Abstract
Background/Objective: Methamphetamine use is associated with intracerebral hemorrhage (ICH) and is a major public health issue. The urine drug screen (UDS) is an essential test to identify and potentially control this risk factor. This study aims to analyze how an academic comprehensive stroke center uses this tool to identify methamphetamine associated ICH. Methods: Retrospective chart review of consecutive patients hospitalized with ICH from January 2013 to December 2017 was performed. Patients were divided based on presence or absence of UDS for methamphetamines. Methamphetamine associated ICH was identified per positive UDS or reported history of use. Features of patients with versus without UDS were compared using chi-square or t-test where appropriate. Results: A total of 596 consecutive patients with ICH were included in this study. UDS was performed in 357 patients (60%), and positive for methamphetamines in 44 patients (12.3%, 44/357). Among the 239 patients without UDS, 12 had self-reported history of methamphetamine abuse (5%, 12/239), resulting in a total of 56 patients with methamphetamine associated ICH (9.4%). Patients with UDS were more likely to be younger than 45 (OR=2.24; 95% CI 0.26-0.78; p=0.004), male (OR=1.65; 95% CI 0.44-0.84; p =0.003), smokers (OR=1.74; 95% CI 1.09-2.77; p<0.001), not on anticoagulant therapy (OR 2.20; 95% CI 0.26-0.78; p=0.004), with NIHSS >4 (OR=1.92; 95% CI 1.34-2.75; p<0.001), without diabetes (OR=1.47; 95% CI 0.471-0.975; p=0.036), requiring EVD (OR=1.63; 95% CI 1.07-2.47; p=0.021) or having a history of methamphetamine use (OR 10.48; 95% CI 2.48-44.34; p<0.001). There was no significant difference in race (p=0.319). Conclusion: At a comprehensive stroke center in Orange County, 9.4% of patients with ICH were methamphetamine related per UDS and history. UDS identified most of the cases (78.6%, 44/56) and was performed in only 60% of the cohort, more often in patients that were younger, male, smokers, with no anticoagulant use or history of diabetes. Methamphetamine associated ICH is common, likely underestimated, and potentially preventable. UDS may be indicated in all patients presenting with ICH and in routine health screening to reduce the risk of methamphetamine associated ICH.
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