Patterns of alcohol and drug abuse in an urban trauma center: the increasing role of cocaine abuse.

Alcohol continues to play a major etiologic role in blunt trauma. It is involved in 65-70% of fatal highway crashes. The role of illicit drugs, although accepted as an etiologic factor in trauma, is less well described. This is especially true of blunt and penetrating trauma related to violent crime. During a 9-month period, in a randomly selected group, blood and urine samples were taken from 169 traumatized patients for alcohol and general toxicology screens. There were 81 cases (47.9%) related to violent crime. One hundred twenty-six patients (74.5%) tested positive for illicit or prescription drugs in their blood. These included cocaine (54.4%), cannabinoids (37.2%), barbiturates (7.1%), amphetamines (4.7%), benzodiazepines (10.1%), opiates (9%), and codeine (1%). Sixty-one patients (35.5%) tested positive for alcohol. Alcohol was found in 6.2% of violent crime-related cases. Illicit drugs were found in 80.3% of violent crime-related cases. Alcohol and drugs, especially illicit drugs, are major etiologic factors in both accidental and crime-related trauma in the urban population. All patients admitted to trauma centers, especially urban trauma centers, should be screened for alcohol and drugs.