Subtance use and type and severity of injury among hospitalized trauma cases: Ohio, 2004-2007

The purpose of this study was to determine whether persons who were injured severely enough to require hospitalization suffered more severe injury when substance use was involved. This was accomplished by evaluating four proxy outcome measures with Ohio Trauma Registry data from January 2004 through December 2007.

Four injury outcomes were identified: injury severity score, admission to an intensive care unit, presence of at least one medical complication, and hospital length of stay. We examined their association with substance (alcohol and/or other drug) use stratified by the likelihood of being tested for substance use, mechanism of injury, sex, age, race, and insurance status. Relative risks and t test scores were calculated.

Among 89,129 trauma cases reported to the Ohio Trauma Registry during 2004-2007, more than 21% were substance users. Those younger than 45 years of age were 65% more likely to use substances than those 45 or older, men were 110% more likely than women, Blacks were 86% more likely than non-Blacks, and uninsured persons were 127% more likely than insured persons. Stratified analyses yielded 16 comparisons (4 Injury Outcomes × 4 Age-Insurance Subgroups). For 13 of these 16 comparisons, injury severity was significantly worse (p < .0001) among substance users than nonusers.

The evidence is strong enough to conclude that, among hospitalized trauma patients, use of substances (alcohol and/or drug) was associated with increased injury severity. These findings appear to be true for the young and old, regardless of insurance status.