{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T14:10:37Z","timestamp":1790691037153,"version":"4.1.0"},"reference-count":20,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T00:00:00Z","timestamp":1790467200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The American Surgeon\u2122"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Substance use among geriatric populations is rising rapidly, posing new challenges for trauma systems. Older adults are particularly vulnerable due to comorbidities and physiologic decline, yet the impact of prehospital substance use in this population after trauma remains largely unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a retrospective review of a Level I trauma registry from 2018-2024, including patients aged \u226565 years. Patients were stratified by urine toxicology (UTox) status into positive (+UTox) and negative (\u2212UTox) groups, excluding isolated opioid and benzodiazepine screens. Primary outcome was in-hospital mortality; secondary outcomes included ICU admission, ICU length of stay (LOS), hospital LOS. Multivariable logistic regression adjusted for demographic and clinical confounders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 11,133 patients, 7.4% were +UTox. These were younger, often male, and had higher rates of substance use history. +UTox patients had increased ICU admission (29.5% vs 17.4%), longer ICU LOS (1.3 vs 0.7 days), and longer hospital LOS (5.9 vs 4.1 days) (all\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001). Mortality was higher in the +UTox group (6.8% vs 4.6%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.01), but UTox positivity was not independently associated with mortality after adjustment (OR 1.13,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.47). Independent predictors of mortality included age, male sex, injury severity, ICU admission, and comorbidities. From 2018-2024, illicit drug use increased from 5.6% to 10.7%, and alcohol positivity rose from 4.9% to 8.0%.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Substance use in geriatric trauma patients is increasing and is associated with greater resource utilization, particularly ICU admission and longer hospitalization. Although not independently linked to mortality, these findings highlight the need for improved screening and targeted interventions in this growing population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00031348261492197","type":"journal-article","created":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:56:43Z","timestamp":1790557003000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Geriatric Substance Use: A Rising Burden for Trauma Systems"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-3721-2381","authenticated-orcid":false,"given":"Jeremy","family":"Miller","sequence":"first","affiliation":[{"name":"Desert Regional Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Connor","family":"Fewel","sequence":"additional","affiliation":[{"name":"Desert Regional Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tia Abu","family":"Sham","sequence":"additional","affiliation":[{"name":"Desert Regional Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Margain","sequence":"additional","affiliation":[{"name":"Desert Regional Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad","family":"Khan","sequence":"additional","affiliation":[{"name":"Desert Regional Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Woods","sequence":"additional","affiliation":[{"name":"Desert Regional Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2247-5221","authenticated-orcid":false,"given":"Mallory","family":"Jebbia","sequence":"additional","affiliation":[{"name":"Desert Regional Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyrillos","family":"Awad","sequence":"additional","affiliation":[{"name":"Desert Regional Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,27]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jagp.2019.06.005"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cger.2021.07.002"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000001229"},{"key":"e_1_3_3_5_2","first-page":"\u25a0","article-title":"National Survey on Drug Use and Health: Annual national report. U.S","author":"Substance Abuse and Mental Health Services Administration","year":"2024","unstructured":"Substance Abuse and Mental Health Services Administration. National Survey on Drug Use and Health: Annual national report. U.S. Department of Health and Human Services. 2024;\u25a0:\u25a0.","journal-title":"Department of Health and Human Services"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","unstructured":"Alhalaseh L Abushams L Qudah R et al. Older adults: a scoping review. Substance use & misuse. Published online. 2025;\u25a0:1-11. doi:10.1080\/10826084.2025.2513525.","DOI":"10.1080\/10826084.2025.2513525"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2021.06.025"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.ccm.0000998680.43877.00"},{"issue":"3","key":"e_1_3_3_9_2","first-page":"211","article-title":"Geriatric trauma: resource use and patient outcomes","volume":"46","author":"McKevitt EC","year":"2003","unstructured":"McKevitt EC, Calvert E, Ng A, et al. Geriatric trauma: resource use and patient outcomes. Can J Surg. 2003;46(3):211-215. PMID: 12812248; PMCID: PMC3211738.","journal-title":"Can J Surg"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.2105\/ajph.79.9.1278"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.TA.w0000g2015.54022jBE"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13017-024-00537-8"},{"key":"e_1_3_3_13_2","first-page":"\u25a0","article-title":"A guide to preventing older adults alcohol and psychoactive medication misuse\/abuse: screening and brief interventions","author":"Berry KL","year":"2012","unstructured":"Berry KL, Blow FC, Cameron KA, et al. A guide to preventing older adults alcohol and psychoactive medication misuse\/abuse: screening and brief interventions. SAMHSA. 2012;\u25a0:\u25a0.","journal-title":"SAMHSA"},{"key":"e_1_3_3_14_2","doi-asserted-by":"crossref","unstructured":"Steffens D Wang L Manning kevin & glanton holzhauer cathryn. Alcohol Use Disorder in Older Adults: A Review of Recent Luterdture on Epioemiolagy Cogairive Outcores and Neuroimaginge Findings and treatment. The American Journal of Geriatric Psychtatry: Open Science Education and Practice. 2024;1:10.","DOI":"10.1016\/j.osep.2024.05.003"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-017-2538-z"},{"key":"e_1_3_3_16_2","first-page":"\u25a0","article-title":"Geriatric trauma practice management Guidelines update","author":"Calland JF","unstructured":"Calland JF, Ingraham AM, Martin ND, et al. Geriatric trauma practice management Guidelines update. Eastern Association for the Surgery of Trauma (EAST). \u25a0;\u25a0:\u25a0.","journal-title":"Eastern Association for the Surgery of Trauma (EAST)"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahr.2023.100178"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12603-020-1469-2"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2014.04.007"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.22122\/ahj.v14i1.1311"},{"key":"e_1_3_3_21_2","unstructured":"American College of Surgeons Committee on Trauma. Best practice guidelines: screening and intervention for mental health disorders and substance use and misuse in the acute trauma patient. 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