Abstract
Background
Adolescent trauma patients are reported to have increased incidence of alcohol and
other drug (AOD) use, but previous studies have included inadequate screening of the
intended populations. A Level 1 Pediatric Trauma Center achieved a 94% rate of AOD
screening. We hypothesized that a positive AOD screening result is associated with
males, increasing age, lower socioeconomic status, violent injury mechanism, higher
Injury Severity Score (ISS), lower GCS, need for operation and increased hospital
length of stay.
Methods
After achieving high rates of screening among admitted trauma alert patients 12–17 years
old, we evaluated patients presenting during 2014–2015. Chi-square tests were used
to compare the percentage of patients with positive test results across sociodemographic,
injury severity measures and patient outcomes.
Results
Three hundred and one patients met criteria for AOD screening during the study period.
Ninety-four percent of these patients received screening and 18% were positive. Males
(21.4%) were more often positive than females (11.6%). Increasing age was directly
correlated with AOD use. Race was associated with a positive screen. Black patients
more often had positive screens (40.9%), as compared with White patients (13.8%) and
other races (23.5%). Patients with commercial insurance (6.6%) were less likely to
be positive than those with no insurance (19.0%) or Medicaid (30.9%). Lower median
household income was associated with positive AOD screening. Patients with violent
injury mechanisms were more likely to screen positive (36.2%) than those with non-violent
mechanisms (18.0%). No statistical differences were found with injury severity scores,
the need for operation, or hospital length of stay.
Conclusions
With near universal screening of adolescent trauma alert admissions, positive AOD
results were more often found with males, increasing age, lower socioeconomic status,
and violent injury mechanism.
Level of evidence
Level III, Retrospective comparative study without negative criteria.
Study Type
Prognostic.
Keywords
To read this article in full you will need to make a payment
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D; use, select 'Corporate R&D; Professionals'
Subscribe:
Subscribe to The American Journal of Emergency MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- A Typological Analysis of California DUI Offenders and DUI Recidivism Correlates. Report No. 100.California Department of Motor Vehicles, Sacramento1985
- Major injury as a unique opportunity to initiate treatment in the alcoholic.Am J Surg. 1988; 156: 558-561
- Identification of problem drinking among drunken drivers.JAMA. 1967; 200: 114-120
- Nonhighway injury fatalities: the roles of alcohol and problem drinking, drugs, and medical impairment.J. Chronic Dis. 1972 Jan; 25: 33-45
- Substance abuse in adolescent trauma.Ann Emerg Med. 1993; 22: 1530-1534
- Toxicology screening in adolescent trauma.Pediatr Emerg Care. 1996; 12: 36-39
- Resources for Optimal Care of the Injured Patient.American College of Surgeons, Chicago2014
- Pediatric SBIRT: understanding the magnitude of the problem.J Trauma Nurs. 2009; 16: 142-147
- Guidelines for alcohol screening in adolescent trauma patients: a report from the Pediatric Trauma Society Guidelines Committee.J Trauma Acute Care Surg. 2012; 74: 671-682
- Screening, brief intervention, and referral to treatment in the adolescent trauma population: examining barriers to implementation.J Trauma Nurs. 2012; 19: 148-151
- The association of race and ethnicity with rates of drug and alcohol testing among US trauma patients.Health Policy. 2004; 69: 159-167
- Evaluation of race and ethnicity on alcohol and drug testing of adolescents admitted with trauma.Acad Emerg Med. 2003; 10: 1253-1259
- Characterization of the drug-positive adolescent trauma population: should we, do we, and does it make a difference if we test?.J. Trauma Surg. 2006; 41: 927-930
- Alcohol interventions for trauma patients are not just for adults: justification for brief interventions for the injured adolescent at a pediatric trauma center.J Trauma. 2010; 69: 202-210
- The advanced practice nurse role in instituting screening, brief intervention and referral to treatment program at the Children's Hospital of Philadelphia.J Trauma Nurs. 2010; 17: 74-79
- Drug use and screening in pediatric trauma.Ther Drug Monit. 2011; 33: 439-442
- Emergency department alcohol and drug screening for Illinois pediatric trauma patients, 1999 to 2009.Am J Surg. 2014; 208: 531-535
- Pediatric trauma patient alcohol screening: a 3 year review of screening at a level 1 pediatric trauma center using the CRAFFT tool.J Pediatr Surg. 2014; 49: 330-332
- Historical income tables: households.(Retrieved from)
- Key Substance Use and Mental Health Indicators in the United States: Results from the 2015 National Survey on Drug Use and Health (HHS Publication No. SMA 16-4984, NSDUH Series H-51).(Retrieved from)http://www.samhsa.gov/data/Date: 2016
- Alcohol, tobacco, and prescription drug use by teens declines. Level of youth with major depressive episodes remains high [Press Release].(Retrieved from:)
Article Info
Publication History
Published online: December 07, 2018
Accepted:
November 29,
2018
Received in revised form:
November 26,
2018
Received:
July 24,
2018
Footnotes
☆Presented in poster format: Pediatric Trauma Society 3rd Annual Conference, 2016.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
