Intracerebral hemorrhage: who gets tested for methamphetamine use and why might it matter?

Background: Methamphetamine use is an emerging risk factor for intracerebral hemorrhage (ICH). The aim of this study was to investigate the use of urine drug screen (UDS) for identifying methamphetamine-associated ICH.

Methods: This is a retrospective, single-center study of consecutive patients hospitalized with spontaneous ICH from January 2013 to December 2017. Patients were divided into groups based on presence of UDS. The characteristics of patients with and without UDS were compared. Factors associated with getting UDS were explored using multivariable analyses.

Results: Five hundred ninety-six patients with ICH were included. UDS was performed in 357 (60%), and positive for methamphetamine in 44 (12.3%). In contrast, only 19 of the 357 patients (5.3%) had a documented history of methamphetamine use. Multivariable analysis demonstrated that patients screened 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), with history of methamphetamine use (OR, 10.48; 95% CI, 2.48-44.34; p <  0.001), without diabetes (OR 1.47; 95% CI, 0.471-0.975; p = 0.036), not on anticoagulant (OR, 2.20; 95% CI, 0.26-0.78; p = 0.004), with National Institutes of Health Stroke Scale (NIHSS) > 4 (OR, 1.92; 95%CI, 1.34-2.75; p <  0.001), or require external ventricular drain (EVD) (OR, 1.63; 95%CI, 1.07-2.47; p = 0.021. There was no significant difference in race (p = 0.319). Reported history of methamphetamine use was the strongest predictor of obtaining a UDS (OR,10.48). Five percent of patients without UDS admitted history of use.

Conclusion: UDS identified 12.3% of ICH patients with methamphetamine use as compared to 5.3% per documented history of drug use. There was no racial bias in ordering UDS. However, it was more often ordered in younger, male, smokers, with history of methamphetamine use, without diabetes or anticoagulant use.