Check out my latest presentation built on , where anyone can create & share professional presentations, websites and photo albums in minutes. Cuando el potencial donante de órganos no sigue una causa judicial, en estas circunstancias de presencia de drogas depresoras del sistema nervioso central, . Si bien estamos interesados en conocer su consumo de diversas drogas, por .. y muerte si se consumen con alcohol, opíáceos u otras drogas depresoras. h.
|Published (Last):||20 December 2016|
|PDF File Size:||4.15 Mb|
|ePub File Size:||12.26 Mb|
|Price:||Free* [*Free Regsitration Required]|
Gaceta Sanitaria accepts and publishes articles in Spanish and English. It is an open access journal.
All of its articles are freely available without charge and distributed under the Creative Commons Attribution-NonCommercial- NoDerivatives 4. The Impact Factor measures the average number of citations received in a particular year by papers published in the journal during the two receding years.
CiteScore measures average citations received per document published. SRJ is a prestige metric based on the idea that not all citations are the same. SJR uses a similar algorithm as the Google page rank; it provides a quantitative and qualitative measure of the journal’s impact. SNIP measures contextual citation impact by wighting citations drogss on the total number of citations in a subject field. The effect of drugs other than alcohol on severity of trauma remains unclear.
Pooled data analyses in previous studies that grouped substances with opposite effects on the central nervous system CNS may have masked the influence of substances on injury severity. The aim was to analyze the effect of stimulant, hallucinogenic and depressant drugs other than alcohol on injury severity in trauma patients. The presence frogas alcohol, stimulant drugs cocaine, amphetamines and methamphetaminesdepressant drugs benzodiazepines, opiates, methadone and barbiturates and hallucinogenic drugs THC and PCP was analyzed in patients between 16 and 70 years old admitted to a trauma hospital between November and June Injury severity was determined prospectively as the Injury Severity Score.
A depresorss analysis was used to quantify the strength of association between exposure to substances and trauma severity, using the presence of alcohol as a stratification variable. Drugs other than alcohol were found in patients The presence of CNS depressant substances was associated with increased injury severity only in patients also exposed to alcohol, with an adjusted odds ratio of 4.
CNS depressant drugs had a strong influence on injury severity in patients who screened positive for alcohol consumption. The role of alcohol as a major causal factor in trauma has been highlighted in several studies.
Although there appears to be agreement that alcohol and other drugs are important risk factors for injury, there is no consensus on the role of these substances in severity.
Some studies found that the presence of these substances increases trauma severity, 16—24 whereas others found no such association.
This leads to depresorass methodological deficiencies in assessing the association between substances other than alcohol and injury severity. For example, drugs with different effects, including opposite effects, on the central nervous system CNS are usually pooled for statistical analysis.
This makes it impossible to analyze the role of these substances in trauma severity. To these limitations must be added the fact that these studies were frequently based on data obtained from national, regional or hospital-based trauma registries.
The factors related to injury severity merit more in-depth analysis. Greater injury severity is strongly associated with increased mortality, more complications, longer hospital stays, and ultimately greater economic costs. The data for this study were from a cohort of patients admitted for traumatic injuries.
Our Hospital is a public tertiary-care hospital with a separate trauma center that covers a population of more thanderpesoras.
The MOTIVA project involved screening for alcohol and drug use in all patients aged 16 to 70 years who were hospitalized depresoraz trauma independently of trauma severity. Informed consent was required before the screening. In sedated patients or unable to collaborate, informed consent was required when the clinical situation was reversed or, if it was not possible, to relatives.
Screening for drugs tetrahydrocannabinol [THC], phencyclidine [PCP], cocaine, amphetamines, methamphetamines, benzodiazepines, opiates, methadone, barbiturates or tricyclic antidepressants was done with urine testing by fluorescence immunoassay. Alcohol consumption was screened by blood testing, and was considered positive when the blood alcohol level was higher than 0. Therefore, personal interviews were conducted to confirm the status of alcohol exposure in patients screened 6 hours after the trauma.
The remaining study variables were collected deresoras the medical records prospectively. This anatomical-based coding system classifies injuries in each of nine body regions using an ordinal scale ofwith 1 as least severe and 6 as most severe. If any of the three scores is a 6, the score is automatically set at Consequently, ISS can take values between 1 and Scores were recorded during the patient’s hospital stay.
For the data analysis, the variable for the presence of drugs other than alcohol was categorized into five strata: The ISS was categorized into three strata: Continuous variables age and days of hospital stay are presented as medians with interquartile ranges. Between-group comparisons of these variables were carried out with the Kruskal-Wallis test. The chi-squared test was used to identify associations between categorical variables sex, mechanism depresorass injury and hospital mortality.
To quantify the strength of association between substance consumption and trauma severity, we used multinomial logistic regression in two models. In model 1 the presence of substances was categorized into the five previously defined levels. The initial analysis was done with the entire sample, and in a second step, the sample was stratified according to the presence or absence of alcohol.
In model 2 the same statistical analyses were repeated but the presence of substances was categorized dichotomously as presence or absence. For both models, we calculated crude odds ratios cORand adjusted odds ratio aOR estimates were obtained by adding age, sex, and mechanism of injury as independent variables.
All analyses were done with the SPSS v. Of all patients aged 16 to 70 years who were hospitalized for trauma during the study periods, Of all patients screened, Alcohol was the substance detected most frequently patients; When we compared the demographic and clinical characteristics of the five groups according to type of drug consumed Table 1we found that age was oldest for consumers of depressant substances, with a median age interquartile range of 51 yearsand much younger in patients who tested positive for hallucinogenics median: The proportion of women was greater in the subgroup of individuals who tested positive for depressant drugs A fall on the same level was the most frequent mechanism of injury in this group In the subgroup of polydrug, alcohol consumption was especially frequent There were no relevant differences between groups in the duration of hospital stay in days or mortality.
Demographic and clinical comparisons according to substance s detected. In the multivariate analysis Table 2the estimates of strength of association between each drug group and the frequency of moderate and severe injuries in model 1 showed that alcohol modified the association between depressant drugs and injury severity. This association was nonexistent in the group who had not been exposed to alcohol, whereas alcohol consumption was associated with an increase in injury severity in the group of patients exposed to CNS depressants, with an adjusted aOR of 4.
This modifying effect did not appear in the other groups. Multivariate analysis of drugs detected and injury severity in the entire sample and by stratums positive or negative for alcohol.
Ajusted odds ratio using a multinomial logistic regression adding varibles age, sex and mechanism of injury. In model 2 Table 3when pooled data were analyzed by grouping drugs with opposite effects, no significant associations were found in the adjusted estimates. Ajusted odds ratio using a multinomial logistic regression adding variables age, sex and mechanism of injury.
A separate analysis of drug subgroups defined according to their effect on the CNS allowed us to identify the specific influence of substances with CNS-depressant effects on injury severity, especially in patients who had consumed alcohol. The results of this study suggest that in the presence of alcohol, substances with a CNS-depressant effect have a strong influence on trauma severity. We were able to distinguish between cases in which the substance was administered as part of the trauma patient’s medical care and cases in which the patient had consumed the substance before the injury.
This allowed us to quantify the effect of CNS-depressant substances on severity without the need to systematically exclude patients who screened positive for opiates or benzodiazepines, in contrast to similar studies that excluded these patients.
There was a high prevalence of benzodiazepine exposure in our population of injured patients. The influence of benzodiazepines on injury prevention is an area of growing interest. Although the exact frequency of use of these nonprescribed substances is not known, it appears evident that the consumption of benzodiazepine and other psychotropic drugs is increasing.
Particular attention should be given to motor vehicle crashes, which can cause serious injury. The conclusions of the European DRUID Driving Under the Influence of Drugs, Alcohol and Medicines depresorras 38 highlight the need for increased monitoring of substances other than alcohol because their frequency of use is clearly increasing. According to depresoraz DRUID study, in some parts of Europe, drivers are more likely to be detected under the influence of depresodas than under the influence of alcohol.
Drogas Depresoras by Odileth Padilla on Prezi
Moreover, a systematic review xepresoras Smink et al. We found that the effect of benzodiazepines along with other depressants on trauma severity was very high, but only in patients who had also consumed alcohol.
The biological interpretation of these results is likely to be related with the delresoras synergistic interaction of combinations of these drugs in CNS depression. This effect impairs driving performance and the ability to react to a potential hazard by causing sedation and increasing risk-taking behavior.
Driving under the combined influence of drugs and alcohol has been found to increase the risk of accidents in various ways due to their influence on the driver’s vision, awareness, perception, reaction time and concentration. Statistical analysis with all patients who were positive for substances in a single group model 2 allowed us to confirm that pooled data analysis by grouping drugs with opposite effects on the CNS is a potentially misleading strategy.
Therefore, some associations between depressant drugs and injury severity may have been masked in previous studies. The profile of patients who tested positive for CNS depressant substances was different from other profiles: These findings reveal the need for further analysis of the differences in these characteristics compared to the classic profile of individuals with trauma associated with alcohol and other drugs, i.
Our systematic analysis was based on all patients between 16 and 70 years of age who were admitted to a trauma hospital, with no other previous selection criteria.
This sampling approach decreased the possibility of selection bias. Some previous studies were based on data obtained from national, regional or hospital trauma registries from which the authors selected records that included available information on the exposure to drugs and alcohol.
This uncertainly introduces an important source of selection bias, because physicians may be more likely to request substance use testing for more severely injured patients or for those with signs of alcohol or drug use. Our study shares a common limitation with previous reports, 14,17 i. Fortunately, this was not the case for the other substances analyzed here, because all patients were screened with appropriate laboratory tests.
On the other hand, our study could be affected by selection bias: Nonetheless, we have no reasons to suspect an independent association between the presence of drugs and the probability of being screened.
We detected an association between the presence of sedative drugs and injury severity in the subgroup of trauma patients who screened positive for alcohol consumption. We believe further knowledge is needed regarding the effect of drugs other than alcohol on trauma severity. Our results support the additional benefits of systematic screening programs for psychoactive drug use in all trauma patients. The information gained from testing would not only provide important data during clinical assessment, but would also enable the healthcare provider to offer appropriate education, counseling, or other types of intervention.
What is known about the topic? Although the effect of alcohol on the severity of the trauma and the occurrence of complications and mortality during hospitalization has been widely assessed in previous studies, the role of drugs other than alcohol remains unclear.