Perceptions and realities of testing for alcohol and other drugs in trauma patients

Routine testing for acute intoxication with alcohol and other drugs in trauma patients is a widely accepted practice at major trauma centers. However, there is often a significant difference between policy and practice. We sought to study the perception and the reality of testing practices at an urban Level I trauma center.

A survey was distributed to all emergency nursing staff and trauma team leaders (TTL). For the empiric aspects of this study, data were obtained from an institutional trauma database. Descriptive statistics and bivariate odds ratios were used to characterize survey responses and empiric data, respectively.

Eighty-nine percent of nurses and 80% of TTLs estimated testing rates for alcohol to be over 80% for all trauma patients. This was compared with the empirically determined rate of 65%. Over 90% of nurses and 70% of TTLs claimed to test all patients. Those more likely to be tested were younger, male, unemployed, or laborers with penetrating injuries, more commonly in the overnight period. Clinicians tended to rely on clinical suspicion of intoxication as a criterion to test. They also tended to be unaware of an association between low socioeconomic status and increased rates of testing in their practices.

Our results suggest that clinicians generally support the notion of routine testing for trauma patients; however, they tend to overestimate the rates at which these tests are performed. Additionally, clinicians demonstrate testing biases that may influence the distribution of care in the acutely injured population.