{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T04:27:03Z","timestamp":1770265623950,"version":"3.49.0"},"reference-count":35,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T00:00:00Z","timestamp":1770163200000},"content-version":"unspecified","delay-in-days":34,"URL":"https:\/\/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":[[2026,1,14]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Benzodiazepine use among adults \u226550 years is increasing and frequently co-occurs with other substances, a pattern linked to trauma risk and greater hospital resource utilization. This study evaluated the impact of benzodiazepine-related polysubstance use on resource utilization in older trauma patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study of trauma patients aged \u226550 admitted to four US trauma centers (January 2016\u2013July 2022). Patients were classified as positive for \u22652 substances including benzodiazepines (PSB+), positive for \u22652 substances excluding benzodiazepines (PSB\u2212), or substance negative (SB\u2212). Outcomes included urine drug screening (UDS) trends, benzodiazepine positivity, and the following hospital resource utilization outcomes: intensive care unit (ICU) admission, ventilation, transfusion, surgery, ICU length of stay (LOS) &gt;4\u2009days, hospital LOS &gt;5\u2009days, or in-hospital complications. Covariates were balanced using inverse probability weighting (IPW).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 24\u2009045 older patients, 13% (n=3008) underwent UDS; 38% were substance positive. The final cohort (n=2201) included 158 (7%) PSB+, 181 (8%) PSB\u2212, and 1862 (85%) SB\u2212 patients. UDS rates declined over time (p&lt;0.001), while PSB+ use slightly increased (p=0.02). Compared with PSB\u2212, PSB+ patients were older (median 60 years vs. 56 years, p&lt;0.001), more often female (37% vs. 23%, p=0.007), and more likely to have falls (47% vs. 32%, p=0.04), high alcohol levels (68% vs. 26%, p=0.001), Glasgow Coma Scale score \u22648 (25% vs. 8%, p&lt;0.001), and Injury Severity Score \u226516 (31% vs. 19%, p=0.02). Unadjusted analyses showed higher ICU admissions, ventilation, transfusions, and complications in PSB+ patients. After IPW, PSB+ remained associated with higher odds of ICU admission (OR 1.84, 95% CI 1.18 to 2.85, p=0.007) and transfusion (OR 1.87, 95% CI 1.04 to 3.39, p=0.04). Among patients aged \u226565, PSB+ conferred more than threefold\u2009higher ICU admission odds (OR 3.35, 95% CI 1.32 to 8.51, p=0.01).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Benzodiazepine-positive polysubstance use in older trauma patients is independently associated with higher odds of ICU-level care and transfusion, supporting early identification of this high-risk population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of evidence<\/jats:title>\n                    <jats:p>Level IV, retrospective study.<\/jats:p>\n                  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