{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T16:14:09Z","timestamp":1787588049950,"version":"build-2736575974"},"reference-count":21,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2021,8,22]],"date-time":"2021-08-22T00:00:00Z","timestamp":1629590400000},"content-version":"unspecified","delay-in-days":21,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Trauma Surg Acute Care Open"],"accepted":{"date-parts":[[2021,8,3]]},"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Urine drug screening (UDS) is a component of trauma workup and of perioperative risk evaluation. Illicit stimulant use has been associated with cardiovascular complications. This study investigates the impact of stimulant use and its interaction with surgery on cardiovascular complications in trauma patients.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Patients were identified from the 2017 National Trauma Data Bank. Univariate and multivariate analyses were used to evaluate the effect of amphetamine and cocaine on mortality, myocardial infarction (MI), and stroke. We evaluated three subsets: all screened patients, those who underwent surgery, and those whose surgery was immediate. Significance was tested with \u03c7<jats:sup>2<\/jats:sup> test for categorical variables, Student\u2019s t-test for continuous variables, and logistic regression for multivariate analysis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>317\u2009688 (32.1%) patients underwent UDS. Multivariate analysis showed protective association between cocaine and mortality OR 0.9 (p=0.028). Cocaine was a non-significant predictor of MI and stroke: OR 0.63 (p=0.065) and 0.91 (p=0.502), respectively. Amphetamine was a non-significant predictor of mortality, MI, and stroke: OR 0.97 (p=0.405), 0.80 (p=0.283), and 1.02 (p=0.857), respectively.<\/jats:p>\n                  <jats:p>On univariate analysis, amphetamine showed a protective association with MI for all screened patients: relative risk (RR) 0.58 (p=0.005), and for surgical patients: RR 0.58 (p=0.019). Amphetamine showed a protective association with mortality for all three subsets: RR 0.83 (p&lt;0.001), 0.78 (p&lt;0.001), and 0.71 (p&lt;0.001), respectively. Cocaine showed a protective association with MI for all screened patients: RR 0.45 (p=0.001), and for surgical patients: RR 0.44 (p=0.005). Cocaine showed a protective association with mortality for all three subsets: RR 0.76 (p&lt;0.001), 0.71 (p&lt;0.001), and 0.63 (p&lt;0.001), respectively.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>UDS positive for cocaine or amphetamine is not an adverse risk factor in trauma, including trauma patients who underwent surgery. The apparent protective effects of illicit drugs warrant further investigation.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Level of evidence<\/jats:title>\n                  <jats:p>Therapeutic\/care management, level IV.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/tsaco-2021-000749","type":"journal-article","created":{"date-parts":[[2021,8,23]],"date-time":"2021-08-23T13:31:08Z","timestamp":1629725468000},"page":"e000749","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Urine drug screen positive for cocaine and amphetamine is not an adverse risk factor for cardiovascular morbidity or mortality in trauma"],"prefix":"10.1136","volume":"6","author":[{"given":"Sangeeta","family":"Satish","sequence":"first","affiliation":[{"name":"Trauma, Saint Louis University, Saint Louis, Missouri, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carl","family":"Freeman","sequence":"additional","affiliation":[{"name":"Trauma, Saint Louis University, Saint Louis, Missouri, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Culhane","sequence":"additional","affiliation":[{"name":"Trauma, Saint Louis University, Saint Louis, Missouri, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,8,23]]},"reference":[{"key":"2025081711083028000_6.1.e000749.1","doi-asserted-by":"crossref","first-page":"913","DOI":"10.1097\/TA.0000000000001229","article-title":"The impact of pre-injury controlled substance use on clinical outcomes after trauma","volume":"81","author":"Cheng","year":"2016","journal-title":"J Trauma Acute Care Surg"},{"key":"2025081711083028000_6.1.e000749.2","doi-asserted-by":"crossref","first-page":"1236","DOI":"10.1007\/s12630-017-0975-0","article-title":"Anesthetic implications of recreational drug use","volume":"64","author":"Beaulieu","year":"2017","journal-title":"Can J Anaesth"},{"key":"2025081711083028000_6.1.e000749.3","doi-asserted-by":"crossref","DOI":"10.3390\/ijms20030584","article-title":"Acute and chronic effects of cocaine on cardiovascular health","volume":"20","author":"Kim","year":"2019","journal-title":"Int J Mol Sci"},{"key":"2025081711083028000_6.1.e000749.4","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1002\/ehf2.12572","article-title":"Methamphetamine-related cardiovascular diseases","volume":"7","author":"Schwarzbach","year":"2020","journal-title":"ESC Heart Fail"},{"key":"2025081711083028000_6.1.e000749.5","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2013\/149892","article-title":"Preoperative screening and case cancellation in cocaine-abusing veterans scheduled for elective surgery","volume":"2013","author":"Elkassabany","year":"2013","journal-title":"Anesthesiol Res Pract"},{"key":"2025081711083028000_6.1.e000749.6","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.142.7.633"},{"key":"2025081711083028000_6.1.e000749.7","doi-asserted-by":"publisher","DOI":"10.1097\/00005373-200109000-00024"},{"key":"2025081711083028000_6.1.e000749.8","doi-asserted-by":"crossref","first-page":"279","DOI":"10.4103\/JETS.JETS_141_19","article-title":"The effect of illegal drug screening results and chronic drug use on perioperative complications in trauma","volume":"13","author":"Culhane","year":"2020","journal-title":"J Emerg Trauma Shock"},{"key":"2025081711083028000_6.1.e000749.9","unstructured":"Procedure Classes Refined for ICD-10-PCS . Healthcare cost and utilization project (HCUP). Rockville, MD: Agency for Healthcare Research and Quality, 2020."},{"key":"2025081711083028000_6.1.e000749.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpa.2014.02.003"},{"key":"2025081711083028000_6.1.e000749.11","doi-asserted-by":"crossref","first-page":"894","DOI":"10.1016\/j.joms.2019.01.016","article-title":"Perioperative management for the cocaine-positive patient undergoing elective surgery under general anesthesia","volume":"77","author":"Saggese","year":"2019","journal-title":"J Oral Maxillofac Surg"},{"key":"2025081711083028000_6.1.e000749.12","first-page":"809","article-title":"Outcomes of cocaine-positive trauma patients undergoing surgery on the first day after admission","volume":"65","author":"Ryb","year":"2008","journal-title":"J Trauma"},{"key":"2025081711083028000_6.1.e000749.13","doi-asserted-by":"crossref","first-page":"98","DOI":"10.4103\/JETS.JETS_86_18","article-title":"Recreational drugs and outcomes in trauma patients","volume":"12","author":"Fujii","year":"2019","journal-title":"J Emerg Trauma Shock"},{"key":"2025081711083028000_6.1.e000749.14","first-page":"895","article-title":"Methamphetamines in trauma: effect on injury patterns and outcome","volume":"66","author":"Hadjizacharia","year":"2009","journal-title":"J Trauma"},{"key":"2025081711083028000_6.1.e000749.15","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e3181622b9b"},{"key":"2025081711083028000_6.1.e000749.16","doi-asserted-by":"crossref","first-page":"189","DOI":"10.4103\/0974-2700.115337","article-title":"Effect of cocaine use on outcomes in traumatic brain injury","volume":"6","author":"Yeung","year":"2013","journal-title":"J Emerg Trauma Shock"},{"key":"2025081711083028000_6.1.e000749.17","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1016\/j.jclinane.2018.12.028","article-title":"Recent cocaine use and the incidence of hemodynamic events during general anesthesia: a retrospective cohort study","volume":"55","author":"Moon","year":"2019","journal-title":"J Clin Anesth"},{"key":"2025081711083028000_6.1.e000749.18","doi-asserted-by":"publisher","DOI":"10.1136\/tsaco-2020-000553"},{"key":"2025081711083028000_6.1.e000749.19","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/ael221"},{"key":"2025081711083028000_6.1.e000749.20","doi-asserted-by":"crossref","DOI":"10.1097\/00003643-200206000-00002","article-title":"Pathophysiology of cocaine abuse","volume":"19","author":"Brownlow","year":"2002","journal-title":"Eur J Anaesthesiol"},{"key":"2025081711083028000_6.1.e000749.21","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.156.5.9704146"}],"container-title":["Trauma Surgery &amp; Acute Care Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/tsaco-2021-000749","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,17]],"date-time":"2025-08-17T18:08:41Z","timestamp":1755454121000},"score":1,"resource":{"primary":{"URL":"https:\/\/tsaco.bmj.com\/lookup\/doi\/10.1136\/tsaco-2021-000749"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8]]},"references-count":21,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2021,8,23]]},"published-print":{"date-parts":[[2021,8]]}},"alternative-id":["10.1136\/tsaco-2021-000749"],"URL":"https:\/\/doi.org\/10.1136\/tsaco-2021-000749","relation":{},"ISSN":["2397-5776"],"issn-type":[{"value":"2397-5776","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8]]}}}