Background:
Substance abuse is a major health crisis in the US, with an estimated 20 million people suffering from substance use disorders (SUD). In addition to rising rates of SUD, Kentucky is located in the northern region of the stroke belt and has one of the highest rates of stroke hospitalizations in the US. Substance use may cause stroke by various mechanisms, including vasoconstriction, endothelial dysfunction, drug-induced vasculopathies, advanced rates of atherosclerosis, and infective endocarditis. We sought to examine the relationship between SUD and stroke outcomes.
Methods:
This is a single center, retrospective chart review of adults age >18 years with a diagnosis of ischemic or hemorrhagic stroke, and SUD based on either urine drug testing or medical record history, admitted between 12/6/2015 and 5/10/2019. We collected length of stay (LOS), admission/discharge NIHSS, discharge modified Rankin Scores, ICH scores, and discharge status and compared them to controls of ischemic stroke without SUD.
Results:
A total of 197 cases were identified [M=147 (74.6%)]. The most common illicit substances identified by testing were stimulants (42.6%, n=84), opioids (32.5%, n=64), and benzodiazepines (28.4%, n=56). Nearly all subjects had multiple substances present on screening. 13.8% (n=27) and 5.6% (n=11) received thrombolysis with either IV alteplase or mechanical thrombectomy, respectively. Compared to a control group of 176 ischemic stroke patients that did not test positive for illicit substances, cases (n= 139, ischemic stroke + SUD) were younger (mean=54.94+/-12.01 vs 66.15 +/- 14.38 yrs , p=0.0137), had a longer LOS (n=139, mean=8.44+/-10.84 vs 5.06 +/- 5.74, p=0.0006), higher admission NIHSS (mean=9.87+/-9.08, p=0.00012), and higher discharge NIHSS (mean=6.51+/-7.13 vs 4.19 +/- 5.73 , p=0.000512).
Conclusion:
Patients with SUD and stroke had longer LOS and worse discharge NIHSS compared to ischemic stroke patients without SUD. This could be due to the different mechanisms that cause strokes in substance users or could be a reflection of the effects of specific substances present at the time of admission. Future directions will include evaluating a hemorrhagic control population and examining a subpopulation of infective endocarditis.
HR-MAS NMR for Rapid Identification of Illicit Substances in Tablets and Blotter Papers Seized by Police Department
