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| ORIGINAL ARTICLE |
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| Year : 2014 | Volume
: 60
| Issue : 4 | Page : 366-371 |
Pre-injury neuro-psychiatric medication use, alone or in combination with cardiac medications, may affect outcomes in trauma patients
JR Wisler1, AN Springer2, K Hateley1, XM Mo3, DC Evans1, CH Cook1, AT Gerlach4, CV Murphy4, DS Eiferman1, SM Steinberg1, SD Bergese2, TJ Papadimos2, SP Stawicki5
1 Department of Surgery, Division of Trauma, Critical Care, and Burn, The Ohio State University College of Medicine, Columbus, Ohio, USA
2 Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, Ohio, USA
3 Department of Biostatistics, The Ohio State University College of Medicine, Columbus, Ohio, USA
4 Department of Pharmacy, The Ohio State University College of Medicine, Columbus, Ohio, USA
5 Department of Research & Innovation, St Luke's University Health Network, Bethlehem, Pennsylvania, USA
Correspondence Address:
Dr. S P Stawicki
Department of Research & Innovation, St Luke's University Health Network, Bethlehem, Pennsylvania
USA
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0022-3859.143957
Background: Recent review of older (≥45-years-old) patients admitted to our trauma center showed that more than one-third were using neuro-psychiatric medications (NPMs) prior to their injury-related admission. Previously published data suggests that use of NPMs may increase patients' risk and severity of injury. We sought to examine the impact of pre-injury NPM use on older trauma patients' morbidity and mortality. Materials and Methods: Retrospective record review included medication regimen characteristics and NPM use (antidepressants-AD, antipsychotics-AP, anxiolytics-AA). Hospital morbidity, mortality, and 90-day survival were examined. Comparisons included regimens involving NPMs, further focusing on their interactions with various cardiac medications (beta blocker - BB; angiotensin-converting enzyme inhibitor/angiotensin receptor blocker - ACE/ARB; calcium channel blocker - CCB). Results: 712 patient records were reviewed (399 males, mean age 63.5 years, median ISS 8). 245 patients were taking at least 1 NPM: AD (158), AP (35), or AA (108) before injury. There was no effect of NPM monotherapy on hospital mortality. Patients taking ≥3 NPMs had significantly lower 90-day survival compared to patients taking ≤2 NPMs (81% for 3 or more NPMs, 95% for no NPMs, and 89% 1-2 NPMs, P < 0.01). Several AD-cardiac medication (CM) combinations were associated with increased mortality compared to monotherapy with either agent (BB-AD 14.7% mortality versus 7.0% for AD monotherapy or 4.8% BB monotherapy, P < 0.05). Combinations of ACE/ARB-AA were associated with increased mortality compared to ACE/ARB monotherapy (11.5% vs 4.9, P = 0.04). Finally, ACE/ARB-AD co-administration had higher mortality than ACE/ARB monotherapy (13.5% vs 4.9%, P = 0.01). Conclusions: Large proportion of older trauma patients was using pre-injury NPMs. Several regimens involving NPMs and CMs were associated with increased in-hospital mortality. Additionally, use of ≥3 NPMs was associated with lower 90-day survival.
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