POLYSUBSTANCE USE AND THE UTILIZATION OF ATYPICAL ANTIPSYCHOTICS FOLLOWING SEVERE TRAUMATIC INJURY

Objectives: Critically ill trauma patients commonly experience delirium and agitation as a manifestation of acute brain dysfunction. Patients who experience delirium are at a higher risk for increased length of stay, cognitive impairment, and death. Post-traumatic agitation is a subset of delirium that is frequently managed with atypical antipsychotics, despite limited evidence supporting their use. Our study aimed to assess the use of atypical antipsychotics (AAP) in patients admitted to the intensive care unit (ICU) following severe traumatic injury. We hypothesize that APP utilization increased with patients who had underlying polysubstance use regardless of the injury severity.

Methods: A single-center, retrospective cohort study was conducted at an urban ACS-verified Level 1 trauma center on adult patients (>18 years) admitted to the trauma service from January 1, 2019 through April 30, 2019. Patients were included if they had a traumatic injury, received an APP (quetiapine, olanzapine, or ziprasidone), had an injury severity score (ISS) of 15 or greater, admitted to the intensive care unit (ICU) and had a minimum hospital length of stay (LOS) of 5 days.

Results: Within this cohort, 229 patients met inclusion criteria, and 54 patients (24%) received a new-start atypical antipsychotic. In comparison to those who did not receive an AAP, patients tended to be younger (median 31 vs. 46 years, p=0.032) with higher rates of penetrating trauma (33.3% vs. 20.0%, p=0.042), predominantly driven by high rates of gunshot wounds in the overall population (31.5% vs. 18.3%, p=0.039). Patients who received an antipsychotic presented with a lower median GCS (12 vs. 15, p< 0.001) and higher rates of urine drug screens (46.3% vs. 29.7%, p=0.024), with higher rates of positive drug screens (42.6% vs. 20.6%, p< 0.001). Rates of traumatic brain injury (TBI) were similar between patients who received an antipsychotic and those who did not (59.3% vs. 46.3%, p=0.096).

Conclusion: Following severe traumatic injury, approximately one-quarter of admitted patients received an atypical antipsychotic. The use of antipsychotics was not associated with higher ISS but utilization was higher in patients with lower admission GCS score and a positive drug screen.