Cerebrovascular Events and Hospital Discharge Outcomes Associated With Drug Use: A Retrospective Case-Matched Study

Richard T Rogers; Ha Tran; Starlie C Belnap; Amy K Starosciak

doi:10.7759/cureus.50190

Cerebrovascular Events and Hospital Discharge Outcomes Associated With Drug Use: A Retrospective Case-Matched Study

Cureus. 2023 Dec 8;15(12):e50190. doi: 10.7759/cureus.50190. eCollection 2023 Dec.

Authors

Richard T Rogers¹, Ha Tran^{2

3}, Starlie C Belnap⁴, Amy K Starosciak^{5

6

4}

Affiliations

¹ Neurology, Florida International University, Herbert Wertheim College of Medicine, Miami, USA.
² Pediatrics, Florida International University, Herbert Wertheim College of Medicine, Miami, USA.
³ Pediatrics, Children's National Hospital, Washington, D.C., USA.
⁴ Miami Neuroscience Institute, Baptist Health South Florida, Miami, USA.
⁵ Translational Medicine, Florida International University, Herbert Wertheim College of Medicine, Miami, USA.
⁶ Center for Research, Baptist Health South Florida, Coral Gables, USA.

Abstract

Introduction Individuals using cocaine, methamphetamines, cannabis, and other mood-altering drugs (MADs) have been reported to have greater stroke risk when compared to individuals who do not use these drugs. Yet, the impact that MAD use has on stroke outcomes has not been adequately explored, with existing research not agreeing on the extent to which the use of these drugs influences stroke outcomes. This study aimed to determine the impact that the use of common MADs has on stroke outcome factors such as length of stay (LOS), discharge modified Rankin Scale (mRS), and discharge disposition. Methods A retrospective case-matched study was conducted with two adult cohorts treated for cerebrovascular accidents: those who use MADs and those who do not use MADs prior to their stroke. Subjects identified for the users of MADs cohort were matched at a 1:1 ratio to those who do not use MADs (control cohort) by age, sex, and stroke type (e.g., hemorrhagic or ischemic). Logistic regression was used to calculate odds ratios for functional outcomes for stroke patients with and without prior MAD use. Results Active users of MADs had an increased overall risk of poor stroke outcome, i.e., increased length of stay, discharge disposition other than to home or to rehabilitation, discharge modified Rankin scale (mRS) 3-6 after controlling for stroke severity from initial National Institutes of Health Stroke Scale (NIHSS) (X²{9}=21.68, p<0.01, Cox adjusted R²=0.31). This finding was driven predominately by increased hospital LOS (p=0.006) among the MAD cohort, whereas discharge mRS 3-6 (p=0.24) and discharge disposition to care facility (p=0.27) and expired (p=0.26) did not vary significantly between groups. Conclusion Our study suggests that patients who had actively used MADs prior to their stroke may be at risk of poorer stroke outcomes, namely an increased LOS. Future research should be conducted to further elucidate which factors, such as individual drugs, amount of drug, acute or recreational use versus chronic or long-term use, and route of administration, for instance, specifically contribute to a longer LOS so that they may be targeted for mitigation.

Keywords: cerebrovascular stroke; discharge disposition; functional outcomes in acute stroke; modified rankin scale; drug use.