{"paper_id":"4d9b59da-83e1-4b2a-8e67-bdf153804f8a","body_text":"The Role of Pre-injury Polysubstance Use on Traumatic Brain Injury and its Impact on Health Resource Utilization Among the U.S. Trauma Patients | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article The Role of Pre-injury Polysubstance Use on Traumatic Brain Injury and its Impact on Health Resource Utilization Among the U.S. Trauma Patients Chisom D. Eze, Mohammad A. Al-Mamun This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6017336/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Pre-injury polysubstance use may worsen outcomes in traumatic brain injury (TBI) patients and increase healthcare burden; however, this association has not been adequately quantified. We investigated polysubstance use’s impact on TBI mortality, severity, and health resource utilization (HRU) in U.S. trauma patients. This retrospective study included isolated TBI patients (≥ 18 years) screened for substance use in U.S. trauma centers from 2017 to 2019. Outcomes were analyzed by polysubstance number (i.e., two substances, and ≥ three substances) and types (cannabinoids and opioids, cannabinoids and stimulants, and other substance combinations) compared to substance-negative users. Logistic regression was used to measure the association between polysubstance use, mortality and TBI severity. Negative binomial regression was used to measure polysubstance use’s association with hospital, ICU and mechanical ventilator length of stay. The co-use of cannabinoids and opioids (1.62 [1.01–2.58], p = 0.04) and cannabinoids and stimulants (1.20 [1.12–1.28], p < 0.0001) were significantly associated with higher odds of mortality and severe TBI, respectively. Furthermore, patients who co-used cannabinoids, stimulants, opioids, and depressants had prolonged hospital stay (β = 0.18, p = 0.001). Specific types of pre-injury polysubstance use were significantly associated with mortality, TBI severity, and HRU. This information will be valuable for healthcare decision-making, provision, and resource allocation. Health sciences/Health care/Health policy Health sciences/Health care/Health services Figures Figure 1 Figure 2 1. Background Traumatic Brain Injury (TBI) is a penetrating or blunt injury causing temporary or permanent disruption of brain function 1–3 . According to the Centers for Disease Control and Prevention (CDC) estimates, 1.5 million people in the U.S. experience TBI annually, with 5.3 million Americans living with a permanent TBI-related disability 4 . Non-fatal TBI is responsible for an estimated annual healthcare expenditure of over $40.6 billion in 2016 5 . Although TBI-related hospitalization dropped to 214,000 in 2020 compared to 288,00 in 2014, TBI-related mortality increased by 18% in 2021 2,6,7 . Compared to women, men are nearly twice and thrice more likely to be hospitalized and die from TBI, respectively 6 . TBI patients in trauma centers consist primarily of fall and motor vehicle accident victims, often mediated by substance and alcohol use 2,8 . Numerous studies and reviews have reported pre-injury illicit drug and alcohol use ranges of 10-81% and 22-81%, respectively, in TBI trauma patients 8–15 . A recent study found that 64% of substance users abuse one substance type; nevertheless, there is a growing case of multiple/polysubstance use 16 . The term polysubstance use can be defined as the concurrent or simultaneous use or misuse of more than one illicit substance or prescription medication. To date, limited studies have evaluated the impact of pre-injury polysubstance use on mortality and health resource utilization (HRU) among U.S. trauma patients but not in TBI patients 17,18 . Further, there is a critical need to evaluate how pre-injury polysubstance use impacts TBI outcomes and patterns of HRU related to it. TBI patients with prior substance use have been associated with lower admitting Glasgow Coma Scale (GCS), during admission 19 . Pre-injury stimulant use in TBI patients was associated with reduced mortality and higher mechanical ventilation duration 12,13 . Additionally, marijuana use has also been associated with reduced mortality in TBI patients 14 . U.S. trauma patients who combined either benzodiazepine and opiate or amphetamine and barbiturate had a higher odds of mortality 18 . However, Khadka et al. reported lower odds of mortality for U.S. trauma patients with opioid-related pre-injury polysubstance use, except for combinations of opioids and stimulants 17 . The study population equally had higher odds for hospital admission and need for mechanical ventilation 17 . Nevertheless, combinations with other substances can precipitate differing outcomes, which could be detrimental to patients and burdensome to the healthcare system. It is warranted to evaluate the effect of pre-injury polysubstance use on outcomes in TBI patients for better risk stratification, care prioritization, and HRU (e.g., inpatient and intensive care unit (ICU) hospitalization, mechanical ventilation use, emergency department visits, imaging services, and surgery) 20 . To date, there is an evidence drought in understanding the impact of pre-injury polysubstance use on TBI outcomes, including mortality, disease severity, and HRU. Thus, our study aimed to evaluate the impact of pre-injury polysubstance use on mortality, TBI severity, and HRU among TBI patients. We hypothesized that TBI patients with pre-injury polysubstance use may have increased mortality, more severe TBI, and greater HRU compared to TBI patients without pre-injury polysubstance use. 2. Materials and Methods 2.1.1Study Design and Population This retrospective study utilized the 2017 to 2019 National Trauma Data Bank (NTDB) database 21 . The NTDB data were obtained from the American College of Surgeons. Since the study does not constitute human subjects research and the NTDB data is deidentified, it was deemed exempt by the West Virginia University Institutional Review Board. The NTDB database contains incident-based information from the electronic records of over 900 participating trauma centers on sociodemographic characteristics, injury type, vital signs, hospital events, diagnoses, comorbidities, procedures, complications, and drug and alcohol screening for U.S. trauma patients 22 . The database provides binary drug screening results for 12 different illicit substances and prescription medications, including amphetamine, barbiturates, benzodiazepines, methamphetamine, ecstasy, cocaine, opioids, oxycodone, methadone, cannabinoids, phencyclidine, and tricyclic antidepressants (TCA). Blood alcohol concentration (BAC) results are also available for these patients. Our study included trauma patients ≥ 18 years old screened for alcohol and substance use with an International Classification of Disease, 10th revision Clinical Modification (ICD-10-CM) codes for traumatic brain injury morbidity (S02.0, S02.1, S02.8, S02.91, S04.02, S04.03, S04.04, S06, and S07.1) 23 . The ICD code, T74.4, for shaken infant syndrome was excluded since we included only adults. Patients unscreened for drugs and alcohol and patients sedated or paralyzed were excluded to assess the significance of pre-injury polysubstance use on outcomes. Furthermore, only patients with isolated TBI were included by excluding patients who also had other face, neck, chest, abdomen, spine, extremity, and external injuries with the body region-specific abbreviated injury scale (AIS) score ≥3. The study comparator groups were TBI patients without substance use, single substance positive, and positive results for at least two substances. We created two polysubstance groups, polysubstance by number and polysubstance by type. The polysubstance by number group is categorized as two and ≥ three substances. The substances were first grouped for polysubstance by type based on their physiologic effect. Thus, we had stimulants (cocaine, methamphetamine, ecstasy, and amphetamine) 24 , opioids (opioids, oxycodone, and methadone) 25 , depressants (barbiturates and benzodiazepines) 26 , and cannabinoids physiologic groups. From these new classes, combinations of two or more substances were created, including cannabinoids + depressants (CD), cannabinoids + stimulants (CS), cannabinoids + opioids (CO), stimulants + depressants (SD), stimulants + opioids (SO), opioids + depressants (OD), cannabinoids + stimulants + depressants (CSD), cannabinoids + stimulants + opioids (CSO), cannabinoids + opioids + depressants (COD), stimulants + opioids + depressants (SOD), and cannabinoids + stimulants + opioids + depressants (CSOD). Patients under these different substance combinations and the physiologic groups were compared to the no substance group. The individual physiologic groups remined in the study to assess the difference in outcomes when substances are used in isolation and in combination. Patients with positive results for other unspecified substances were excluded from the study as they would not add valuable information to the interpretation of our study findings. Also, TCA and phencyclidine positive patients were also excluded from the study due to their low frequency to focus on the more commonly detected substances in TBI patients. 2.1.2 Study Variables The primary outcomes were mortality and TBI severity. Mortality was defined as death during hospitalization. Patients who died in the emergency room, declared dead on arrival or with untreatable injuries (injury severity score (ISS) = 75) 27 were excluded to ensure unbiased outcome assessment. TBI severity was defined using the head AIS score. Thus, patients with a head AIS score <3 were classified as less severe TBI and ≥3 as severe TBI 12,15,28 . The secondary outcome was HRUs which included hospital length of stays (HLOS), ICU LOS, and total ventilator days (TVD). Covariates utilized in the analyses included age, sex, race, ethnicity, trauma type, injury mechanism, and payment method. Comorbidities included psychiatric, cardiovascular, substance use disorder (SUD), alcohol use disorder (AUD), disseminated cancer, chronic obstructive pulmonary disorder (COPD), diabetes mellitus, chronic renal failure, smoking status, bleeding disorder, anticoagulant therapy, and cirrhosis. Furthermore, total GCS, systolic blood pressure (SBP), and pulse rate were included as covariates, while the odds of mortality were evaluated, as recommended by the NTDB guidelines 22 . Other covariates include head AIS category and BAC. 2.1.3 Data Analysis 2.1.3.1 Missing Data We excluded patients with missing data for the outcomes. Furthermore, we conducted a missing variable imputation for missing at random (MAR) values for pulse rate, SBP, total GCS, and BAC via predictive mean matching using the MICE package in R 29 . Missing values for categorical covariates like sex, race, ethnicity, injury mechanism, trauma type, and payment method were labeled as “Missing” and included in the data analysis. 2.1.3.2 Statistical Analysis Descriptive statistics were conducted to summarize patient characteristics in the comparison groups. Based on the distribution (normal or non-normal), mean and standard deviation or median and interquartile range was reported for each continuous patient characteristic. Patient characteristics between comparators groups were compared using the Chi-square test for categorical variables. Levene’s test for homogeneity of variance was conducted for the continuous variables and given the significant results (p <0.05). Welch’s Analysis of Variance (ANOVA) was reported for continuous variables. Bonferroni adjustment was made for multiple comparisons. Furthermore, descriptive statistics of the study outcomes for the comparison groups were compared using a chi-square test and ANOVA for categorical and continuous outcomes, respectively. Univariate logistic and negative binomial regression models were utilized to assess the relationships between the predictor variables and the categorical (mortality and TBI severity) and count (HLOS, ICU LOS and TVD) outcome variables, respectively. The negative binomial model was used to account for overdispersion within the count outcome variables. Predictors with p-values <0.25 from the univariate analysis were included alongside the primary independent variables in the adjusted multivariable logistic and negative binomial regression models used to assess the association between the comparison groups and the study outcomes. Nonetheless, the covariates were evaluated for multicollinearity before inclusion in the model, and all included covariates had a variance inflation factor (VIF) of less than 5. 2.1.3.3. Subgroup Analysis The analyses were repeated for all TBI patients (isolated and non-isolated TBI) while adjusting for other body region injuries to evaluate the effect of polysubstance use on TBI outcomes in the presence of other injuries. Other body injuries were categorized as no/minor to moderate injury (AIS ≤2) and severe injury (≥3) based on the body region-specific AIS score. 2.1.4 Statement of Ethics This study was conducted in accordance with the ethical standards laid down in the Declaration of Helsinki. The requirement for ethical approval of this study and the need to obtain informed consent was waived by the Institutional Review Board of West Virginia University. 3. Results Of 3,138,896 trauma patients in the 2017 – 2019 NTDB database (see Fig. 1), 119,316 isolated TBI patients met the inclusion criteria. Among these isolated TBI patients, 75,624 (63.4%) had no substance use, while 28,823 (24.2%), 10,681 (9.0%) and 4,188 (3.5%) tested positive for one, two and ≥three substances, respectively (Table 1). Among substance-positive TBI patients, cannabinoid (55.5%) was the most detected substance (Table 2), followed by amphetamine (26.3%), and benzodiazepines (17.3%). Interestingly, more TBI patients with polysubstance use tested positive for CS, SD, SO, CD, and CO across the three years (Fig. 2). Concerning polysubstance by number, the trend in polysubstance use was similar from 2017 to 2019, with more patients using two substances relative to ≥three substances use (Fig. 2). 3.1.1 Baseline Isolated TBI Patient Characteristics The baseline characteristics of the patients according to polysubstance by number are presented in Table 1. Majority of male patients (76.2%) used two substances. White TBI patients (72.1%) used ≥ three substances more, while black patients (23.5%) frequently ingested one substance. Two substances use occurred more in publicly insured (46.1%) and uninsured (20.0%) isolated TBI patients. However, more patients 28 – 43 years old were positive for two (38.2%) and ≥three substances (39.9%). Furthermore, more road traffic accidents (RTA) victims (51.5%%) were positive for ≥3 substances. Nevertheless, falls (43.8%) were the major mechanism of TBI in substance-negative patients. When comparing comorbidities, psychiatric comorbidities occurred more in two substance users (16.8%). Moreover, patients with no substance use had higher proportions of cardiovascular comorbidities (33.7%) and diabetes mellitus (14.0%). Meanwhile, more patients using ≥ three substances have SUD (33.0%) and were current smokers (46.1%). Mean pulse rate (92.2 beats per minute) was higher in two substance-positive patients. However, substance-negative patients had the highest mean SBP (142.79mmHg) and were older with a mean age of 51.70 years. When we compare the TBI patients by polysubstance type (supplementary file, Table S1), males more commonly used CS (80.7%), and females majorly used OD (40.4%). Between the age groups, polysubstance types detection showed an interesting variation with CD detected more in 18 – 27-year-old patients (42.5%), CSO in the 28 – 43 years group (48.0%), and OD among 44 – 64 years old patients (44.3%). Among white patients, OD (82.5%) was more detected, whereas CO (28.9%) was more common among black patients. In the between groups comparison of the descriptive statistics of study outcomes (supplementary file, Table S2), there were more deceased no substance-positive patients (4.5%). However, there were more cases of severe TBI in the two substances-positive group (38.9%). The mean HLOS (5.54 ± 8.52) and ICU LOS (4.67 ± 5.85) were longer for one substance-positive patients while TVD (5.39 ± 6.71) was highest for no substance-positive patients. Within polysubstance types, SOD-positive patients had the highest mean HLOS (6.14 ± 8.58), TVD (5.95 ± 7.48), and ICU LOS (4.92 ± 5.27). 3.1.2 Risk of Mortality in Isolated Traumatic Brain Injury Patients with Pre-injury Polysubstance Use Compared to TBI patients with no substance use, ≥three substances users (OR: 0.75 [0.59 – 0.95], p = 0.02) had significant lower odds of mortality (Table 4). The relationship with mortality was unaffected in the analysis for non-isolated TBI adjusted for other body region injuries (supplementary file, Table S3). Based on polysubstance by type, significant, increased odds of mortality was observed in TBI patients positive for CO (1.62 [1.01 – 2.58], p = 0.04). Meanwhile, SD-positive patients had lower odds of mortality (OR 0.66 [0.46 – 0.94], p = 0.02). Among single substance groups, depressant use was associated with significant, lower odds of mortality (0.76 [0.63 – 0.93], P = 0.01). Nevertheless, the odds of mortality for CO-positive patients remained high but non-significant in the non-isolated TBI analysis (supplementary file, Table S3). 3.1.3 Risk of Severe TBI in Isolated Traumatic Brain Injury Patients with Pre-injury Polysubstance Use The odds of severe TBI were highest for the two substances group (1.11 [1.05 – 1.16], p<0.0001) in Table 4. Within polysubstance types, CS was associated with the highest, significant odds of severe TBI (1.20 [1.12 – 1.28], p<0.0001). Furthermore, high, significant odds of severe TBI were observed for cannabinoid (1.10 [1.05 – 1.15], p<0.0001) and stimulant (1.09 [1.04 – 1.15], p = 0.001) only-positive patients. The non-isolated TBI analysis did not present any major deviation from the findings observed in isolated TBI patients (supplementary file, Table S3). 3.1.4 Health Resource Utilization in Isolated Traumatic Brain Injury Patients with Pre-injury Polysubstance Use The TBI patients with single (β = 0.03, p<0.0001) and two substances (0.03, p = 0.001) use had significantly higher HLOS (Table 4) when compared to no substance patients. ICU LOS, was lower but non-significant for all substance-positive groups compared to no substance patients. Similar trend was seen for TVD. Nevertheless, the relationship was significant for one (-0.06, p = 0.001) and two substances (-0.08, p = 0.002) groups. HRUs was similar and comparable in the subgroup analysis except for increased, non-significant ICU LOS (0.002, p = 0.85) for one substance-positive patients (supplementary file, Table S4). The polysubstance by type analysis presented a more elaborated relationship between polysubstance use and HRU (Table 4). The analysis revealed significant and increased HLOS for pre-injury OD use (0.07, p = 0.03), SO use (0.05, p = 0.04), and CSOD use (0.18, p = 0.001) in TBI patients. Increased, significant HLOS was also seen for the distinct single substance groups except cannabinoids only. Cannabinoid-positive patients (-0.05, p = 0.02) also had significant, shorter TVD and CO-positive patients (-0.14, p = 0.003) had significant, shorter ICU LOS. Findings from the non-isolated TBI analysis also mirror the isolated TBI analysis except for a few discrepancies (supplementary file, Table S4). For instance, CSOD (0.06, p = 0.16) was associated with increased but non-significant HLOS and the increased HLOS observed for SOD group (0.1, p = 0.02) became significant. Discussion The impact of pre-injury substance use on TBI outcomes was limited by a lack of comprehensive investigation on polysubstance use 12–14 . Most of the previous studies investigated specific substances, when used alone 12–14 . Henceforth, our study investigated and presented the impact of polysubstance use by number and type on TBI outcomes (e.g., mortality, TBI severity, and HRUs). We found that TBI patients used cannabinoids, amphetamines, benzodiazepines, cocaine, and opioids more, which agrees with the commonly reported substances in trauma patients in other studies 12,18,28,30,31 . We also found that TBI patients who were male, aged 28-43 years, white, publicly insured, or with prior history of SUD and smoking had higher pre-injury polysubstance use. These findings illuminate the challenges of specific populations with and the need of targeted interventions aimed at curtailing polysubstance use. Beside the demographic patterns, we found that TBI patients had predominant substance use combinations including CS, SD, SO, CO, and CD. When assessing the risk of mortality, most polysubstance groups had lower odds of mortality, except for CO. A look at the impact of the individual constituents of CO on mortality revealed a non-significant yet trend toward increased mortality odds (Table 3). This phenomenon might explain why the combination had high mortality odds. One study reported low mortality odds for tetrahydrocannabinol (THC)-positive TBI patients which varies from our finding 14 . Nevertheless, it’s imperative to highlight distinctions between both studies that may explain this variation. First, the study was conducted in a single center using non-isolated TBI patients without adjusting for injuries of other body regions. It was not clear if these patients were only THC-positive hence they may have had other interacting substances influencing the outcome. Additionally, the study did not account for other possible predictors of mortality like comorbidities in their logistic regression model especially since the THC-negative group were older and more likely to have confounding comorbidities which may have biased their estimate. Our study addressed these confounding factors by including only isolated TBI patients. Additionally, we ensured patients were positive for only a specific substance or combination of substances and adjusted for comorbidities. Our study also included a more nationally representative sample of TBI patients which aids the external validity of our finding. Another study found lower, non-significant mortality odds for opiate-positive trauma patients 18 . Their result differed from findings from our primary analysis which is unsurprising since the patient populations differ. Nevertheless, it does align with findings from our subgroup analysis for non-isolated TBI patients. The situation presents two possible scenarios; isolated and non-isolated TBI, when risk-stratifying opioid-positive TBI patients. It is plausible to mention that the impact of polysubstance use on TBI severity has not been broadly explored in the US population. Nevertheless, Andelic et al. reported increased odds of severe TBI in Norwegian patients with pre-injury substance use 28 . Their findings were not substance-specific and made no distinction on the impact of single or polysubstance use on TBI severity. Our study fills this gap and introduces new evidence on the unique substance combinations associated with either increased or reduced odds of severe TBI among U.S. patients. Henceforth, our study showed a significant, increased odds of severe TBI for CS-positive patients and for its component substances, cannabinoids and stimulants (Table 3). This information can guide prioritizing healthcare and resource utilization for TBI patients positive for this substance class. Our study findings uncovered that some polysubstance types including OD, SO, and CSOD were associated with higher HLOS. Additionally, we found increased HLOS for depressants, opioids, and stimulants which are the key substances in these polysubstance types. Therefore, there may be an interaction between these substances leading to higher HLOS in TBI patients. More investigation would be required to uncover any probable mechanism. Another intriguing finding is the decreased HLOS, ICU LOS, and TVD for CO-positive patients which could be related to the increased mortality odds in the group. Interestingly, it was illuminating to see that although specific polysubstance types were associated with prolonged HLOS, they were not associated with increased ICU LOS and TVD. There are documented associations between substance use and increased HLOS in TBI and other trauma patients 12,17,18 . A study found prolonged HLOS in stimulant-positive isolated TBI patients 12 . Cheng et al., reported a prolonged HLOS in trauma patients positive for amphetamine, barbiturate, benzodiazepine, cocaine, and opiate and also found shorter HLOS in polysubstance combinations with increased mortality odds 18 . Another study reported increased odds of hospital and ICU admission, and mechanical ventilation need for different polysubstance combinations in trauma patients including opioids and stimulants and opioid and benzodiazepines 17 . Nevertheless, while odds of hospital and ICU admission and mechanical ventilation need may be high for polysubstance use reported by Khadka et al. 17 , the length of stay could have a differing relationship as shown in our study for TBI patients. Our study findings expand the horizon of the information about the impact of polysubstance use on TBI outcomes. Additionally, it might be useful for identifying at-risk patients and informing healthcare decision-making tailored towards refining and optimizing patient care approaches for improved outcomes. It could also aid in planning and allocating health resources and minimizing wastage in trauma centers from the payer and provider perspectives. With limited health resource or funding availability in trauma centers 32 and the high cost of operating a trauma center 33 , an informed approach to resource allocation driven by distinct patient characteristics and needs based on substances used will improve the standard of care. The elucidated patterns of polysubstance use will also inform healthcare policymakers on the nature of the problem, the attending difficulties and burden imposed on patient care and HRU, and guide future, targeted interventions aimed at curtailing polysubstance use. Our study has several strengths. First, it investigated the intricate patterns of polysubstance use in TBI patients and the impact of these patterns on mortality, TBI severity, and HRU. This investigation will fill the evidence gap created by the growing problem of polysubstance use. Our study consolidates prior research findings and introduces new evidence on the unexplored association between depressants and opioids use and TBI outcomes and the impact of polysubstance use on TBI severity. Second, this study ensured TBI patients were positive for only the substances they were grouped into to ensure a less bias-prone analysis of the outcomes. Third, our study utilized a nationally representative dataset which enhanced its external validity. Fourth, we also included TBI patients with different disease severity levels to gain a more wholesome insight into the patient acuity. Finally, we conducted a subgroup analysis on non-isolated TBI patients to evaluate possible similarities and changes in our outcome estimates that could be attributable to the patient characteristics. Doing this also enabled us to examine the effect of pre-injury polysubstance use on the possible real-world scenarios of TBI occurrence, isolated and non-isolated TBI, among U.S. patients. Despite these strengths, this study also had some limitations. The voluntary nature of trauma centers reporting to the NTDB database may introduce a selection bias and limit generalizability of our findings. The NTDB does not report substance concentrations, which impedes the ability to investigate the dose-dependent association of polysubstance use on TBI outcomes. Furthermore, prescription medications like opioids and benzodiazepines detected in TBI patients may have been administered by emergency medical personnel or prescribed for other indications. However, there is no clear distinction about the probable use of these substances in these unique situations. Also, only 21.8% of patients in the NTDB database during the study period (Fig. 1) had drug and alcohol screening, which limited the number of participants included in the study. Furthermore, missing data, especially on important outcome variables like hospital length of stay, reduced the number of TBI patients included in certain outcome analyses. Lastly, there could be center-level variations in the care process such as the decision to admit to the ICU which was not accounted for in this study and could have influenced the HRU of TBI patients. Conclusion In conclusion, we found unique associations of pre-injury polysubstance use with mortality, severe TBI, and HRU among TBI patients. Pre-injury cannabinoids and stimulants co-use was associated with higher odds of mortality; cannabinoids and stimulants co-use was associated with increased odds of severe TBI, while opioids and depressants, stimulants and opioids, and cannabinoids, stimulants, opioids, and depressants co-use were associated with prolonged HLOS. Further studies will be needed to uncover the relationship between polysubstance use on other outcomes like TBI complications and other HRUs like surgical procedures. Future studies can also investigate the probable cellular or molecular mechanisms of increased or reduced mortality, TBI severity, and HRU associated with different substance combinations. Declarations Acknowledgement The authors thank Dr. James Bardes, M.D. for his assistance with data extraction from the National Trauma Databank database. Ethical Statement The study was performed in accordance with the ethical principles established in the Declaration of Helsinki. Ethical approval and the need to obtain informed consent were waived by the Institutional Review Board of West Virginia University. Author Contributions Statement CDE and MAA were involved in the conceptualization of this research and are responsible for the authorship and publication. CDE conducted the data cleaning, statistical analysis and writing of the initial draft of the manuscript. CDE and MAA both reviewed, edited, proof-read and approved the final manuscript. Data Availability Statement The data that supports the findings of the current study are available from the American College of Surgeons (ACS), but are not publicly available since they were used under license. However, data are available from the corresponding author upon reasonable request and with permission from ACS. Competing Interest The authors declare no competing financial or non-financial interests. 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Tables Table 1: Baseline Characteristics of Isolated Traumatic Brain Injury Patients for Polysubstance by Number Characteristics No substance, N = 75,624 (63.38) One substance, N = 28,823 (24.16) Two substances, N = 10,681 (8.95) ≥ Three substances, N = 4,188 (3.51) p-value Sex, n(%) <0.0001 Male 49,745 (65.78) 21,622 (75.02) 8,138 (76.19) 3,063 (73.14) Female 25,872 (34.21) 7,197 (24.97) 2,542 (23.80) 1,124 (26.84) Missing 7 (0.01) 4 (0.01) 1 (0.01) 1 (0.02) Age, n(%) 0.0001 18 - 27 12,844 (16.98) 8,352 (28.98) 2,906 (27.21) 1,098 (26.22) 28 - 43 15,899 (21.02) 8,916 (30.93) 4,079 (38.16) 1,669 (39.85) 44 - 64 23,372 (30.91) 8,746 (30.34) 3,184 (29.81) 1,164 (27.79) ≥65 23,509 (31.09) 2,809 (9.75) 512 (4.79) 257 (6.14) Race, n(%) <0.0001 Asian 2,471 (3.27) 375 (1.30) 114 (1.07) 42 (1.00) Pacific Islander 281 (0.37) 88 (0.31) 48 (0.45) 33 (0.79) Other 8,058 (10.66) 2,609 (9.05) 928 (8.69) 279 (6.66) American Indian 716 (0.95) 421 (1.46) 173 (1.62) 59 (1.41) Black 10,317 (13.64) 6,760 (23.45) 2,214 (20.73) 681 (16.26) White 52,493 (69.41) 18,047 (62.61) 6,984 (65.39) 3,021 (72.13) Missing 1,288 (1.70) 523 (1.81) 220 (2.06) 73 (1.74) Ethnicity, n(%) <0.0001 Hispanic/Latino 10,776 (14.25) 4,018 (13.94) 1,523 (14.26 447 (10.67) Non-Hispanic/Latino 61,767 (81.68) 23,836 (82.70) 8,808 (82.46) 2,848 (68.00) Missing 3,081 (4.07) 969 (3.36) 350 (3.28) 893 (21.32) Trauma type, n (%) <0.0001 Blunt 71,553 (94.62) 26,095 (90.54) 9,509 (89.03) 3,766 (89.92) Penetrating 1,671 (2.21) 1,426 (4.95) 630 (5.90) 221 (5.28) Other unspecified 1,288 (1.70) 831 (2.88) 341 (3.19) 141 (3.37) Missing 1,112 (1.47) 471 (1.63) 201 (1.88) 60 (1.43) Injury Mechanism, n(%) <0.0001 Fall 33,151 (43.84) 7,762 (26.93) 2,129 (19.93) 813 (19.41) Road traffic accidents 30,287 (40.05) 13,449 (46.66) 5,105 (47.80) 2,155 (51.46) Assault 8,275 (10.94) 5,473 (18.99) 2,538 (23.76) 890 (21.25) Other 2,599 (3.44) 1,467 (5.09) 644 (6.03) 253 (6.04) Missing 1.312 (1.73) 672 (2.33) 265 (2.48) 77 (1.84) Head AIS, n (%) 0.0001 Minor/moderate head injury 45,571 (60.26) 17,441 (60.51) 6,290 (58.89) 2,785 (66.50) Severe head injury 28,385 (37.53) 10,539 (36.56) 4,005 (37.50) 1,283 (30.64) Unknown 1,668 (2.21) 843 (2.92) 386 (3.61) 120 (2.87) Payment Method, n(%) <0.0001 Public 33,211 (43.92) 11,967 (41.52) 4,928 (46.14) 1,914 (45.70) Private 29,039 (38.40) 10,072 (34.94) 3,113 (29.15) 1,326 (31.66) Uninsured 8,570 (11.33) 5,113 (17.74) 2,141 (20.04) 727 (17.36) Other 3,416 (4.52) 1,261 (4.37) 379 (3.55) 109 (2.60) Missing 1,388 (1.84) 410 (1.42) 120 (1.12) 112 (2.67) Comorbidities (Yes), n(%) Psychiatric 8,765 (11.59) 4,323 (15.00) 1,793 (16.79) 663 (15.83) <0.0001 Alcohol Use Disorder 7,482 (9.89) 3,547 (12.31) 1,209 (11.32) 427 (10.20) <0.0001 Disseminated Cancer 470 (0.62) 79 (0.27) 29 (0.27) 6 (0.14) <0.0001 COPD 3,692 (4.88) 1,115 (3.87) 361 (3.38) 188 (4.49) <0.0001 Cardiovascular 25,463 (33.67) 5,547 (19.25) 1,607 (15.05) 699 (16.69) <0.0001 Diabetes Mellitus 10,549 (13.95) 1,945 (6.75) 541 (5.07) 227 (5.42) <0.0001 Chronic Renal Failure 753 (1.00) 113 (0.39) 25 (0.23) 20 (0.48) <0.0001 Smoking 13,655 (18.06) 9,895 (34.33) 4,565 (42.74) 1,930 (46.08) <0.0001 Substance Use Disorder 3,274 (4.33) 6,036 (20.94) 3,331 (31.19) 1,380 (32.95) <0.0001 Anticoagulant therapy 7,929 (10.48) 1,085 (3.76) 261 (2.44) 125 (2.98) <0.0001 Bleeding disorder 988 (1.31) 234 (0.81) 68 (0.64) 21 (0.50) <0.0001 Cirrhosis 1,021 (1.35) 328 (1.14) 119 (1.11) 45 (1.07) 0.01 Age, Mean (SD) 51.70 (20.57) 40.65 (16.90) 38.68 (14.30) 39.03 (14.97) <0.0001 Pulse rate, Mean (SD) 89.49 (19.31) 91.12 (20.47) 92.22 (20.53) 91.70 (20.55) <0.0001 Systolic Blood Pressure, Mean (SD) 142.79 (26.43) 138.62 (24.83) 137.20 (23.44) 137.07 (24.25) <0.0001 Injury Severity Score, Median (IQR) 9 (5 - 14) 9 (5 - 14) 9 (5 - 14) 8 (5 - 12) <0.0001 Total GCS, Median (IQR) 15 (14 - 15) 15 (14 - 15) 15 (14 - 15) 15 (14 - 15) <0.0001 Blood alcohol concentration, Mean (SD) 0.06 (0.11) 0.07 (0.12) 0.06 (0.10) 0.04 (0.09) <0.0001 Abbreviations: COPD (Chronic Obstructive Pulmonary Disorder), GCS (Glasgow Coma Scale), IQR (Interquartile range), SD (Standard deviation). Chi-square tests were conducted for categorical variables, and ANOVA was conducted for continuous variables. Table 2: Distribution of Substances Used Among Substance-positive Traumatic Brain Injury Patients (N = 31,524). Substances N (%) Amphetamine 8,286 (26.29) Barbiturates 1,427 (4.53) Benzodiazepines 5,451 (17.29) Cocaine 6,223 (19.74) Methamphetamine 2,818 (8.94) Ecstasy 843 (2.67) Methadone 467 (1.48) Opioid 5,233 (16.60) Oxycodone 935 (2.97) Cannabinoid 17,500 (55.51) Table 3: Adjusted Odds of Mortality and Severe TBI For Isolated Traumatic Brain Injury Patients. Mortality a TBI Severity b Groups OR (95% CI) p-value OR (95% CI) p-value Polysubstance Use by Number of Substances No Substance Ref. Ref. Ref. Ref. One substance 0.96 (0.87 - 1.05) 0.37 1.07 (1.03 - 1.10) 0.0002 Two Substances 0.94 (0.81 - 1.09) 0.4 1.11 (1.05 - 1.16) <0.0001 ≥Three Substances 0.75 (0.59 - 0.95) 0.02 0.80 (0.73 - 0.87) <0.0001 Polysubstance Use by Type of Substances No Substance Ref. Ref. Ref. Ref. One Substances Cannabinoids 1.04 (0.91 - 1.18) 0.57 1.10 (1.05 - 1.15) <0.0001 Depressants 0.76 (0.63 - 0.93) 0.01 1.07 (0.98 - 1.16) 0.12 Opioids 1.03 (0.78 - 1.35) 0.86 0.93 (0.85 - 1.00) 0.06 Stimulants 0.99 (0.85 - 1.16) 0.91 1.09 (1.04 - 1.15) 0.001 Two Substances Cannabinoids and Depressants 0.87 (0.62 - 1.23) 0.44 1.04 (0.92 - 1.19) 0.53 Cannabinoids and Opioids 1.62 (1.01 - 2.58) 0.04 1.15 (0.99 - 1.33) 0.06 Cannabinoids and Stimulants 0.92 (0.75 - 1.13) 0.42 1.20 (1.12 - 1.28) <0.0001 Opioids and Depressants 0.72 (0.43 - 1.21) 0.21 0.87 (0.73 - 1.03) 0.1 Stimulants and Depressants 0.66 (0.46 - 0.94) 0.02 0.62 (0.54 - 0.70) <0.0001 Stimulants and Opioids 0.92 (0.56 - 1.50) 0.73 1.14 (0.99 - 1.30) 0.06 ≥Three Substances Cannabinoids, Opioids and Depressants 0.46 (0.17 - 1.19) 0.11 0.94 (0.70 - 1.26) 0.68 Cannabinoids, Stimulants and Depressants 0.63 (0.38 - 1.05) 0.08 0.88 (0.73 - 1.07) 0.2 Cannabinoids, Stimulants and Opioids 1.17 (0.64 - 2.14) 0.61 1.12 (0.93 - 1.34) 0.23 Stimulants, Opioids and Depressants 0.95 (0.42 - 2.16) 0.91 0.94 (0.71 - 1.24) 0.66 Cannabinoids, Stimulants, Opioids and Depressants 0.93 (0.36 - 2.36) 0.87 0.79 (0.60 - 1.06) 0.12 a Model was adjusted for age, sex, race, ethnicity, trauma type, injury mechanism, payment method, comorbidities (psychiatric, COPD, cardiovascular, diabetes, cancer, smoking status, renal, anticoagulant use, bleeding, cirrhosis, SUD, pulse rate, SBP, BAC, head AIS, and total GCS. b Model was adjusted for age, sex, race, ethnicity, trauma type, injury mechanism, payment method, comorbidities (AUD, COPD, cardiovascular, diabetes, cancer, smoking status, renal, anticoagulant use, bleeding, cirrhosis, SUD, pulse rate, SBP, BAC, and total GCS. Table 4: Adjusted Negative Binomial Regression Analysis of Health Resource Utilization in Isolated Traumatic Brain Injury Patients. Hospital Length of Stay (HLOS) a ICU Length of Stay (ICULOS) b Total Ventilator Days (TVD) c Groups Estimate p-value Estimate p-value Estimate p-value Polysubstance Use by Number of Substances No Substance Ref. Ref. Ref. Ref. Ref. Ref. One substance 0.03 <0.0001 -0.01 0.54 -0.06 0.001 Two Substances 0.03 0.001 -0.02 0.18 -0.08 0.002 ≥Three Substances 0.02 0.17 -0.02 0.47 -0.04 0.26 Polysubstance Use by Type of Substances No Substance Ref. Ref. Ref. Ref. Ref. Ref. One substance Cannabinoids -0.02 0.05 -0.01 0.41 -0.05 0.02 Depressants 0.06 0.0004 -0.02 0.35 -0.13 0.0003 Opioids 0.06 0.0001 -0.03 0.32 -0.06 0.35 Stimulants 0.1 <0.0001 0.01 0.57 -0.03 0.25 Two substances Cannabinoids and Depressants 0.001 0.97 -0.03 0.38 -0.08 0.11 Cannabinoids and Opioids -0.04 0.12 -0.14 0.003 -0.15 0.1 Cannabinoids and Stimulants 0.01 0.41 -0.01 0.82 -0.07 0.03 Opioids and Depressants 0.07 0.03 0.03 0.6 -0.12 0.22 Stimulants and Depressants -0.03 0.11 -0.01 0.9 -0.05 0.36 Stimulants and Opioids 0.05 0.04 -0.02 0.64 -0.1 0.23 ≥Three substances Cannabinoids, Opioids and Depressants -0.07 0.18 -0.11 0.24 -0.14 0.36 Cannabinoids, Stimulants and Depressants 0.01 0.81 -0.01 0.8 -0.02 0.77 Cannabinoids, Stimulants and Opioids 0.05 0.16 0.03 0.56 0.1 0.32 Stimulants, Opioids and Depressants 0.1 0.06 0.03 0.67 0.06 0.6 Cannabinoids, Stimulants, Opioids and Depressants 0.18 0.001 0.05 0.58 -0.07 0.63 a Model was adjusted for age, sex, race, trauma type, injury mechanism, payment method, comorbidities (psychiatric, AUD, COPD, cardiovascular, diabetes, cancer, renal, anticoagulant use, bleeding, cirrhosis, SUD, pulse rate, SBP, BAC, head AIS, and total GCS. b Model was adjusted for age, sex, race, trauma type, injury mechanism, payment method, comorbidities (AUD, COPD, cardiovascular, diabetes, smoking status, renal, anticoagulant use, bleeding, cirrhosis, SUD, pulse rate, SBP, BAC, head AIS, and total GCS. c Model was adjusted for age, sex, race, ethnicity, trauma type, injury mechanism, payment method, comorbidities (COPD, AUD, cardiovascular, diabetes, cancer, smoking status, renal, anticoagulant use, bleeding, cirrhosis, pulse rate, SBP, BAC, head AIS, and total GCS. Additional Declarations No competing interests reported. Supplementary Files Supplemetaryinformationfile.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 05 Apr, 2026 Reviewers agreed at journal 22 Mar, 2026 Reviewers agreed at journal 14 Jan, 2026 Reviewers invited by journal 27 Nov, 2025 Editor assigned by journal 09 Jun, 2025 Editor invited by journal 17 Feb, 2025 Submission checks completed at journal 14 Feb, 2025 First submitted to journal 12 Feb, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-6017336\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":false,\"archivedVersions\":[],\"articleType\":\"Article\",\"associatedPublications\":[],\"authors\":[{\"id\":468478300,\"identity\":\"a24c3d64-72d7-45fe-80cf-9637374982db\",\"order_by\":0,\"name\":\"Chisom D. 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(A) Polysubstance by Type. (B) Polysubstance by Number.\\u003c/p\\u003e\\n\\u003cp\\u003eAbbreviations: NS (No substance), C (Cannabinoids), D (Depressants), O (Opioids), S (Stimulants), CD (Cannabinoids + depressants), CO (Cannabinoids + opioids), CS (Cannabinoids + stimulants), OD (Opioids + depressants), SD (Stimulants + depressants), SO (Stimulants + opioids), COD (Cannabinoids + opioids + depressants), CSD (Cannabinoids + stimulants + depressants), CSO (Cannabinoids + stimulants + opioids), SOD (Stimulants + opioids + depressants), CSOD (Cannabinoids + stimulants + opioids + depressants)\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"floatimage2.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6017336/v1/c882a7df1062e2de6d8c5bb9.png\"},{\"id\":87243331,\"identity\":\"c9e3d868-2cf2-415f-859f-ef51178662b1\",\"added_by\":\"auto\",\"created_at\":\"2025-07-22 01:56:53\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":1895715,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6017336/v1/3eb035b7-ffdd-48cf-a794-8b10fd074533.pdf\"},{\"id\":87242037,\"identity\":\"acbe16b5-7293-4b53-9e18-8babb689bb28\",\"added_by\":\"auto\",\"created_at\":\"2025-07-22 01:40:52\",\"extension\":\"docx\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":50127,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"Supplemetaryinformationfile.docx\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6017336/v1/74b2ca89b8879acabf2692db.docx\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"The Role of Pre-injury Polysubstance Use on Traumatic Brain Injury and its Impact on Health Resource Utilization Among the U.S. Trauma Patients\",\"fulltext\":[{\"header\":\"1. Background\",\"content\":\"\\u003cp\\u003eTraumatic Brain Injury (TBI) is a penetrating or blunt injury causing temporary or permanent disruption of brain function\\u003csup\\u003e1\\u0026ndash;3\\u003c/sup\\u003e. According to the Centers for Disease Control and Prevention (CDC) estimates, 1.5 million people in the U.S. experience TBI annually, with 5.3 million Americans living with a permanent TBI-related disability\\u003csup\\u003e4\\u003c/sup\\u003e. Non-fatal TBI is responsible for an estimated annual healthcare expenditure of over $40.6 billion in 2016\\u003csup\\u003e5\\u003c/sup\\u003e. Although TBI-related hospitalization dropped to 214,000 in 2020 compared to 288,00 in 2014, TBI-related mortality increased by 18% in 2021\\u003csup\\u003e2,6,7\\u003c/sup\\u003e. Compared to women, men are nearly twice and thrice more likely to be hospitalized and die from TBI, respectively\\u003csup\\u003e6\\u003c/sup\\u003e. TBI patients in trauma centers consist primarily of fall and motor vehicle accident victims, often mediated by substance and alcohol use\\u003csup\\u003e2,8\\u003c/sup\\u003e. Numerous studies and reviews have reported pre-injury illicit drug and alcohol use ranges of 10-81% and 22-81%, respectively, in TBI trauma patients\\u003csup\\u003e8\\u0026ndash;15\\u003c/sup\\u003e. A recent study found that 64% of substance users abuse one substance type; nevertheless, there is a growing case of multiple/polysubstance use\\u003csup\\u003e16\\u003c/sup\\u003e. The term polysubstance use can be defined as the concurrent or simultaneous use or misuse of more than one illicit substance or prescription medication. To date, limited studies have evaluated the impact of pre-injury polysubstance use on mortality and health resource utilization (HRU) among U.S. trauma patients but not in TBI patients\\u003csup\\u003e17,18\\u003c/sup\\u003e. Further, there is a critical need to evaluate how pre-injury polysubstance use impacts TBI outcomes and patterns of HRU related to it. \\u0026nbsp; \\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eTBI patients with prior substance use have been associated with lower admitting Glasgow Coma Scale (GCS), during admission\\u003csup\\u003e19\\u003c/sup\\u003e. Pre-injury stimulant use in TBI patients was associated with reduced mortality and higher mechanical ventilation duration\\u003csup\\u003e12,13\\u003c/sup\\u003e. Additionally, marijuana use has also been associated with reduced mortality in TBI patients\\u003csup\\u003e14\\u003c/sup\\u003e. U.S. trauma patients who combined either benzodiazepine and opiate or amphetamine and barbiturate had a higher odds of mortality\\u003csup\\u003e18\\u003c/sup\\u003e. However, Khadka et al. reported lower odds of mortality for U.S. trauma patients with opioid-related pre-injury polysubstance use, except for combinations of opioids and stimulants\\u003csup\\u003e17\\u003c/sup\\u003e. The study population equally had higher odds for hospital admission and need for mechanical ventilation\\u003csup\\u003e17\\u003c/sup\\u003e. Nevertheless, combinations with other substances can precipitate differing outcomes, which could be detrimental to patients and burdensome to the healthcare system. It is warranted to evaluate the effect of pre-injury polysubstance use on outcomes in TBI patients for better risk stratification, care prioritization, and HRU (e.g., inpatient and intensive care unit (ICU) hospitalization, mechanical ventilation use, emergency department visits, imaging services, and surgery)\\u003csup\\u003e20\\u003c/sup\\u003e.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eTo date, there is an evidence drought in understanding the impact of pre-injury polysubstance use on TBI outcomes, including mortality, disease severity, and HRU. Thus, our study aimed to evaluate the impact of pre-injury polysubstance use on mortality, TBI severity, and HRU among TBI patients. We hypothesized that TBI patients with pre-injury polysubstance use may have increased mortality, more severe TBI, and greater HRU compared to TBI patients without pre-injury polysubstance use. \\u0026nbsp;\\u003c/p\\u003e\"},{\"header\":\"2. Materials and Methods\",\"content\":\"\\u003ch3\\u003e2.1.1Study Design and Population\\u003c/h3\\u003e\\n\\u003cp\\u003eThis retrospective study utilized the 2017 to 2019 National Trauma Data Bank (NTDB) database\\u003csup\\u003e21\\u003c/sup\\u003e. The NTDB data were obtained from the American College of Surgeons. Since the study does not constitute human subjects research and the NTDB data is deidentified, it was deemed exempt by the West Virginia University Institutional Review Board. The NTDB database contains incident-based information from the electronic records of over 900 participating trauma centers on sociodemographic characteristics, injury type, vital signs, hospital events, diagnoses, comorbidities, procedures, complications, and drug and alcohol screening for U.S. trauma patients\\u003csup\\u003e22\\u003c/sup\\u003e. \\u0026nbsp; The database provides binary drug screening results for 12 different illicit substances and prescription medications, including amphetamine, barbiturates, benzodiazepines, methamphetamine, ecstasy, cocaine, opioids, oxycodone, methadone, cannabinoids, phencyclidine, and tricyclic antidepressants (TCA). Blood alcohol concentration (BAC) results are also available for these patients.\\u003c/p\\u003e\\n\\u003cp\\u003eOur study included trauma patients \\u0026ge; 18 years old screened for alcohol and substance use with an International Classification of Disease, 10th revision Clinical Modification (ICD-10-CM) codes for traumatic brain injury morbidity (S02.0, S02.1, S02.8, S02.91, S04.02, S04.03, S04.04, S06, and S07.1)\\u003csup\\u003e23\\u003c/sup\\u003e. The ICD code, T74.4, for shaken infant syndrome was excluded since we included only adults. Patients unscreened for drugs and alcohol and patients sedated or paralyzed were excluded to assess the significance of pre-injury polysubstance use on outcomes. Furthermore, only patients with isolated TBI were included by excluding patients who also had other face, neck, chest, abdomen, spine, extremity, and external injuries with the body region-specific abbreviated injury scale (AIS) score \\u0026ge;3.\\u003c/p\\u003e\\n\\u003cp\\u003eThe study comparator groups were TBI patients without substance use, single substance positive, and positive results for at least two substances. We created two polysubstance groups, polysubstance by number and polysubstance by type. The polysubstance by number group is categorized as two and \\u0026ge; three substances. The substances were first grouped for polysubstance by type based on their physiologic effect. Thus, we had stimulants (cocaine, methamphetamine, ecstasy, and amphetamine)\\u003csup\\u003e24\\u003c/sup\\u003e, opioids (opioids, oxycodone, and methadone)\\u003csup\\u003e25\\u003c/sup\\u003e, depressants (barbiturates and benzodiazepines)\\u003csup\\u003e26\\u003c/sup\\u003e, and cannabinoids physiologic groups. From these new classes, combinations of two or more substances were created, including cannabinoids + depressants (CD), cannabinoids + stimulants (CS), cannabinoids + opioids (CO), stimulants + depressants (SD), stimulants + opioids (SO), opioids + depressants (OD), cannabinoids + stimulants + depressants (CSD), cannabinoids + stimulants + opioids (CSO), cannabinoids + opioids + depressants (COD), stimulants + opioids + depressants (SOD), and cannabinoids + stimulants + opioids + depressants (CSOD). Patients under these different substance combinations and the physiologic groups were compared to the no substance group. The individual physiologic groups remined in the study to assess the difference in outcomes when substances are used in isolation and in combination. Patients with positive results for other unspecified substances were excluded from the study as they would not add valuable information to the interpretation of our study findings. Also, TCA and phencyclidine positive patients were also excluded from the study due to their low frequency to focus on the more commonly detected substances in TBI patients.\\u003c/p\\u003e\\n\\u003ch3\\u003e2.1.2 Study Variables\\u003c/h3\\u003e\\n\\u003cp\\u003eThe primary outcomes were mortality and TBI severity. Mortality was defined as death during hospitalization. Patients who died in the emergency room, declared dead on arrival or with untreatable injuries (injury severity score (ISS) = 75)\\u003csup\\u003e27\\u003c/sup\\u003e were excluded to ensure unbiased outcome assessment. TBI severity was defined using the head AIS score. Thus, patients with a head AIS score \\u0026lt;3 were classified as less severe TBI and \\u0026ge;3 as severe TBI\\u003csup\\u003e12,15,28\\u003c/sup\\u003e. The secondary outcome was HRUs which included hospital length of stays (HLOS), ICU LOS, and total ventilator days (TVD).\\u003c/p\\u003e\\n\\u003cp\\u003eCovariates utilized in the analyses included age, sex, race, ethnicity, trauma type, injury mechanism, and payment method. Comorbidities included psychiatric, cardiovascular, substance use disorder (SUD), alcohol use disorder (AUD), disseminated cancer, chronic obstructive pulmonary disorder (COPD), diabetes mellitus, chronic renal failure, smoking status, bleeding disorder, anticoagulant therapy, and cirrhosis. Furthermore, total GCS, systolic blood pressure (SBP), and pulse rate were included as covariates, while the odds of mortality were evaluated, as recommended by the NTDB guidelines\\u003csup\\u003e22\\u003c/sup\\u003e. Other covariates include head AIS category and BAC.\\u003c/p\\u003e\\n\\u003ch3\\u003e2.1.3 Data Analysis\\u003c/h3\\u003e\\n\\u003ch4\\u003e2.1.3.1 Missing Data\\u003c/h4\\u003e\\n\\u003cp\\u003eWe excluded patients with missing data for the outcomes. Furthermore, we conducted a missing variable imputation for missing at random (MAR) values for pulse rate, SBP, total GCS, and BAC via predictive mean matching using the MICE package in R\\u003csup\\u003e29\\u003c/sup\\u003e. Missing values for categorical covariates like sex, race, ethnicity, injury mechanism, trauma type, and payment method were labeled as \\u0026ldquo;Missing\\u0026rdquo; and included in the data analysis.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003ch4\\u003e2.1.3.2 Statistical Analysis\\u003c/h4\\u003e\\n\\u003cp\\u003eDescriptive statistics were conducted to summarize patient characteristics in the comparison groups. Based on the distribution (normal or non-normal), mean and standard deviation or median and interquartile range was reported for each continuous patient characteristic. Patient characteristics between comparators groups were compared using the Chi-square test for categorical variables. Levene\\u0026rsquo;s test for homogeneity of variance was conducted for the continuous variables and given the significant results (p \\u0026lt;0.05). Welch\\u0026rsquo;s Analysis of Variance (ANOVA) was reported for continuous variables. Bonferroni adjustment was made for multiple comparisons. Furthermore, descriptive statistics of the study outcomes for the comparison groups were compared using a chi-square test and ANOVA for categorical and continuous outcomes, respectively.\\u003c/p\\u003e\\n\\u003cp\\u003eUnivariate logistic and negative binomial regression models were utilized to assess the relationships between the predictor variables and the categorical (mortality and TBI severity) and count (HLOS, ICU LOS and TVD) outcome variables, respectively. The negative binomial model was used to account for overdispersion within the count outcome variables. Predictors with p-values \\u0026lt;0.25 from the univariate analysis were included alongside the primary independent variables in the adjusted multivariable logistic and negative binomial regression models used to assess the association between the comparison groups and the study outcomes. Nonetheless, the covariates were evaluated for multicollinearity before inclusion in the model, and all included covariates had a variance inflation factor (VIF) of less than 5.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003ch4\\u003e2.1.3.3. Subgroup Analysis\\u003c/h4\\u003e\\n\\u003cp\\u003eThe analyses were repeated for all TBI patients (isolated and non-isolated TBI) while adjusting for other body region injuries to evaluate the effect of polysubstance use on TBI outcomes in the presence of other injuries. Other body injuries were categorized as no/minor to moderate injury (AIS \\u0026le;2) and severe injury (\\u0026ge;3) based on the body region-specific AIS score.\\u003c/p\\u003e\\n\\u003ch3\\u003e2.1.4 Statement of Ethics\\u003c/h3\\u003e\\n\\u003cp\\u003eThis study was conducted in accordance with the ethical standards laid down in the Declaration of Helsinki. \\u0026nbsp;The requirement for ethical approval of this study and the need to obtain informed consent was waived by the Institutional Review Board of West Virginia University.\\u003c/p\\u003e\"},{\"header\":\"3. Results\",\"content\":\"\\u003cp\\u003eOf 3,138,896 trauma patients in the 2017 \\u0026ndash; 2019 NTDB database (see Fig. 1), 119,316 isolated TBI patients met the inclusion criteria. Among these isolated TBI patients, 75,624 (63.4%) had no substance use, while 28,823 (24.2%), 10,681 (9.0%) and 4,188 (3.5%) tested positive for one, two and \\u0026ge;three substances, respectively (Table 1). Among substance-positive TBI patients, cannabinoid (55.5%) was the most detected substance (Table 2), followed by amphetamine (26.3%), and benzodiazepines (17.3%). Interestingly, more TBI patients with polysubstance use tested positive for CS, SD, SO, CD, and CO across the three years (Fig. 2). Concerning polysubstance by number, the trend in polysubstance use was similar from 2017 to 2019, with more patients using two substances relative to \\u0026ge;three substances use (Fig. 2).\\u003c/p\\u003e\\n\\u003ch3\\u003e3.1.1 Baseline Isolated TBI Patient Characteristics\\u003c/h3\\u003e\\n\\u003cp\\u003eThe baseline characteristics of the patients according to polysubstance by number are presented in Table 1. Majority of male patients (76.2%) used two substances. White TBI patients (72.1%) used \\u0026ge; three substances more, while black patients (23.5%) frequently ingested one substance. Two substances use occurred more in publicly insured (46.1%) and uninsured (20.0%) isolated TBI patients. However, more patients 28 \\u0026ndash; 43 years old were positive for two (38.2%) and \\u0026ge;three substances (39.9%). Furthermore, more road traffic accidents (RTA) victims (51.5%%) were positive for \\u0026ge;3 substances. Nevertheless, falls (43.8%) were the major mechanism of TBI in substance-negative patients. When comparing comorbidities, psychiatric comorbidities occurred more in two substance users (16.8%). Moreover, patients with no substance use had higher proportions of cardiovascular comorbidities (33.7%) and diabetes mellitus (14.0%). Meanwhile, more patients using \\u0026ge; three substances have SUD (33.0%) and were current smokers (46.1%). \\u0026nbsp;Mean pulse rate (92.2 beats per minute) was higher in two substance-positive patients. However, substance-negative patients had the highest mean SBP (142.79mmHg) and were older with a mean age of 51.70 years.\\u003c/p\\u003e\\n\\u003cp\\u003eWhen we compare the TBI patients by polysubstance type (supplementary file, Table S1), males more commonly used CS (80.7%), and females majorly used OD (40.4%). Between the age groups, polysubstance types detection showed an interesting variation with CD detected more in 18 \\u0026ndash; 27-year-old patients (42.5%), CSO in the 28 \\u0026ndash; 43 years group (48.0%), and OD among 44 \\u0026ndash; 64 years old patients (44.3%). Among white patients, OD (82.5%) was more detected, whereas CO (28.9%) was more common among black patients. In the between groups comparison of the descriptive statistics of study outcomes (supplementary file, Table S2), there were more deceased no substance-positive patients (4.5%). However, there were more cases of severe TBI in the two substances-positive group (38.9%). The mean HLOS (5.54 \\u0026plusmn; 8.52) and ICU LOS (4.67 \\u0026plusmn; 5.85) were longer for one substance-positive patients while TVD (5.39 \\u0026plusmn; 6.71) was highest for no substance-positive patients. Within polysubstance types, SOD-positive patients had the highest mean HLOS (6.14 \\u0026plusmn; 8.58), TVD (5.95 \\u0026plusmn; 7.48), and ICU LOS (4.92 \\u0026plusmn; 5.27).\\u003c/p\\u003e\\n\\u003ch3\\u003e3.1.2 Risk of Mortality in Isolated Traumatic Brain Injury Patients with Pre-injury Polysubstance Use\\u003c/h3\\u003e\\n\\u003cp\\u003eCompared to TBI patients with no substance use, \\u0026ge;three substances users (OR: 0.75 [0.59 \\u0026ndash; 0.95], p = 0.02) had significant lower odds of mortality (Table 4). The relationship with mortality was unaffected in the analysis for non-isolated TBI adjusted for other body region injuries (supplementary file, Table S3).\\u003c/p\\u003e\\n\\u003cp\\u003eBased on polysubstance by type, significant, increased odds of mortality was observed in TBI patients positive for CO (1.62 [1.01 \\u0026ndash; 2.58], p = 0.04). Meanwhile, SD-positive patients had lower odds of mortality (OR 0.66 [0.46 \\u0026ndash; 0.94], p = 0.02). Among single substance groups, depressant use was associated with significant, lower odds of mortality (0.76 [0.63 \\u0026ndash; 0.93], P = 0.01). Nevertheless, the odds of mortality for CO-positive patients remained high but non-significant in the non-isolated TBI analysis (supplementary file, Table S3).\\u003c/p\\u003e\\n\\u003ch3\\u003e3.1.3 Risk of Severe TBI in Isolated Traumatic Brain Injury Patients with Pre-injury Polysubstance Use\\u003c/h3\\u003e\\n\\u003cp\\u003eThe odds of severe TBI were highest for the two substances group (1.11 [1.05 \\u0026ndash; 1.16], p\\u0026lt;0.0001) in Table 4.\\u003c/p\\u003e\\n\\u003cp\\u003eWithin polysubstance types, CS was associated with the highest, significant odds of severe TBI (1.20 [1.12 \\u0026ndash; 1.28], p\\u0026lt;0.0001). Furthermore, high, significant odds of severe TBI were observed for cannabinoid (1.10 [1.05 \\u0026ndash; 1.15], p\\u0026lt;0.0001) and stimulant (1.09 [1.04 \\u0026ndash; 1.15], p = 0.001) only-positive patients. The non-isolated TBI analysis did not present any major deviation from the findings observed in isolated TBI patients (supplementary file, Table S3).\\u0026nbsp;\\u003c/p\\u003e\\n\\u003ch3\\u003e3.1.4 Health Resource Utilization in Isolated Traumatic Brain Injury Patients with Pre-injury Polysubstance Use\\u003c/h3\\u003e\\n\\u003cp\\u003eThe TBI patients with single (\\u0026beta; = 0.03, p\\u0026lt;0.0001) and two substances (0.03, p = 0.001) use had significantly higher HLOS (Table 4) when compared to no substance patients. ICU LOS, was lower but non-significant for all substance-positive groups compared to no substance patients. Similar trend was seen for TVD. Nevertheless, the relationship was significant for one (-0.06, p = 0.001) and two substances (-0.08, p = 0.002) groups. HRUs was similar and comparable in the subgroup analysis except for increased, non-significant ICU LOS (0.002, p = 0.85) for one substance-positive patients (supplementary file, Table S4).\\u003c/p\\u003e\\n\\u003cp\\u003eThe polysubstance by type analysis presented a more elaborated relationship between polysubstance use and HRU (Table 4). The analysis revealed significant and increased HLOS for pre-injury OD use (0.07, p = 0.03), SO use (0.05, p = 0.04), and CSOD use (0.18, p = 0.001) in TBI patients. \\u0026nbsp; Increased, significant HLOS was also seen for the distinct single substance groups except cannabinoids only. Cannabinoid-positive patients (-0.05, p = 0.02) also had significant, shorter TVD and CO-positive patients (-0.14, p = 0.003) had significant, shorter ICU LOS. \\u0026nbsp;Findings from the non-isolated TBI analysis also mirror the isolated TBI analysis except for a few discrepancies (supplementary file, Table S4). For instance, CSOD (0.06, p = 0.16) was associated with increased but non-significant HLOS and the increased HLOS observed for SOD group (0.1, p = 0.02) became significant.\\u0026nbsp;\\u003c/p\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eThe impact of pre-injury substance use on TBI outcomes was limited by a lack of comprehensive investigation on polysubstance use\\u003csup\\u003e12\\u0026ndash;14\\u003c/sup\\u003e. Most of the previous studies investigated specific substances, when used alone\\u003csup\\u003e12\\u0026ndash;14\\u003c/sup\\u003e. Henceforth, our study investigated and presented the impact of polysubstance use by number and type on TBI outcomes (e.g., mortality, TBI severity, and HRUs). We found that TBI patients used cannabinoids, amphetamines, benzodiazepines, cocaine, and opioids more, which agrees with the commonly reported substances in trauma patients in other studies\\u003csup\\u003e12,18,28,30,31\\u003c/sup\\u003e. We also found that TBI patients who were male, aged 28-43 years, white, publicly insured, or with prior history of SUD and smoking had higher pre-injury polysubstance use. These findings illuminate the challenges of specific populations with and the need of targeted interventions aimed at curtailing polysubstance use. Beside the demographic patterns, we found that TBI patients had predominant substance use combinations including CS, SD, SO, CO, and CD.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eWhen assessing the risk of mortality, most polysubstance groups had lower odds of mortality, except for CO. A look at the impact of the individual constituents of CO on mortality revealed a non-significant yet trend toward increased mortality odds (Table 3). This phenomenon might explain why the combination had high mortality odds. One study reported low mortality odds for tetrahydrocannabinol (THC)-positive TBI patients which varies from our finding\\u003csup\\u003e14\\u003c/sup\\u003e. Nevertheless, it\\u0026rsquo;s imperative to highlight distinctions between both studies that may explain this variation. First, the study was conducted in a single center using non-isolated TBI patients without adjusting for injuries of other body regions. It was not clear if these patients were only THC-positive hence they may have had other interacting substances influencing the outcome. Additionally, the study did not account for other possible predictors of mortality like comorbidities in their logistic regression model especially since the THC-negative group were older and more likely to have confounding comorbidities which may have biased their estimate. Our study addressed these confounding factors by including only isolated TBI patients. Additionally, we ensured patients were positive for only a specific substance or combination of substances and adjusted for comorbidities. Our study also included a more nationally representative sample of TBI patients which aids the external validity of our finding. Another study found lower, non-significant mortality odds for opiate-positive trauma patients\\u003csup\\u003e18\\u003c/sup\\u003e. Their result differed from findings from our primary analysis which is unsurprising since the patient populations differ. Nevertheless, it does align with findings from our subgroup analysis for non-isolated TBI patients. The situation presents two possible scenarios; isolated and non-isolated TBI, when risk-stratifying opioid-positive TBI patients. \\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eIt is plausible to mention that the impact of polysubstance use on TBI severity has not been broadly explored in the US population. Nevertheless, Andelic et al. reported increased odds of severe TBI in Norwegian patients with pre-injury substance use\\u003csup\\u003e28\\u003c/sup\\u003e. Their findings were not substance-specific and made no distinction on the impact of single or polysubstance use on TBI severity. Our study fills this gap and introduces new evidence on the unique substance combinations associated with either increased or reduced odds of severe TBI among U.S. patients. Henceforth, our study showed a significant, increased odds of severe TBI for CS-positive patients and for its component substances, cannabinoids and stimulants (Table 3). This information can guide prioritizing healthcare and resource utilization for TBI patients positive for this substance class.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eOur study findings uncovered that some polysubstance types including OD, SO, and CSOD were associated with higher HLOS. Additionally, we found increased HLOS for depressants, opioids, and stimulants which are the key substances in these polysubstance types. Therefore, there may be an interaction between these substances leading to higher HLOS in TBI patients. More investigation would be required to uncover any probable mechanism. Another intriguing finding is the decreased HLOS, ICU LOS, and TVD for CO-positive patients which could be related to the increased mortality odds in the group. Interestingly, it was illuminating to see that although specific polysubstance types were associated with prolonged HLOS, they were not associated with increased ICU LOS and TVD. There are documented associations between substance use and increased HLOS in TBI and other trauma patients\\u003csup\\u003e12,17,18\\u003c/sup\\u003e. A study found prolonged HLOS in stimulant-positive isolated TBI patients\\u003csup\\u003e12\\u003c/sup\\u003e. Cheng et al., reported a prolonged HLOS in trauma patients positive for amphetamine, barbiturate, benzodiazepine, cocaine, and opiate and also found shorter HLOS in polysubstance combinations with increased mortality odds\\u003csup\\u003e18\\u003c/sup\\u003e. Another study reported increased odds of hospital and ICU admission, and mechanical ventilation need for different polysubstance combinations in trauma patients including opioids and stimulants and opioid and benzodiazepines\\u003csup\\u003e17\\u003c/sup\\u003e. Nevertheless, while odds of hospital and ICU admission and mechanical ventilation need may be high for polysubstance use reported by Khadka et al.\\u003csup\\u003e17\\u003c/sup\\u003e, the length of stay could have a differing relationship as shown in our study for TBI patients.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eOur study findings expand the horizon of the information about the impact of polysubstance use on TBI outcomes. Additionally, it might be useful for identifying at-risk patients and informing healthcare decision-making tailored towards refining and optimizing patient care approaches for improved outcomes. It could also aid in planning and allocating health resources and minimizing wastage in trauma centers from the payer and provider perspectives. With limited health resource or funding availability in trauma centers\\u003csup\\u003e32\\u003c/sup\\u003e and the high cost of operating a trauma center\\u003csup\\u003e33\\u003c/sup\\u003e, an informed approach to resource allocation driven by distinct patient characteristics and needs based on substances used will improve the standard of care. The elucidated patterns of polysubstance use will also inform healthcare policymakers on the nature of the problem, the attending difficulties and burden imposed on patient care and HRU, and guide future, targeted interventions aimed at curtailing polysubstance use. \\u0026nbsp;\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eOur study has several strengths. First, it investigated the intricate patterns of polysubstance use in TBI patients and the impact of these patterns on mortality, TBI severity, and HRU. This investigation will fill the evidence gap created by the growing problem of polysubstance use. Our study consolidates prior research findings and introduces new evidence on the unexplored association between depressants and opioids use and TBI outcomes and the impact of polysubstance use on TBI severity. Second, this study ensured TBI patients were positive for only the substances they were grouped into to ensure a less bias-prone analysis of the outcomes. Third, our study utilized a nationally representative dataset which enhanced its external validity. Fourth, we also included TBI patients with different disease severity levels to gain a more wholesome insight into the patient acuity. Finally, we conducted a subgroup analysis on non-isolated TBI patients to evaluate possible similarities and changes in our outcome estimates that could be attributable to the patient characteristics. Doing this also enabled us to examine the effect of pre-injury polysubstance use on the possible real-world scenarios of TBI occurrence, isolated and non-isolated TBI, among U.S. patients.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eDespite these strengths, this study also had some limitations. The voluntary nature of trauma centers reporting to the NTDB database may introduce a selection bias and limit generalizability of our findings. The NTDB does not report substance concentrations, which impedes the ability to investigate the dose-dependent association of polysubstance use on TBI outcomes. Furthermore, prescription medications like opioids and benzodiazepines detected in TBI patients may have been administered by emergency medical personnel or prescribed for other indications. However, there is no clear distinction about the probable use of these substances in these unique situations. Also, only 21.8% of patients in the NTDB database during the study period (Fig. 1) had drug and alcohol screening, which limited the number of participants included in the study. Furthermore, missing data, especially on important outcome variables like hospital length of stay, reduced the number of TBI patients included in certain outcome analyses. Lastly, there could be center-level variations in the care process such as the decision to admit to the ICU which was not accounted for in this study and could have influenced the HRU of TBI patients.\\u003c/p\\u003e\"},{\"header\":\"Conclusion\",\"content\":\"\\u003cp\\u003eIn conclusion, we found unique associations of pre-injury polysubstance use with mortality, severe TBI, and HRU among TBI patients. Pre-injury cannabinoids and stimulants co-use was associated with higher odds of mortality; cannabinoids and stimulants co-use was associated with increased odds of severe TBI, while opioids and depressants, stimulants and opioids, and cannabinoids, stimulants, opioids, and depressants co-use were associated with prolonged HLOS. Further studies will be needed to uncover the relationship between polysubstance use on other outcomes like TBI complications and other HRUs like surgical procedures. Future studies can also investigate the probable cellular or molecular mechanisms of increased or reduced mortality, TBI severity, and HRU associated with different substance combinations.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003ch2\\u003eAcknowledgement\\u003c/h2\\u003e\\n\\u003cp\\u003eThe authors thank Dr. James Bardes, M.D. for his assistance with data extraction from the National Trauma Databank database.\\u003c/p\\u003e\\n\\u003ch2\\u003eEthical Statement\\u003c/h2\\u003e\\n\\u003cp\\u003eThe study was performed in accordance with the ethical principles established in the Declaration of Helsinki. Ethical approval and the need to obtain informed consent were waived by the Institutional Review Board of West Virginia University.\\u003c/p\\u003e\\n\\u003ch2\\u003eAuthor Contributions Statement\\u003c/h2\\u003e\\n\\u003cp\\u003eCDE and MAA were involved in the conceptualization of this research and are responsible for the authorship and publication. CDE conducted the data cleaning, statistical analysis and writing of the initial draft of the manuscript. CDE and MAA both reviewed, edited, proof-read and approved the final manuscript.\\u003c/p\\u003e\\n\\u003ch2\\u003eData Availability Statement\\u003c/h2\\u003e\\n\\u003cp\\u003eThe data that supports the findings of the current study are available from the American College of Surgeons (ACS), but are not publicly available since they were used under license. However, data are available from the corresponding author upon reasonable request and with permission from ACS.\\u003c/p\\u003e\\n\\u003ch2\\u003eCompeting Interest\\u003c/h2\\u003e\\n\\u003cp\\u003eThe authors declare no competing financial or non-financial interests.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n\\u003cli\\u003eTraumatic Brain Injury (TBI) | National Institute of Neurological Disorders and Stroke. https://www.ninds.nih.gov/health-information/disorders/traumatic-brain-injury-tbi.\\u003c/li\\u003e\\n\\u003cli\\u003eCapizzi, A., Woo, J. \\u0026amp; Verduzco-Gutierrez, M. Traumatic Brain Injury: An Overview of Epidemiology, Pathophysiology, and Medical Management. \\u003cem\\u003eMed. Clin. North Am.\\u003c/em\\u003e \\u003cstrong\\u003e104\\u003c/strong\\u003e, 213\\u0026ndash;238 (2020).\\u003c/li\\u003e\\n\\u003cli\\u003eWhat are the possible effects of traumatic brain injury (TBI)? | NICHD - Eunice Kennedy Shriver National Institute of Child Health and Human Development. https://www.nichd.nih.gov/health/topics/tbi/conditioninfo/effects (2020).\\u003c/li\\u003e\\n\\u003cli\\u003eReport to Congress: Traumatic Brain Injury in the United States | Concussion | Traumatic Brain Injury | CDC Injury Center. https://www.cdc.gov/traumaticbraininjury/pubs/tbi_report_to_congress.html (2019).\\u003c/li\\u003e\\n\\u003cli\\u003eCDC. Cost of Injury \\u0026amp; Violence. \\u003cem\\u003eCenters for Disease Control and Prevention\\u003c/em\\u003e https://www.cdc.gov/injury/features/health-econ-cost-of-injury/index.html (2023).\\u003c/li\\u003e\\n\\u003cli\\u003eTBI Data | Concussion | Traumatic Brain Injury | CDC Injury Center. https://www.cdc.gov/traumaticbraininjury/data/index.html (2023).\\u003c/li\\u003e\\n\\u003cli\\u003eTraumatic Brain Injury / Concussion | Concussion | Traumatic Brain Injury | CDC Injury Center. https://www.cdc.gov/traumaticbraininjury/index.html (2023).\\u003c/li\\u003e\\n\\u003cli\\u003eWilliams, H. \\u003cem\\u003eet al.\\u003c/em\\u003e Epidemiology of Adults Receiving Acute Inpatient Rehabilitation for a Primary Diagnosis of Traumatic Brain Injury in the United States. \\u003cem\\u003eJ. Head Trauma Rehabil.\\u003c/em\\u003e \\u003cstrong\\u003e30\\u003c/strong\\u003e, 122\\u0026ndash;135 (2015).\\u003c/li\\u003e\\n\\u003cli\\u003eTaylor, L. A., Kreutzer, J. S., Demm, S. R. \\u0026amp; Meade, M. A. Traumatic brain injury and substance abuse: A review and analysis of the literature. \\u003cem\\u003eNeuropsychol. Rehabil.\\u003c/em\\u003e \\u003cstrong\\u003e13\\u003c/strong\\u003e, 165\\u0026ndash;188 (2003).\\u003c/li\\u003e\\n\\u003cli\\u003eParry-Jones, B. L., Vaughan, F. L. \\u0026amp; Miles Cox, W. Traumatic brain injury and substance misuse: A systematic review of prevalence and outcomes research (1994\\u0026ndash;2004). \\u003cem\\u003eNeuropsychol. Rehabil.\\u003c/em\\u003e \\u003cstrong\\u003e16\\u003c/strong\\u003e, 537\\u0026ndash;560 (2006).\\u003c/li\\u003e\\n\\u003cli\\u003eWest, S. L. Substance use among persons with traumatic brain injury: A review. \\u003cem\\u003eNeuroRehabilitation\\u003c/em\\u003e \\u003cstrong\\u003e29\\u003c/strong\\u003e, 1\\u0026ndash;8 (2011).\\u003c/li\\u003e\\n\\u003cli\\u003eJakob, D. A. \\u003cem\\u003eet al.\\u003c/em\\u003e Pre-injury stimulant use in isolated severe traumatic brain injury: effect on outcomes. \\u003cem\\u003eEur. J. Trauma Emerg. Surg.\\u003c/em\\u003e \\u003cstrong\\u003e49\\u003c/strong\\u003e, 1683\\u0026ndash;1691 (2023).\\u003c/li\\u003e\\n\\u003cli\\u003eYeung, J. T., Williams, J. \\u0026amp; Bowling, W. M. Effect of cocaine use on outcomes in traumatic brain injury. \\u003cem\\u003eJ. Emerg. Trauma Shock\\u003c/em\\u003e \\u003cstrong\\u003e6\\u003c/strong\\u003e, 189\\u0026ndash;194 (2013).\\u003c/li\\u003e\\n\\u003cli\\u003eNguyen, B. M. \\u003cem\\u003eet al.\\u003c/em\\u003e Effect of Marijuana Use on Outcomes in Traumatic Brain Injury. \\u003cem\\u003eAm. Surg.\\u003c/em\\u003e \\u003cstrong\\u003e80\\u003c/strong\\u003e, 979\\u0026ndash;983 (2014).\\u003c/li\\u003e\\n\\u003cli\\u003evan Wijck, S. F. \\u003cem\\u003eet al.\\u003c/em\\u003e Association between alcohol intoxication and mortality in severe traumatic brain injury in the emergency department: a retrospective cohort. \\u003cem\\u003eEur. J. Emerg. Med.\\u003c/em\\u003e \\u003cstrong\\u003e28\\u003c/strong\\u003e, 97\\u0026ndash;103 (2021).\\u003c/li\\u003e\\n\\u003cli\\u003eBailey, A. J. \\u0026amp; McHugh, R. K. Why do we focus on the exception and not the rule? Examining the prevalence of mono- versus polysubstance use in the general population. \\u003cem\\u003eAddiction\\u003c/em\\u003e \\u003cstrong\\u003e118\\u003c/strong\\u003e, 2026\\u0026ndash;2029 (2023).\\u003c/li\\u003e\\n\\u003cli\\u003eKhadka, S., Bardes, J. M. \\u0026amp; Al-Mamun, M. A. Opioid-related polysubstance use and its effect on mortality and health resource utilization among trauma patients. \\u003cem\\u003eInj. Epidemiol.\\u003c/em\\u003e \\u003cstrong\\u003e10\\u003c/strong\\u003e, 54 (2023).\\u003c/li\\u003e\\n\\u003cli\\u003eCheng, V. \\u003cem\\u003eet al.\\u003c/em\\u003e The impact of pre-injury controlled substance use on clinical outcomes after trauma. \\u003cem\\u003eJ. Trauma Acute Care Surg.\\u003c/em\\u003e \\u003cstrong\\u003e81\\u003c/strong\\u003e, 913\\u0026ndash;920 (2016).\\u003c/li\\u003e\\n\\u003cli\\u003eKelly, M. P., Johnson, C. T., Knoller, N., Drubach, D. A. \\u0026amp; Winslow, M. M. Substance abuse, traumatic brain injury and neuropsychological outcome. \\u003cem\\u003eBrain Inj.\\u003c/em\\u003e \\u003cstrong\\u003e11\\u003c/strong\\u003e, 391\\u0026ndash;402 (1997).\\u003c/li\\u003e\\n\\u003cli\\u003eDismuke, C. E., Walker, R. J. \\u0026amp; Egede, L. E. Utilization and Cost of Health Services in Individuals With Traumatic Brain Injury. \\u003cem\\u003eGlob. J. Health Sci.\\u003c/em\\u003e \\u003cstrong\\u003e7\\u003c/strong\\u003e, 156\\u0026ndash;169 (2015).\\u003c/li\\u003e\\n\\u003cli\\u003eAbout NTDB. \\u003cem\\u003eACS\\u003c/em\\u003e https://www.facs.org/quality-programs/trauma/quality/national-trauma-data-bank/about-ntdb/.\\u003c/li\\u003e\\n\\u003cli\\u003eHashmi, Z. G., Kaji, A. H. \\u0026amp; Nathens, A. B. Practical Guide to Surgical Data Sets: National Trauma Data Bank (NTDB). \\u003cem\\u003eJAMA Surg.\\u003c/em\\u003e \\u003cstrong\\u003e153\\u003c/strong\\u003e, 852\\u0026ndash;853 (2018).\\u003c/li\\u003e\\n\\u003cli\\u003eHedegaard, H., Johnson, R. L., Warner, M., Chen, L.-H. \\u0026amp; Annest, J. L. Proposed Framework for Presenting Injury Data Using the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) Diagnosis Codes. \\u003cem\\u003eNatl. Health Stat. Rep.\\u003c/em\\u003e 1\\u0026ndash;20 (2016).\\u003c/li\\u003e\\n\\u003cli\\u003eStimulants. https://www.dea.gov/factsheets/stimulants.\\u003c/li\\u003e\\n\\u003cli\\u003ePrescription Opioids | Opioids | CDC. https://www.cdc.gov/opioids/basics/prescribed.html (2021).\\u003c/li\\u003e\\n\\u003cli\\u003eDepressants. https://www.dea.gov/factsheets/depressants.\\u003c/li\\u003e\\n\\u003cli\\u003eManagement, I. of T. and I. Injury scoring. \\u003cem\\u003eInstitute of Trauma and Injury Management\\u003c/em\\u003e https://aci.health.nsw.gov.au/networks/trauma/data/injury-scoring (2021).\\u003c/li\\u003e\\n\\u003cli\\u003eAndelic, N. \\u003cem\\u003eet al.\\u003c/em\\u003e Effects of acute substance use and pre-injury substance abuse on traumatic brain injury severity in adults admitted to a trauma centre. \\u003cem\\u003eJ. Trauma Manag. Outcomes\\u003c/em\\u003e \\u003cstrong\\u003e4\\u003c/strong\\u003e, 6 (2010).\\u003c/li\\u003e\\n\\u003cli\\u003eAustin, P. C., White, I. R., Lee, D. S. \\u0026amp; van Buuren, S. Missing Data in Clinical Research: A Tutorial on Multiple Imputation. \\u003cem\\u003eCan. J. Cardiol.\\u003c/em\\u003e \\u003cstrong\\u003e37\\u003c/strong\\u003e, 1322\\u0026ndash;1331 (2021).\\u003c/li\\u003e\\n\\u003cli\\u003eO\\u0026rsquo;Phelan, K., McArthur, D. L., Chang, C. W. J., Green, D. \\u0026amp; Hovda, D. A. The impact of substance abuse on mortality in patients with severe traumatic brain injury. \\u003cem\\u003eJ. Trauma\\u003c/em\\u003e \\u003cstrong\\u003e65\\u003c/strong\\u003e, 674\\u0026ndash;677 (2008).\\u003c/li\\u003e\\n\\u003cli\\u003eShymon, S. J. \\u003cem\\u003eet al.\\u003c/em\\u003e Current illicit drug use profile of orthopaedic trauma patients and its effect on hospital length of stay. \\u003cem\\u003eInjury\\u003c/em\\u003e \\u003cstrong\\u003e51\\u003c/strong\\u003e, 887\\u0026ndash;891 (2020).\\u003c/li\\u003e\\n\\u003cli\\u003eThe 5 biggest challenges facing community and rural trauma centers \\u0026ndash; Trauma System News. https://trauma-news.com/2024/09/the-5-biggest-challenges-facing-community-and-rural-trauma-centers/.\\u003c/li\\u003e\\n\\u003cli\\u003eFracasso, J. L. \\u0026amp; Ahmed, N. Trauma centers: an underfunded but essential asset to the community. \\u003cem\\u003eTrauma Surg. Acute Care Open\\u003c/em\\u003e \\u003cstrong\\u003e9\\u003c/strong\\u003e, e001436 (2024).\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"},{\"header\":\"Tables\",\"content\":\"\\u003cp\\u003eTable 1: Baseline Characteristics of Isolated Traumatic Brain Injury Patients for Polysubstance by Number\\u003c/p\\u003e\\n\\u003ctable border=\\\"0\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"752\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30.3191%;\\\"\\u003e\\n \\u003cp\\u003eCharacteristics\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 13.5638%;\\\"\\u003e\\n \\u003cp\\u003eNo substance, N = 75,624 (63.38)\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 15.9574%;\\\"\\u003e\\n \\u003cp\\u003eOne substance, N = 28,823 (24.16)\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 16.7553%;\\\"\\u003e\\n \\u003cp\\u003eTwo substances, N = 10,681 (8.95)\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 14.3617%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026ge; Three substances, N = 4,188 (3.51)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.04255%;\\\"\\u003e\\n \\u003cp\\u003ep-value\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30.3191%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eSex, n(%)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 13.5638%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 15.9574%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 16.7553%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 14.3617%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.04255%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026lt;0.0001\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30.3191%;\\\"\\u003e\\n \\u003cp\\u003eMale\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 13.5638%;\\\"\\u003e\\n \\u003cp\\u003e49,745 (65.78)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 15.9574%;\\\"\\u003e\\n \\u003cp\\u003e21,622 (75.02)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 16.7553%;\\\"\\u003e\\n \\u003cp\\u003e8,138 (76.19)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 14.3617%;\\\"\\u003e\\n \\u003cp\\u003e3,063 (73.14)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.04255%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30.3191%;\\\"\\u003e\\n \\u003cp\\u003eFemale\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 13.5638%;\\\"\\u003e\\n \\u003cp\\u003e25,872 (34.21)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 15.9574%;\\\"\\u003e\\n \\u003cp\\u003e7,197 (24.97)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 16.7553%;\\\"\\u003e\\n \\u003cp\\u003e2,542 (23.80)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 14.3617%;\\\"\\u003e\\n \\u003cp\\u003e1,124 (26.84)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.04255%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30.3191%;\\\"\\u003e\\n \\u003cp\\u003eMissing\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 13.5638%;\\\"\\u003e\\n \\u003cp\\u003e7 (0.01)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 15.9574%;\\\"\\u003e\\n \\u003cp\\u003e4 (0.01)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 16.7553%;\\\"\\u003e\\n \\u003cp\\u003e1 (0.01)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 14.3617%;\\\"\\u003e\\n \\u003cp\\u003e1 (0.02)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.04255%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30.3191%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eAge, n(%)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 13.5638%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 15.9574%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 16.7553%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 14.3617%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.04255%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.0001\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30.3191%;\\\"\\u003e\\n \\u003cp\\u003e18 - 27\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 13.5638%;\\\"\\u003e\\n \\u003cp\\u003e12,844 (16.98)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 15.9574%;\\\"\\u003e\\n \\u003cp\\u003e8,352 (28.98)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 16.7553%;\\\"\\u003e\\n \\u003cp\\u003e2,906 (27.21)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 14.3617%;\\\"\\u003e\\n \\u003cp\\u003e1,098 (26.22)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.04255%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30.3191%;\\\"\\u003e\\n \\u003cp\\u003e28 - 43\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 13.5638%;\\\"\\u003e\\n \\u003cp\\u003e15,899 (21.02)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 15.9574%;\\\"\\u003e\\n \\u003cp\\u003e8,916 (30.93)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 16.7553%;\\\"\\u003e\\n \\u003cp\\u003e4,079 (38.16)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 14.3617%;\\\"\\u003e\\n \\u003cp\\u003e1,669 (39.85)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.04255%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30.3191%;\\\"\\u003e\\n \\u003cp\\u003e44 - 64\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 13.5638%;\\\"\\u003e\\n \\u003cp\\u003e23,372 (30.91)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 15.9574%;\\\"\\u003e\\n \\u003cp\\u003e8,746 (30.34)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 16.7553%;\\\"\\u003e\\n \\u003cp\\u003e3,184 (29.81)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 14.3617%;\\\"\\u003e\\n \\u003cp\\u003e1,164 (27.79)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.04255%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30.3191%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026ge;65\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 13.5638%;\\\"\\u003e\\n \\u003cp\\u003e23,509 (31.09)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 15.9574%;\\\"\\u003e\\n \\u003cp\\u003e2,809 (9.75)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 16.7553%;\\\"\\u003e\\n \\u003cp\\u003e512 (4.79)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 14.3617%;\\\"\\u003e\\n 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Islander\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 13.5638%;\\\"\\u003e\\n \\u003cp\\u003e281 (0.37)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 15.9574%;\\\"\\u003e\\n \\u003cp\\u003e88 (0.31)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 16.7553%;\\\"\\u003e\\n \\u003cp\\u003e48 (0.45)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 14.3617%;\\\"\\u003e\\n \\u003cp\\u003e33 (0.79)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.04255%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30.3191%;\\\"\\u003e\\n \\u003cp\\u003eOther\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 13.5638%;\\\"\\u003e\\n \\u003cp\\u003e8,058 (10.66)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 15.9574%;\\\"\\u003e\\n \\u003cp\\u003e2,609 (9.05)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 16.7553%;\\\"\\u003e\\n \\u003cp\\u003e928 (8.69)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 14.3617%;\\\"\\u003e\\n \\u003cp\\u003e279 (6.66)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.04255%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30.3191%;\\\"\\u003e\\n \\u003cp\\u003eAmerican Indian\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 13.5638%;\\\"\\u003e\\n \\u003cp\\u003e716 (0.95)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 15.9574%;\\\"\\u003e\\n \\u003cp\\u003e421 (1.46)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 16.7553%;\\\"\\u003e\\n \\u003cp\\u003e173 (1.62)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 14.3617%;\\\"\\u003e\\n \\u003cp\\u003e59 (1.41)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.04255%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30.3191%;\\\"\\u003e\\n \\u003cp\\u003eBlack\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 13.5638%;\\\"\\u003e\\n \\u003cp\\u003e10,317 (13.64)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 15.9574%;\\\"\\u003e\\n \\u003cp\\u003e6,760 (23.45)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 16.7553%;\\\"\\u003e\\n \\u003cp\\u003e2,214 (20.73)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 14.3617%;\\\"\\u003e\\n \\u003cp\\u003e681 (16.26)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.04255%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30.3191%;\\\"\\u003e\\n \\u003cp\\u003eWhite\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 13.5638%;\\\"\\u003e\\n \\u003cp\\u003e52,493 (69.41)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 15.9574%;\\\"\\u003e\\n \\u003cp\\u003e18,047 (62.61)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 16.7553%;\\\"\\u003e\\n \\u003cp\\u003e6,984 (65.39)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 14.3617%;\\\"\\u003e\\n \\u003cp\\u003e3,021 (72.13)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.04255%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30.3191%;\\\"\\u003e\\n \\u003cp\\u003eMissing\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 13.5638%;\\\"\\u003e\\n \\u003cp\\u003e1,288 (1.70)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 15.9574%;\\\"\\u003e\\n \\u003cp\\u003e523 (1.81)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 16.7553%;\\\"\\u003e\\n \\u003cp\\u003e220 (2.06)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 14.3617%;\\\"\\u003e\\n \\u003cp\\u003e73 (1.74)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.04255%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30.3191%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eEthnicity, n(%)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 13.5638%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 15.9574%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 16.7553%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 14.3617%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.04255%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026lt;0.0001\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30.3191%;\\\"\\u003e\\n \\u003cp\\u003eHispanic/Latino\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 13.5638%;\\\"\\u003e\\n \\u003cp\\u003e10,776 (14.25)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 15.9574%;\\\"\\u003e\\n \\u003cp\\u003e4,018 (13.94)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 16.7553%;\\\"\\u003e\\n \\u003cp\\u003e1,523 (14.26\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 14.3617%;\\\"\\u003e\\n \\u003cp\\u003e447 (10.67)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.04255%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30.3191%;\\\"\\u003e\\n \\u003cp\\u003eNon-Hispanic/Latino\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 13.5638%;\\\"\\u003e\\n \\u003cp\\u003e61,767 (81.68)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 15.9574%;\\\"\\u003e\\n \\u003cp\\u003e23,836 (82.70)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 16.7553%;\\\"\\u003e\\n \\u003cp\\u003e8,808 (82.46)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 14.3617%;\\\"\\u003e\\n \\u003cp\\u003e2,848 (68.00)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.04255%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30.3191%;\\\"\\u003e\\n \\u003cp\\u003eMissing\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 13.5638%;\\\"\\u003e\\n \\u003cp\\u003e3,081 (4.07)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 15.9574%;\\\"\\u003e\\n \\u003cp\\u003e969 (3.36)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 16.7553%;\\\"\\u003e\\n \\u003cp\\u003e350 (3.28)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 14.3617%;\\\"\\u003e\\n \\u003cp\\u003e893 (21.32)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.04255%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30.3191%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eTrauma type, n (%)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 13.5638%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 15.9574%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 16.7553%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 14.3617%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.04255%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026lt;0.0001\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30.3191%;\\\"\\u003e\\n \\u003cp\\u003eBlunt\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 13.5638%;\\\"\\u003e\\n \\u003cp\\u003e71,553 (94.62)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 15.9574%;\\\"\\u003e\\n \\u003cp\\u003e26,095 (90.54)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 16.7553%;\\\"\\u003e\\n \\u003cp\\u003e9,509 (89.03)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 14.3617%;\\\"\\u003e\\n \\u003cp\\u003e3,766 (89.92)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.04255%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30.3191%;\\\"\\u003e\\n \\u003cp\\u003ePenetrating\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 13.5638%;\\\"\\u003e\\n \\u003cp\\u003e1,671 (2.21)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 15.9574%;\\\"\\u003e\\n \\u003cp\\u003e1,426 (4.95)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 16.7553%;\\\"\\u003e\\n \\u003cp\\u003e630 (5.90)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 14.3617%;\\\"\\u003e\\n \\u003cp\\u003e221 (5.28)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.04255%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30.3191%;\\\"\\u003e\\n \\u003cp\\u003eOther unspecified\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 13.5638%;\\\"\\u003e\\n \\u003cp\\u003e1,288 (1.70)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 15.9574%;\\\"\\u003e\\n \\u003cp\\u003e831 (2.88)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 16.7553%;\\\"\\u003e\\n \\u003cp\\u003e341 (3.19)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 14.3617%;\\\"\\u003e\\n \\u003cp\\u003e141 (3.37)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.04255%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30.3191%;\\\"\\u003e\\n \\u003cp\\u003eMissing\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 13.5638%;\\\"\\u003e\\n \\u003cp\\u003e1,112 (1.47)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 15.9574%;\\\"\\u003e\\n \\u003cp\\u003e471 (1.63)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 16.7553%;\\\"\\u003e\\n \\u003cp\\u003e201 (1.88)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 14.3617%;\\\"\\u003e\\n \\u003cp\\u003e60 (1.43)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.04255%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30.3191%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eInjury Mechanism, n(%)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 13.5638%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 15.9574%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 16.7553%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 14.3617%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.04255%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026lt;0.0001\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30.3191%;\\\"\\u003e\\n \\u003cp\\u003eFall\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 13.5638%;\\\"\\u003e\\n \\u003cp\\u003e33,151 (43.84)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 15.9574%;\\\"\\u003e\\n \\u003cp\\u003e7,762 (26.93)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 16.7553%;\\\"\\u003e\\n \\u003cp\\u003e2,129 (19.93)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 14.3617%;\\\"\\u003e\\n \\u003cp\\u003e813 (19.41)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.04255%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30.3191%;\\\"\\u003e\\n \\u003cp\\u003eRoad traffic accidents\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 13.5638%;\\\"\\u003e\\n \\u003cp\\u003e30,287 (40.05)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 15.9574%;\\\"\\u003e\\n \\u003cp\\u003e13,449 (46.66)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 16.7553%;\\\"\\u003e\\n \\u003cp\\u003e5,105 (47.80)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 14.3617%;\\\"\\u003e\\n \\u003cp\\u003e2,155 (51.46)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.04255%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30.3191%;\\\"\\u003e\\n \\u003cp\\u003eAssault\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 13.5638%;\\\"\\u003e\\n \\u003cp\\u003e8,275 (10.94)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 15.9574%;\\\"\\u003e\\n \\u003cp\\u003e5,473 (18.99)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 16.7553%;\\\"\\u003e\\n \\u003cp\\u003e2,538 (23.76)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 14.3617%;\\\"\\u003e\\n \\u003cp\\u003e890 (21.25)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.04255%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30.3191%;\\\"\\u003e\\n \\u003cp\\u003eOther\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 13.5638%;\\\"\\u003e\\n \\u003cp\\u003e2,599 (3.44)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 15.9574%;\\\"\\u003e\\n \\u003cp\\u003e1,467 (5.09)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 16.7553%;\\\"\\u003e\\n \\u003cp\\u003e644 (6.03)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 14.3617%;\\\"\\u003e\\n \\u003cp\\u003e253 (6.04)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.04255%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30.3191%;\\\"\\u003e\\n \\u003cp\\u003eMissing\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 13.5638%;\\\"\\u003e\\n \\u003cp\\u003e1.312 (1.73)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 15.9574%;\\\"\\u003e\\n \\u003cp\\u003e672 (2.33)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 16.7553%;\\\"\\u003e\\n \\u003cp\\u003e265 (2.48)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 14.3617%;\\\"\\u003e\\n \\u003cp\\u003e77 (1.84)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.04255%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30.3191%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eHead AIS, n (%)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 13.5638%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 15.9574%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 16.7553%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 14.3617%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.04255%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.0001\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30.3191%;\\\"\\u003e\\n \\u003cp\\u003eMinor/moderate head injury\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 13.5638%;\\\"\\u003e\\n \\u003cp\\u003e45,571 (60.26)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 15.9574%;\\\"\\u003e\\n \\u003cp\\u003e17,441 (60.51)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 16.7553%;\\\"\\u003e\\n \\u003cp\\u003e6,290 (58.89)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 14.3617%;\\\"\\u003e\\n \\u003cp\\u003e2,785 (66.50)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.04255%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30.3191%;\\\"\\u003e\\n \\u003cp\\u003eSevere head injury\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 13.5638%;\\\"\\u003e\\n \\u003cp\\u003e28,385 (37.53)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 15.9574%;\\\"\\u003e\\n \\u003cp\\u003e10,539 (36.56)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 16.7553%;\\\"\\u003e\\n \\u003cp\\u003e4,005 (37.50)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 14.3617%;\\\"\\u003e\\n \\u003cp\\u003e1,283 (30.64)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.04255%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30.3191%;\\\"\\u003e\\n \\u003cp\\u003eUnknown\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 13.5638%;\\\"\\u003e\\n \\u003cp\\u003e1,668 (2.21)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 15.9574%;\\\"\\u003e\\n \\u003cp\\u003e843 (2.92)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 16.7553%;\\\"\\u003e\\n \\u003cp\\u003e386 (3.61)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 14.3617%;\\\"\\u003e\\n \\u003cp\\u003e120 (2.87)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.04255%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30.3191%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ePayment Method, n(%)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 13.5638%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 15.9574%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 16.7553%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 14.3617%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.04255%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026lt;0.0001\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30.3191%;\\\"\\u003e\\n \\u003cp\\u003ePublic\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 13.5638%;\\\"\\u003e\\n \\u003cp\\u003e33,211 (43.92)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 15.9574%;\\\"\\u003e\\n \\u003cp\\u003e11,967 (41.52)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 16.7553%;\\\"\\u003e\\n \\u003cp\\u003e4,928 (46.14)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 14.3617%;\\\"\\u003e\\n \\u003cp\\u003e1,914 (45.70)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.04255%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30.3191%;\\\"\\u003e\\n \\u003cp\\u003ePrivate\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 13.5638%;\\\"\\u003e\\n \\u003cp\\u003e29,039 (38.40)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 15.9574%;\\\"\\u003e\\n \\u003cp\\u003e10,072 (34.94)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 16.7553%;\\\"\\u003e\\n \\u003cp\\u003e3,113 (29.15)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 14.3617%;\\\"\\u003e\\n \\u003cp\\u003e1,326 (31.66)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.04255%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30.3191%;\\\"\\u003e\\n \\u003cp\\u003eUninsured\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 13.5638%;\\\"\\u003e\\n \\u003cp\\u003e8,570 (11.33)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 15.9574%;\\\"\\u003e\\n \\u003cp\\u003e5,113 (17.74)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 16.7553%;\\\"\\u003e\\n \\u003cp\\u003e2,141 (20.04)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 14.3617%;\\\"\\u003e\\n \\u003cp\\u003e727 (17.36)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.04255%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30.3191%;\\\"\\u003e\\n \\u003cp\\u003eOther\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 13.5638%;\\\"\\u003e\\n \\u003cp\\u003e3,416 (4.52)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 15.9574%;\\\"\\u003e\\n \\u003cp\\u003e1,261 (4.37)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 16.7553%;\\\"\\u003e\\n \\u003cp\\u003e379 (3.55)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 14.3617%;\\\"\\u003e\\n \\u003cp\\u003e109 (2.60)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.04255%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30.3191%;\\\"\\u003e\\n \\u003cp\\u003eMissing\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 13.5638%;\\\"\\u003e\\n \\u003cp\\u003e1,388 (1.84)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 15.9574%;\\\"\\u003e\\n \\u003cp\\u003e410 (1.42)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 16.7553%;\\\"\\u003e\\n \\u003cp\\u003e120 (1.12)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 14.3617%;\\\"\\u003e\\n \\u003cp\\u003e112 (2.67)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.04255%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30.3191%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eComorbidities (Yes), n(%)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 13.5638%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 15.9574%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 16.7553%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 14.3617%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.04255%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30.3191%;\\\"\\u003e\\n \\u003cp\\u003ePsychiatric\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 13.5638%;\\\"\\u003e\\n \\u003cp\\u003e8,765 (11.59)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 15.9574%;\\\"\\u003e\\n \\u003cp\\u003e4,323 (15.00)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 16.7553%;\\\"\\u003e\\n \\u003cp\\u003e1,793 (16.79)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 14.3617%;\\\"\\u003e\\n \\u003cp\\u003e663 (15.83)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.04255%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026lt;0.0001\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30.3191%;\\\"\\u003e\\n \\u003cp\\u003eAlcohol Use Disorder\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 13.5638%;\\\"\\u003e\\n \\u003cp\\u003e7,482 (9.89)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 15.9574%;\\\"\\u003e\\n \\u003cp\\u003e3,547 (12.31)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 16.7553%;\\\"\\u003e\\n \\u003cp\\u003e1,209 (11.32)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 14.3617%;\\\"\\u003e\\n \\u003cp\\u003e427 (10.20)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.04255%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026lt;0.0001\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30.3191%;\\\"\\u003e\\n \\u003cp\\u003eDisseminated Cancer\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 13.5638%;\\\"\\u003e\\n \\u003cp\\u003e470 (0.62)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 15.9574%;\\\"\\u003e\\n \\u003cp\\u003e79 (0.27)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 16.7553%;\\\"\\u003e\\n \\u003cp\\u003e29 (0.27)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 14.3617%;\\\"\\u003e\\n \\u003cp\\u003e6 (0.14)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.04255%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026lt;0.0001\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30.3191%;\\\"\\u003e\\n \\u003cp\\u003eCOPD\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 13.5638%;\\\"\\u003e\\n \\u003cp\\u003e3,692 (4.88)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 15.9574%;\\\"\\u003e\\n \\u003cp\\u003e1,115 (3.87)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 16.7553%;\\\"\\u003e\\n \\u003cp\\u003e361 (3.38)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 14.3617%;\\\"\\u003e\\n \\u003cp\\u003e188 (4.49)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.04255%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026lt;0.0001\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30.3191%;\\\"\\u003e\\n \\u003cp\\u003eCardiovascular\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 13.5638%;\\\"\\u003e\\n \\u003cp\\u003e25,463 (33.67)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 15.9574%;\\\"\\u003e\\n \\u003cp\\u003e5,547 (19.25)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 16.7553%;\\\"\\u003e\\n \\u003cp\\u003e1,607 (15.05)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 14.3617%;\\\"\\u003e\\n \\u003cp\\u003e699 (16.69)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.04255%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026lt;0.0001\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30.3191%;\\\"\\u003e\\n \\u003cp\\u003eDiabetes Mellitus\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 13.5638%;\\\"\\u003e\\n \\u003cp\\u003e10,549 (13.95)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 15.9574%;\\\"\\u003e\\n \\u003cp\\u003e1,945 (6.75)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 16.7553%;\\\"\\u003e\\n \\u003cp\\u003e541 (5.07)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 14.3617%;\\\"\\u003e\\n \\u003cp\\u003e227 (5.42)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.04255%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026lt;0.0001\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30.3191%;\\\"\\u003e\\n \\u003cp\\u003eChronic Renal Failure\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 13.5638%;\\\"\\u003e\\n \\u003cp\\u003e753 (1.00)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 15.9574%;\\\"\\u003e\\n \\u003cp\\u003e113 (0.39)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 16.7553%;\\\"\\u003e\\n \\u003cp\\u003e25 (0.23)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 14.3617%;\\\"\\u003e\\n \\u003cp\\u003e20 (0.48)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.04255%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026lt;0.0001\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30.3191%;\\\"\\u003e\\n \\u003cp\\u003eSmoking\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 13.5638%;\\\"\\u003e\\n \\u003cp\\u003e13,655 (18.06)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 15.9574%;\\\"\\u003e\\n \\u003cp\\u003e9,895 (34.33)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 16.7553%;\\\"\\u003e\\n \\u003cp\\u003e4,565 (42.74)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 14.3617%;\\\"\\u003e\\n \\u003cp\\u003e1,930 (46.08)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.04255%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026lt;0.0001\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30.3191%;\\\"\\u003e\\n \\u003cp\\u003eSubstance Use Disorder\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 13.5638%;\\\"\\u003e\\n \\u003cp\\u003e3,274 (4.33)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 15.9574%;\\\"\\u003e\\n \\u003cp\\u003e6,036 (20.94)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 16.7553%;\\\"\\u003e\\n \\u003cp\\u003e3,331 (31.19)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 14.3617%;\\\"\\u003e\\n \\u003cp\\u003e1,380 (32.95)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.04255%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026lt;0.0001\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30.3191%;\\\"\\u003e\\n \\u003cp\\u003eAnticoagulant therapy\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 13.5638%;\\\"\\u003e\\n \\u003cp\\u003e7,929 (10.48)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 15.9574%;\\\"\\u003e\\n \\u003cp\\u003e1,085 (3.76)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 16.7553%;\\\"\\u003e\\n \\u003cp\\u003e261 (2.44)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 14.3617%;\\\"\\u003e\\n \\u003cp\\u003e125 (2.98)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.04255%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026lt;0.0001\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30.3191%;\\\"\\u003e\\n \\u003cp\\u003eBleeding disorder\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 13.5638%;\\\"\\u003e\\n \\u003cp\\u003e988 (1.31)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 15.9574%;\\\"\\u003e\\n \\u003cp\\u003e234 (0.81)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 16.7553%;\\\"\\u003e\\n \\u003cp\\u003e68 (0.64)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 14.3617%;\\\"\\u003e\\n \\u003cp\\u003e21 (0.50)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.04255%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026lt;0.0001\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30.3191%;\\\"\\u003e\\n \\u003cp\\u003eCirrhosis\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 13.5638%;\\\"\\u003e\\n \\u003cp\\u003e1,021 (1.35)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 15.9574%;\\\"\\u003e\\n \\u003cp\\u003e328 (1.14)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 16.7553%;\\\"\\u003e\\n \\u003cp\\u003e119 (1.11)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 14.3617%;\\\"\\u003e\\n \\u003cp\\u003e45 (1.07)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.04255%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.01\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30.3191%;\\\"\\u003e\\n \\u003cp\\u003eAge, Mean (SD)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 13.5638%;\\\"\\u003e\\n \\u003cp\\u003e51.70 (20.57)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 15.9574%;\\\"\\u003e\\n \\u003cp\\u003e40.65 (16.90)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 16.7553%;\\\"\\u003e\\n \\u003cp\\u003e38.68 (14.30)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 14.3617%;\\\"\\u003e\\n \\u003cp\\u003e39.03 (14.97)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.04255%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026lt;0.0001\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30.3191%;\\\"\\u003e\\n \\u003cp\\u003ePulse rate, Mean (SD)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 13.5638%;\\\"\\u003e\\n \\u003cp\\u003e89.49 (19.31)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 15.9574%;\\\"\\u003e\\n \\u003cp\\u003e91.12 (20.47)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 16.7553%;\\\"\\u003e\\n \\u003cp\\u003e92.22 (20.53)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 14.3617%;\\\"\\u003e\\n \\u003cp\\u003e91.70 (20.55)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.04255%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026lt;0.0001\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30.3191%;\\\"\\u003e\\n \\u003cp\\u003eSystolic Blood Pressure, Mean (SD)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 13.5638%;\\\"\\u003e\\n \\u003cp\\u003e142.79 (26.43)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 15.9574%;\\\"\\u003e\\n \\u003cp\\u003e138.62 (24.83)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 16.7553%;\\\"\\u003e\\n \\u003cp\\u003e137.20 (23.44)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 14.3617%;\\\"\\u003e\\n \\u003cp\\u003e137.07 (24.25)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.04255%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026lt;0.0001\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30.3191%;\\\"\\u003e\\n \\u003cp\\u003eInjury Severity Score, Median (IQR)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 13.5638%;\\\"\\u003e\\n \\u003cp\\u003e9 (5 - 14)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 15.9574%;\\\"\\u003e\\n \\u003cp\\u003e9 (5 - 14)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 16.7553%;\\\"\\u003e\\n \\u003cp\\u003e9 (5 - 14)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 14.3617%;\\\"\\u003e\\n \\u003cp\\u003e8 (5 - 12)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.04255%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026lt;0.0001\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30.3191%;\\\"\\u003e\\n \\u003cp\\u003eTotal GCS, Median (IQR)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 13.5638%;\\\"\\u003e\\n \\u003cp\\u003e15 (14 - 15)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 15.9574%;\\\"\\u003e\\n \\u003cp\\u003e15 (14 - 15)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 16.7553%;\\\"\\u003e\\n \\u003cp\\u003e15 (14 - 15)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 14.3617%;\\\"\\u003e\\n \\u003cp\\u003e15 (14 - 15)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.04255%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026lt;0.0001\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30.3191%;\\\"\\u003e\\n \\u003cp\\u003eBlood alcohol concentration, Mean (SD)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 13.5638%;\\\"\\u003e\\n \\u003cp\\u003e0.06 (0.11)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 15.9574%;\\\"\\u003e\\n \\u003cp\\u003e0.07 (0.12)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 16.7553%;\\\"\\u003e\\n \\u003cp\\u003e0.06 (0.10)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 14.3617%;\\\"\\u003e\\n \\u003cp\\u003e0.04 (0.09)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.04255%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026lt;0.0001\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003eAbbreviations: COPD (Chronic Obstructive Pulmonary Disorder), GCS (Glasgow Coma Scale), IQR (Interquartile range), SD (Standard deviation). Chi-square tests were conducted for categorical variables, and ANOVA was conducted for continuous variables.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable 2:\\u0026nbsp;\\u003c/strong\\u003eDistribution of Substances Used Among Substance-positive Traumatic Brain Injury Patients (N = 31,524).\\u0026nbsp;\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"452\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 48.8938%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eSubstances\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 51.1062%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eN (%)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 48.8938%;\\\"\\u003e\\n \\u003cp\\u003eAmphetamine\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 51.1062%;\\\"\\u003e\\n \\u003cp\\u003e8,286 (26.29)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 48.8938%;\\\"\\u003e\\n \\u003cp\\u003eBarbiturates\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 51.1062%;\\\"\\u003e\\n \\u003cp\\u003e1,427 (4.53)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 48.8938%;\\\"\\u003e\\n \\u003cp\\u003eBenzodiazepines\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 51.1062%;\\\"\\u003e\\n \\u003cp\\u003e5,451 (17.29)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 48.8938%;\\\"\\u003e\\n \\u003cp\\u003eCocaine\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 51.1062%;\\\"\\u003e\\n \\u003cp\\u003e6,223 (19.74)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 48.8938%;\\\"\\u003e\\n \\u003cp\\u003eMethamphetamine\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 51.1062%;\\\"\\u003e\\n \\u003cp\\u003e2,818 (8.94)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 48.8938%;\\\"\\u003e\\n \\u003cp\\u003eEcstasy\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 51.1062%;\\\"\\u003e\\n \\u003cp\\u003e843 (2.67)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 48.8938%;\\\"\\u003e\\n \\u003cp\\u003eMethadone\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 51.1062%;\\\"\\u003e\\n \\u003cp\\u003e467 (1.48)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 48.8938%;\\\"\\u003e\\n \\u003cp\\u003eOpioid\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 51.1062%;\\\"\\u003e\\n \\u003cp\\u003e5,233 (16.60)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 48.8938%;\\\"\\u003e\\n \\u003cp\\u003eOxycodone\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 51.1062%;\\\"\\u003e\\n \\u003cp\\u003e935 (2.97)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 48.8938%;\\\"\\u003e\\n \\u003cp\\u003eCannabinoid\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 51.1062%;\\\"\\u003e\\n \\u003cp\\u003e17,500 (55.51)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e\\u003cbr\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eTable 3: Adjusted Odds of Mortality and Severe TBI For Isolated Traumatic Brain Injury Patients.\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"754\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 41.3793%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" valign=\\\"bottom\\\" style=\\\"width: 30.2387%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eMortality\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" valign=\\\"bottom\\\" style=\\\"width: 28.382%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eTBI Severity\\u003csup\\u003eb\\u003c/sup\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 41.3793%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eGroups\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 23.2095%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eOR (95% CI)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 7.02918%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ep-value\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 18.8329%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eOR (95% CI)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.54907%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ep-value\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd colspan=\\\"5\\\" valign=\\\"bottom\\\" style=\\\"width: 100%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ePolysubstance Use by Number of Substances\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 41.3793%;\\\"\\u003e\\n \\u003cp\\u003eNo Substance\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 23.2095%;\\\"\\u003e\\n \\u003cp\\u003eRef.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 7.02918%;\\\"\\u003e\\n \\u003cp\\u003eRef.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 18.8329%;\\\"\\u003e\\n \\u003cp\\u003eRef.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.54907%;\\\"\\u003e\\n \\u003cp\\u003eRef.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 41.3793%;\\\"\\u003e\\n \\u003cp\\u003eOne substance\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 23.2095%;\\\"\\u003e\\n \\u003cp\\u003e0.96 (0.87 - 1.05)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 7.02918%;\\\"\\u003e\\n \\u003cp\\u003e0.37\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 18.8329%;\\\"\\u003e\\n \\u003cp\\u003e1.07 (1.03 - 1.10)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.54907%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.0002\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 41.3793%;\\\"\\u003e\\n \\u003cp\\u003eTwo Substances\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 23.2095%;\\\"\\u003e\\n \\u003cp\\u003e0.94 (0.81 - 1.09)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 7.02918%;\\\"\\u003e\\n \\u003cp\\u003e0.4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 18.8329%;\\\"\\u003e\\n \\u003cp\\u003e1.11 (1.05 - 1.16)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.54907%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026lt;0.0001\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 41.3793%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026ge;Three Substances\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 23.2095%;\\\"\\u003e\\n \\u003cp\\u003e0.75 (0.59 - 0.95)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 7.02918%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.02\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 18.8329%;\\\"\\u003e\\n \\u003cp\\u003e0.80 (0.73 - 0.87)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.54907%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026lt;0.0001\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd colspan=\\\"5\\\" valign=\\\"bottom\\\" style=\\\"width: 100%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ePolysubstance Use by Type of Substances\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 41.3793%;\\\"\\u003e\\n \\u003cp\\u003eNo Substance\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 23.2095%;\\\"\\u003e\\n \\u003cp\\u003eRef.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 7.02918%;\\\"\\u003e\\n \\u003cp\\u003eRef.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 18.8329%;\\\"\\u003e\\n \\u003cp\\u003eRef.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.54907%;\\\"\\u003e\\n \\u003cp\\u003eRef.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 41.3793%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eOne Substances\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 23.2095%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 7.02918%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 18.8329%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.54907%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 41.3793%;\\\"\\u003e\\n \\u003cp\\u003eCannabinoids\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 23.2095%;\\\"\\u003e\\n \\u003cp\\u003e1.04 (0.91 - 1.18)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 7.02918%;\\\"\\u003e\\n \\u003cp\\u003e0.57\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 18.8329%;\\\"\\u003e\\n \\u003cp\\u003e1.10 (1.05 - 1.15)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.54907%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026lt;0.0001\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 41.3793%;\\\"\\u003e\\n \\u003cp\\u003eDepressants\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 23.2095%;\\\"\\u003e\\n \\u003cp\\u003e0.76 (0.63 - 0.93)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 7.02918%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.01\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 18.8329%;\\\"\\u003e\\n \\u003cp\\u003e1.07 (0.98 - 1.16)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.54907%;\\\"\\u003e\\n \\u003cp\\u003e0.12\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 41.3793%;\\\"\\u003e\\n \\u003cp\\u003eOpioids\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 23.2095%;\\\"\\u003e\\n \\u003cp\\u003e1.03 (0.78 - 1.35)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 7.02918%;\\\"\\u003e\\n \\u003cp\\u003e0.86\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 18.8329%;\\\"\\u003e\\n \\u003cp\\u003e0.93 (0.85 - 1.00)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.54907%;\\\"\\u003e\\n \\u003cp\\u003e0.06\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 41.3793%;\\\"\\u003e\\n \\u003cp\\u003eStimulants\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 23.2095%;\\\"\\u003e\\n \\u003cp\\u003e0.99 (0.85 - 1.16)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 7.02918%;\\\"\\u003e\\n \\u003cp\\u003e0.91\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 18.8329%;\\\"\\u003e\\n \\u003cp\\u003e1.09 (1.04 - 1.15)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.54907%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.001\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 41.3793%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eTwo Substances\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 23.2095%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 7.02918%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 18.8329%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.54907%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 41.3793%;\\\"\\u003e\\n \\u003cp\\u003eCannabinoids and Depressants\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 23.2095%;\\\"\\u003e\\n \\u003cp\\u003e0.87 (0.62 - 1.23)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 7.02918%;\\\"\\u003e\\n \\u003cp\\u003e0.44\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 18.8329%;\\\"\\u003e\\n \\u003cp\\u003e1.04 (0.92 - 1.19)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.54907%;\\\"\\u003e\\n \\u003cp\\u003e0.53\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 41.3793%;\\\"\\u003e\\n \\u003cp\\u003eCannabinoids and Opioids\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 23.2095%;\\\"\\u003e\\n \\u003cp\\u003e1.62 (1.01 - 2.58)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 7.02918%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.04\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 18.8329%;\\\"\\u003e\\n \\u003cp\\u003e1.15 (0.99 - 1.33)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.54907%;\\\"\\u003e\\n \\u003cp\\u003e0.06\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 41.3793%;\\\"\\u003e\\n \\u003cp\\u003eCannabinoids and Stimulants\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 23.2095%;\\\"\\u003e\\n \\u003cp\\u003e0.92 (0.75 - 1.13)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 7.02918%;\\\"\\u003e\\n \\u003cp\\u003e0.42\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 18.8329%;\\\"\\u003e\\n \\u003cp\\u003e1.20 (1.12 - 1.28)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.54907%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026lt;0.0001\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 41.3793%;\\\"\\u003e\\n \\u003cp\\u003eOpioids and Depressants\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 23.2095%;\\\"\\u003e\\n \\u003cp\\u003e0.72 (0.43 - 1.21)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 7.02918%;\\\"\\u003e\\n \\u003cp\\u003e0.21\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 18.8329%;\\\"\\u003e\\n \\u003cp\\u003e0.87 (0.73 - 1.03)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.54907%;\\\"\\u003e\\n \\u003cp\\u003e0.1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 41.3793%;\\\"\\u003e\\n \\u003cp\\u003eStimulants and Depressants\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 23.2095%;\\\"\\u003e\\n \\u003cp\\u003e0.66 (0.46 - 0.94)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 7.02918%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.02\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 18.8329%;\\\"\\u003e\\n \\u003cp\\u003e0.62 (0.54 - 0.70)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.54907%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026lt;0.0001\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 41.3793%;\\\"\\u003e\\n \\u003cp\\u003eStimulants and Opioids\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 23.2095%;\\\"\\u003e\\n \\u003cp\\u003e0.92 (0.56 - 1.50)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 7.02918%;\\\"\\u003e\\n \\u003cp\\u003e0.73\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 18.8329%;\\\"\\u003e\\n \\u003cp\\u003e1.14 (0.99 - 1.30)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.54907%;\\\"\\u003e\\n \\u003cp\\u003e0.06\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 41.3793%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026ge;Three Substances\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 23.2095%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 7.02918%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 18.8329%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.54907%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 41.3793%;\\\"\\u003e\\n \\u003cp\\u003eCannabinoids, Opioids and Depressants\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 23.2095%;\\\"\\u003e\\n \\u003cp\\u003e0.46 (0.17 - 1.19)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 7.02918%;\\\"\\u003e\\n \\u003cp\\u003e0.11\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 18.8329%;\\\"\\u003e\\n \\u003cp\\u003e0.94 (0.70 - 1.26)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.54907%;\\\"\\u003e\\n \\u003cp\\u003e0.68\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 41.3793%;\\\"\\u003e\\n \\u003cp\\u003eCannabinoids, Stimulants and Depressants\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 23.2095%;\\\"\\u003e\\n \\u003cp\\u003e0.63 (0.38 - 1.05)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 7.02918%;\\\"\\u003e\\n \\u003cp\\u003e0.08\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 18.8329%;\\\"\\u003e\\n \\u003cp\\u003e0.88 (0.73 - 1.07)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.54907%;\\\"\\u003e\\n \\u003cp\\u003e0.2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 41.3793%;\\\"\\u003e\\n \\u003cp\\u003eCannabinoids, Stimulants and Opioids\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 23.2095%;\\\"\\u003e\\n \\u003cp\\u003e1.17 (0.64 - 2.14)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 7.02918%;\\\"\\u003e\\n \\u003cp\\u003e0.61\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 18.8329%;\\\"\\u003e\\n \\u003cp\\u003e1.12 (0.93 - 1.34)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.54907%;\\\"\\u003e\\n \\u003cp\\u003e0.23\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 41.3793%;\\\"\\u003e\\n \\u003cp\\u003eStimulants, Opioids and Depressants\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 23.2095%;\\\"\\u003e\\n \\u003cp\\u003e0.95 (0.42 - 2.16)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 7.02918%;\\\"\\u003e\\n \\u003cp\\u003e0.91\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 18.8329%;\\\"\\u003e\\n \\u003cp\\u003e0.94 (0.71 - 1.24)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.54907%;\\\"\\u003e\\n \\u003cp\\u003e0.66\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 41.3793%;\\\"\\u003e\\n \\u003cp\\u003eCannabinoids, Stimulants, Opioids and Depressants\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 23.2095%;\\\"\\u003e\\n \\u003cp\\u003e0.93 (0.36 - 2.36)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 7.02918%;\\\"\\u003e\\n \\u003cp\\u003e0.87\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 18.8329%;\\\"\\u003e\\n \\u003cp\\u003e0.79 (0.60 - 1.06)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.54907%;\\\"\\u003e\\n \\u003cp\\u003e0.12\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e\\u003csup\\u003ea\\u003c/sup\\u003eModel was adjusted for age, sex, race, ethnicity, trauma type, injury mechanism, payment method, comorbidities (psychiatric, COPD, cardiovascular, diabetes, cancer, smoking status, renal, anticoagulant use, bleeding, cirrhosis, SUD, pulse rate, SBP, BAC, head AIS, and total GCS.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003csup\\u003eb\\u003c/sup\\u003eModel was adjusted for age, sex, race, ethnicity, trauma type, injury mechanism, payment method, comorbidities (AUD, COPD, cardiovascular, diabetes, cancer, smoking status, renal, anticoagulant use, bleeding, cirrhosis, SUD, pulse rate, SBP, BAC, and total GCS.\\u003c/p\\u003e\\n\\u003cp\\u003eTable 4: Adjusted Negative Binomial Regression Analysis of Health Resource Utilization in Isolated Traumatic Brain Injury Patients.\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"773\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 42.044%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" valign=\\\"bottom\\\" style=\\\"width: 21.216%;\\\"\\u003e\\n \\u003cp\\u003eHospital Length of Stay (HLOS)\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" valign=\\\"bottom\\\" style=\\\"width: 20.3105%;\\\"\\u003e\\n \\u003cp\\u003eICU Length of Stay (ICULOS)\\u003csup\\u003eb\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" valign=\\\"bottom\\\" style=\\\"width: 16.4295%;\\\"\\u003e\\n \\u003cp\\u003eTotal Ventilator Days (TVD)\\u003csup\\u003ec\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 42.044%;\\\"\\u003e\\n \\u003cp\\u003eGroups\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 10.9961%;\\\"\\u003e\\n \\u003cp\\u003eEstimate\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 10.2199%;\\\"\\u003e\\n \\u003cp\\u003ep-value\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 10.9961%;\\\"\\u003e\\n \\u003cp\\u003eEstimate\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.31436%;\\\"\\u003e\\n \\u003cp\\u003ep-value\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 8.66753%;\\\"\\u003e\\n \\u003cp\\u003eEstimate\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 7.76197%;\\\"\\u003e\\n \\u003cp\\u003ep-value\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd colspan=\\\"7\\\" valign=\\\"bottom\\\" style=\\\"width: 100%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ePolysubstance Use by Number of Substances\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 42.044%;\\\"\\u003e\\n \\u003cp\\u003eNo Substance\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 10.9961%;\\\"\\u003e\\n \\u003cp\\u003eRef.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 10.2199%;\\\"\\u003e\\n \\u003cp\\u003eRef.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 10.9961%;\\\"\\u003e\\n \\u003cp\\u003eRef.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.31436%;\\\"\\u003e\\n \\u003cp\\u003eRef.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 8.66753%;\\\"\\u003e\\n \\u003cp\\u003eRef.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 7.76197%;\\\"\\u003e\\n \\u003cp\\u003eRef.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 42.044%;\\\"\\u003e\\n \\u003cp\\u003eOne substance\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 10.9961%;\\\"\\u003e\\n \\u003cp\\u003e0.03\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 10.2199%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026lt;0.0001\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 10.9961%;\\\"\\u003e\\n \\u003cp\\u003e-0.01\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.31436%;\\\"\\u003e\\n \\u003cp\\u003e0.54\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 8.66753%;\\\"\\u003e\\n \\u003cp\\u003e-0.06\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 7.76197%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.001\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 42.044%;\\\"\\u003e\\n \\u003cp\\u003eTwo Substances\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 10.9961%;\\\"\\u003e\\n \\u003cp\\u003e0.03\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 10.2199%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.001\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 10.9961%;\\\"\\u003e\\n \\u003cp\\u003e-0.02\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.31436%;\\\"\\u003e\\n \\u003cp\\u003e0.18\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 8.66753%;\\\"\\u003e\\n \\u003cp\\u003e-0.08\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 7.76197%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.002\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 42.044%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026ge;Three Substances\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 10.9961%;\\\"\\u003e\\n \\u003cp\\u003e0.02\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 10.2199%;\\\"\\u003e\\n \\u003cp\\u003e0.17\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 10.9961%;\\\"\\u003e\\n \\u003cp\\u003e-0.02\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.31436%;\\\"\\u003e\\n \\u003cp\\u003e0.47\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 8.66753%;\\\"\\u003e\\n \\u003cp\\u003e-0.04\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 7.76197%;\\\"\\u003e\\n \\u003cp\\u003e0.26\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd colspan=\\\"7\\\" valign=\\\"bottom\\\" style=\\\"width: 100%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ePolysubstance Use by Type of Substances\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 42.044%;\\\"\\u003e\\n \\u003cp\\u003eNo Substance\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 10.9961%;\\\"\\u003e\\n \\u003cp\\u003eRef.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 10.2199%;\\\"\\u003e\\n \\u003cp\\u003eRef.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 10.9961%;\\\"\\u003e\\n \\u003cp\\u003eRef.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.31436%;\\\"\\u003e\\n \\u003cp\\u003eRef.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 8.66753%;\\\"\\u003e\\n \\u003cp\\u003eRef.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 7.76197%;\\\"\\u003e\\n \\u003cp\\u003eRef.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 42.044%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eOne substance\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 10.9961%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 10.2199%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 10.9961%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.31436%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 8.66753%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 7.76197%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 42.044%;\\\"\\u003e\\n \\u003cp\\u003eCannabinoids\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 10.9961%;\\\"\\u003e\\n \\u003cp\\u003e-0.02\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 10.2199%;\\\"\\u003e\\n \\u003cp\\u003e0.05\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 10.9961%;\\\"\\u003e\\n \\u003cp\\u003e-0.01\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.31436%;\\\"\\u003e\\n \\u003cp\\u003e0.41\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 8.66753%;\\\"\\u003e\\n \\u003cp\\u003e-0.05\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 7.76197%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.02\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 42.044%;\\\"\\u003e\\n \\u003cp\\u003eDepressants\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 10.9961%;\\\"\\u003e\\n \\u003cp\\u003e0.06\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 10.2199%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.0004\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 10.9961%;\\\"\\u003e\\n \\u003cp\\u003e-0.02\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.31436%;\\\"\\u003e\\n \\u003cp\\u003e0.35\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 8.66753%;\\\"\\u003e\\n \\u003cp\\u003e-0.13\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 7.76197%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.0003\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 42.044%;\\\"\\u003e\\n \\u003cp\\u003eOpioids\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 10.9961%;\\\"\\u003e\\n \\u003cp\\u003e0.06\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 10.2199%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.0001\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 10.9961%;\\\"\\u003e\\n \\u003cp\\u003e-0.03\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.31436%;\\\"\\u003e\\n \\u003cp\\u003e0.32\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 8.66753%;\\\"\\u003e\\n \\u003cp\\u003e-0.06\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 7.76197%;\\\"\\u003e\\n \\u003cp\\u003e0.35\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 42.044%;\\\"\\u003e\\n \\u003cp\\u003eStimulants\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 10.9961%;\\\"\\u003e\\n \\u003cp\\u003e0.1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 10.2199%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026lt;0.0001\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 10.9961%;\\\"\\u003e\\n \\u003cp\\u003e0.01\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.31436%;\\\"\\u003e\\n \\u003cp\\u003e0.57\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 8.66753%;\\\"\\u003e\\n \\u003cp\\u003e-0.03\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 7.76197%;\\\"\\u003e\\n \\u003cp\\u003e0.25\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 42.044%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eTwo substances\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 10.9961%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 10.2199%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 10.9961%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.31436%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 8.66753%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 7.76197%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 42.044%;\\\"\\u003e\\n \\u003cp\\u003eCannabinoids and Depressants\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 10.9961%;\\\"\\u003e\\n \\u003cp\\u003e0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 10.2199%;\\\"\\u003e\\n \\u003cp\\u003e0.97\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 10.9961%;\\\"\\u003e\\n \\u003cp\\u003e-0.03\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.31436%;\\\"\\u003e\\n \\u003cp\\u003e0.38\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 8.66753%;\\\"\\u003e\\n \\u003cp\\u003e-0.08\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 7.76197%;\\\"\\u003e\\n \\u003cp\\u003e0.11\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 42.044%;\\\"\\u003e\\n \\u003cp\\u003eCannabinoids and Opioids\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 10.9961%;\\\"\\u003e\\n \\u003cp\\u003e-0.04\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 10.2199%;\\\"\\u003e\\n \\u003cp\\u003e0.12\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 10.9961%;\\\"\\u003e\\n \\u003cp\\u003e-0.14\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.31436%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.003\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 8.66753%;\\\"\\u003e\\n \\u003cp\\u003e-0.15\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 7.76197%;\\\"\\u003e\\n \\u003cp\\u003e0.1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 42.044%;\\\"\\u003e\\n \\u003cp\\u003eCannabinoids and Stimulants\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 10.9961%;\\\"\\u003e\\n \\u003cp\\u003e0.01\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 10.2199%;\\\"\\u003e\\n \\u003cp\\u003e0.41\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 10.9961%;\\\"\\u003e\\n \\u003cp\\u003e-0.01\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.31436%;\\\"\\u003e\\n \\u003cp\\u003e0.82\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 8.66753%;\\\"\\u003e\\n \\u003cp\\u003e-0.07\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 7.76197%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.03\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 42.044%;\\\"\\u003e\\n \\u003cp\\u003eOpioids and Depressants\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 10.9961%;\\\"\\u003e\\n \\u003cp\\u003e0.07\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 10.2199%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.03\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 10.9961%;\\\"\\u003e\\n \\u003cp\\u003e0.03\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.31436%;\\\"\\u003e\\n \\u003cp\\u003e0.6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 8.66753%;\\\"\\u003e\\n \\u003cp\\u003e-0.12\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 7.76197%;\\\"\\u003e\\n \\u003cp\\u003e0.22\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 42.044%;\\\"\\u003e\\n \\u003cp\\u003eStimulants and Depressants\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 10.9961%;\\\"\\u003e\\n \\u003cp\\u003e-0.03\\u003c/p\\u003e\\n 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\\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 10.2199%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.04\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 10.9961%;\\\"\\u003e\\n \\u003cp\\u003e-0.02\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.31436%;\\\"\\u003e\\n \\u003cp\\u003e0.64\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 8.66753%;\\\"\\u003e\\n \\u003cp\\u003e-0.1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 7.76197%;\\\"\\u003e\\n \\u003cp\\u003e0.23\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 42.044%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026ge;Three substances\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 10.9961%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 10.2199%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 10.9961%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.31436%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 8.66753%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 7.76197%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 42.044%;\\\"\\u003e\\n \\u003cp\\u003eCannabinoids, Opioids and Depressants\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 10.9961%;\\\"\\u003e\\n \\u003cp\\u003e-0.07\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 10.2199%;\\\"\\u003e\\n \\u003cp\\u003e0.18\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 10.9961%;\\\"\\u003e\\n \\u003cp\\u003e-0.11\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.31436%;\\\"\\u003e\\n \\u003cp\\u003e0.24\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 8.66753%;\\\"\\u003e\\n \\u003cp\\u003e-0.14\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 7.76197%;\\\"\\u003e\\n \\u003cp\\u003e0.36\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 42.044%;\\\"\\u003e\\n \\u003cp\\u003eCannabinoids, Stimulants and Depressants\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 10.9961%;\\\"\\u003e\\n \\u003cp\\u003e0.01\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 10.2199%;\\\"\\u003e\\n \\u003cp\\u003e0.81\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 10.9961%;\\\"\\u003e\\n \\u003cp\\u003e-0.01\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.31436%;\\\"\\u003e\\n \\u003cp\\u003e0.8\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 8.66753%;\\\"\\u003e\\n \\u003cp\\u003e-0.02\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 7.76197%;\\\"\\u003e\\n \\u003cp\\u003e0.77\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 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style=\\\"width: 42.044%;\\\"\\u003e\\n \\u003cp\\u003eStimulants, Opioids and Depressants\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 10.9961%;\\\"\\u003e\\n \\u003cp\\u003e0.1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 10.2199%;\\\"\\u003e\\n \\u003cp\\u003e0.06\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 10.9961%;\\\"\\u003e\\n \\u003cp\\u003e0.03\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.31436%;\\\"\\u003e\\n \\u003cp\\u003e0.67\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 8.66753%;\\\"\\u003e\\n \\u003cp\\u003e0.06\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 7.76197%;\\\"\\u003e\\n \\u003cp\\u003e0.6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 42.044%;\\\"\\u003e\\n \\u003cp\\u003eCannabinoids, Stimulants, Opioids and Depressants\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 10.9961%;\\\"\\u003e\\n \\u003cp\\u003e0.18\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 10.2199%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.001\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 10.9961%;\\\"\\u003e\\n \\u003cp\\u003e0.05\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 9.31436%;\\\"\\u003e\\n \\u003cp\\u003e0.58\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 8.66753%;\\\"\\u003e\\n \\u003cp\\u003e-0.07\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 7.76197%;\\\"\\u003e\\n \\u003cp\\u003e0.63\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e\\u003csup\\u003ea\\u003c/sup\\u003eModel was adjusted for age, sex, race, trauma type, injury mechanism, payment method, comorbidities (psychiatric, AUD, COPD, cardiovascular, diabetes, cancer, renal, anticoagulant use, bleeding, cirrhosis, SUD, pulse rate, SBP, BAC, head AIS, and total GCS.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003csup\\u003eb\\u003c/sup\\u003eModel was adjusted for age, sex, race, trauma type, injury mechanism, payment method, comorbidities (AUD, COPD, cardiovascular, diabetes, smoking status, renal, anticoagulant use, bleeding, cirrhosis, SUD, pulse rate, SBP, BAC, head AIS, and total GCS.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003csup\\u003ec\\u003c/sup\\u003eModel was adjusted for age, sex, race, ethnicity, trauma type, injury mechanism, payment method, comorbidities (COPD, AUD, cardiovascular, diabetes, cancer, smoking status, renal, anticoagulant use, bleeding, cirrhosis, pulse rate, SBP, BAC, head AIS, and total GCS.\\u003c/p\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":true,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"scientific-reports\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"scirep\",\"sideBox\":\"Learn more about [Scientific Reports](http://www.nature.com/srep/)\",\"snPcode\":\"\",\"submissionUrl\":\"\",\"title\":\"Scientific Reports\",\"twitterHandle\":\"\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"stoa\",\"reportingPortfolio\":\"Scientific Reports\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true},\"keywords\":\"\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-6017336/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-6017336/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003ePre-injury polysubstance use may worsen outcomes in traumatic brain injury (TBI) patients and increase healthcare burden; however, this association has not been adequately quantified. We investigated polysubstance use\\u0026rsquo;s impact on TBI mortality, severity, and health resource utilization (HRU) in U.S. trauma patients. This retrospective study included isolated TBI patients (\\u0026ge;\\u0026thinsp;18 years) screened for substance use in U.S. trauma centers from 2017 to 2019. Outcomes were analyzed by polysubstance number (i.e., two substances, and \\u0026ge;\\u0026thinsp;three substances) and types (cannabinoids and opioids, cannabinoids and stimulants, and other substance combinations) compared to substance-negative users. Logistic regression was used to measure the association between polysubstance use, mortality and TBI severity. Negative binomial regression was used to measure polysubstance use\\u0026rsquo;s association with hospital, ICU and mechanical ventilator length of stay. The co-use of cannabinoids and opioids (1.62 [1.01\\u0026ndash;2.58], p\\u0026thinsp;=\\u0026thinsp;0.04) and cannabinoids and stimulants (1.20 [1.12\\u0026ndash;1.28], p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.0001) were significantly associated with higher odds of mortality and severe TBI, respectively. Furthermore, patients who co-used cannabinoids, stimulants, opioids, and depressants had prolonged hospital stay (β\\u0026thinsp;=\\u0026thinsp;0.18, p\\u0026thinsp;=\\u0026thinsp;0.001). Specific types of pre-injury polysubstance use were significantly associated with mortality, TBI severity, and HRU. This information will be valuable for healthcare decision-making, provision, and resource allocation.\\u003c/p\\u003e\",\"manuscriptTitle\":\"The Role of Pre-injury Polysubstance Use on Traumatic Brain Injury and its Impact on Health Resource Utilization Among the U.S. Trauma Patients\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2025-07-22 01:40:47\",\"doi\":\"10.21203/rs.3.rs-6017336/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2026-04-05T20:44:18+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"160696026050547327258284795459232816092\",\"date\":\"2026-03-22T15:55:43+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"333254923081919972720336232461475660910\",\"date\":\"2026-01-14T23:53:03+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"\",\"date\":\"2025-11-27T11:24:09+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2025-06-09T05:07:59+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvited\",\"content\":\"\",\"date\":\"2025-02-17T19:34:23+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2025-02-15T04:13:53+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"Scientific Reports\",\"date\":\"2025-02-12T17:53:14+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"scientific-reports\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"scirep\",\"sideBox\":\"Learn more about [Scientific Reports](http://www.nature.com/srep/)\",\"snPcode\":\"\",\"submissionUrl\":\"\",\"title\":\"Scientific Reports\",\"twitterHandle\":\"\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"stoa\",\"reportingPortfolio\":\"Scientific Reports\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"49fd5f95-7e61-4c1e-9dfd-552d82d15f67\",\"owner\":[],\"postedDate\":\"July 22nd, 2025\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"under-review\",\"subjectAreas\":[{\"id\":49734713,\"name\":\"Health sciences/Health care/Health policy\"},{\"id\":49734714,\"name\":\"Health sciences/Health care/Health services\"}],\"tags\":[],\"updatedAt\":\"2025-07-22T01:40:48+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2025-07-22 01:40:47\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-6017336\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-6017336\",\"identity\":\"rs-6017336\",\"version\":[\"v1\"]},\"buildId\":\"8U1c8b4HqxoKbykW_rLl7\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}