The Role of Pre-injury Polysubstance Use on Traumatic Brain Injury and its Impact on Health Resource Utilization Among the U.S. Trauma Patients

Pre-injury polysubstance use may worsen outcomes in traumatic brain injury (TBI) patients and increase healthcare burden; however, this association has not been adequately quantified. We investigated polysubstance use’s impact on TBI mortality, severity, and health resource utilization (HRU) in U.S. trauma patients. This retrospective study included isolated TBI patients (≥ 18 years) screened for substance use in U.S. trauma centers from 2017 to 2019. Outcomes were analyzed by polysubstance number (i.e., two substances, and ≥ three substances) and types (cannabinoids and opioids, cannabinoids and stimulants, and other substance combinations) compared to substance-negative users. Logistic regression was used to measure the association between polysubstance use, mortality and TBI severity. Negative binomial regression was used to measure polysubstance use’s association with hospital, ICU and mechanical ventilator length of stay. The co-use of cannabinoids and opioids (1.62 [1.01–2.58], p = 0.04) and cannabinoids and stimulants (1.20 [1.12–1.28], p < 0.0001) were significantly associated with higher odds of mortality and severe TBI, respectively. Furthermore, patients who co-used cannabinoids, stimulants, opioids, and depressants had prolonged hospital stay (β = 0.18, p = 0.001). Specific types of pre-injury polysubstance use were significantly associated with mortality, TBI severity, and HRU. This information will be valuable for healthcare decision-making, provision, and resource allocation.