• Keishi Yamaguchi, Kyosuke Takahashi, Dominik Andreas Jakob, Takeru Abe, Kazuhide Matsushima, and Demetrios Demetriades.
• Division of Acute Care Surgery, Department of Surgery, University of Southern California, 2051 Marengo Street, Los Angeles, CA, 90033, USA.
• Eur J Trauma Emerg Surg. 2025 Jan 24; 51 (1): 5050.

PurposeThe aim of this study was to explore the association between pre-injury narcotic drug use (opioids, methadone, and/or oxycodone) and outcomes in isolated severe traumatic brain injury (TBI) patients.MethodsACS TQIP study included adult trauma patients (≥ 16 years) with complete drug and alcohol screening. Isolated severe TBI was defined as head trauma with AIS 3-5 and without significant extracranial trauma. Exact matching was used to compare patients with isolated pre-injury narcotic drug use to those with no illicit drug or alcohol use. Patients were matched 1:1 based on the following matching criteria: age, gender, mechanism of injury, Injury Severity Score, systolic blood pressure, head AIS, and comorbidities.ResultsOf 1,846,630 patients, 141,058 had isolated severe head injuries with complete drug and alcohol screenings. After exact matching, 1,560 patients in each group were analyzed. There were no significant differences in hospital mortality, craniectomy rates, complication rates, or length of hospital stay. Patients that tested positive for narcotics had lower rates of mechanical ventilation (16.5% vs. 25.3%, p < 0.01) and shorter ICU stays [3 (2-4) days vs. 3 (2-6) days; p < 0.01].ConclusionPre-injury narcotic drug use in isolated severe TBI is not associates with adverse outcomes. Further research is needed to understand the biochemical and physiological effects of narcotic drugs on TBI outcomes.© 2025. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.

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