratio ns greater than 80 mg/dl. There was a significantly higher prevalence of al cohol intoxication in the group not involved in a road traffic accident (RT A) compared with the group who were involved in a RTA. Initial screening of urine for drugs revealed a prevalence of 51%. After 12 exclusions due to i atrogenic administration of opiates, the final confirmed prevalence was 35% in this trauma population. The individual drug prevalence was 13% for cann abinoids, 11% for codeine, 8% for morphine, 6% for amphetamine, 6% for benz odiazepines, 3% for cocaine, 1% for dihydrocodeine, and 1% for methadone. Conclusions-There is a notable prevalence of drug and alcohol use in this B ritish accident and emergency trauma population. A significantly higher pre valence for alcohol intoxication was found in the non-RTA group compared wi th the RTA group. The patterns of drug usage detected reflect local influen ces and less cocaine use is seen compared with American studies. The associ ation between alcohol, drugs, and trauma, together with ethically acceptabl e methods of screening, are discussed.