Toxicology screening in oral and maxillofacial trauma patients

The role of alcohol in facial trauma is recognised but we know of no research on the possible contribution made by the use of illicit drugs in patients with facial injuries, or the interactions that may occur during anaesthesia. We aimed to find out whether illegal drugs were identified in the urine of patients with maxillofacial injuries, what substances were present, and whether patients were willing to disclose use of drugs at the time of injury. Over a 12-month period we prospectively studied consecutive patients with facial injuries who were referred by accident and emergency (A&E) to the department of oral and maxillofacial surgery (OMFS) for inpatient assessment and treatment within 24 h of injury. Anonymised data on patients were obtained from questionnaires that were linked to a urine sample provided on admission. Results were obtained using immunoassay and gas chromatography with mass spectrometry. A total of 105 patients with facial injuries were eligible and 95 (90%) provided a urine sample and completed the questionnaire; 2 samples were of insufficient volume and were discarded before analysis. Twelve patients (13%) admitted using drugs at the time of injury but 44 (47%) samples tested positive for illegal drugs; fewer showed the presence of alcohol (n = 37; 40%). Use of drugs, although often denied, is widespread among patients with facial injuries. It is important to consider the role that drugs have in patients who present with traumatic injuries, the interactions misused drugs may have with anaesthesia, and any possible benefits that targeted prevention strategies would have in this group.