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Screening Adolescent Trauma Patients for Substance Use at 10 Pediatric Trauma Centers
Michael J Mello1, Sara J Becker, Anthony Spirito
1Departments of Emergency Medicine (Drs Mello, Zonfrillo, and Baird and Ms Bromberg), Psychiatry and Human Behavior (Dr Spirito), and Surgery (Dr Wills), Alpert Medical School of Brown University, Providence, Rhode Island; Departments of Health Services, Policy and Practice (Dr Mello) and Behavioral and Social Sciences (Drs Becker and Scott), Brown University School of Public Health, Providence, Rhode Island; Injury Prevention Center of Rhode Island Hospital-Hasbro Children's Hospital, Providence, Rhode Island (Drs Mello, Wills, Zonfrillo, and Baird and Mss Bromberg and Nimaja); Dell Children's Trauma and Injury Research Center, Dell Children's Medical Center, Austin, Texas (Dr Barczyk); Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts (Dr Lee); Division of Pediatrics, Intermountain Primary Children's Hospital, Salt Lake City, Utah (Dr Pruitt); Department of Pediatrics, Harborview Medical Center, Seattle, Washington (Dr Ebel); Department of Pediatrics, Hennepin County Medical Center, Minneapolis, Minnesota (Dr Kiragu); Department of Pediatric Surgery, Johns Hopkins Children's Center, Baltimore, Maryland (Dr Nasr); Department of Pediatric Surgery, UMass Memorial Medical Center, Worcester, Massachusetts (Dr Aidlen); and Department of Pediatric Surgery, Arkansas Children's Hospital, Little Rock (Dr Maxson).
Background:
The American College of Surgeons Committee on Trauma recommends universal alcohol screening be part of the evaluation of admitted trauma patients. Yet, suboptimal screening rates have been reported for admitted adult and adolescent trauma patients. This lack of screening, in turn, has limited the ability of trauma services to provide patients with brief interventions during their hospital admission and subsequent referrals to treatment after discharge. The primary aim of this study was to examine current rates of alcohol and other drug screening with admitted injured adolescents across a national cohort of 10 pediatric trauma centers.
Methods:
This retrospective observational study was nested within a larger adolescent screening, brief intervention, and referral to treatment implementation study (Clinicaltrials.gov NCT03297060). Ten pediatric trauma centers participated in a retrospective chart review of a random sample of adolescent trauma patients presenting for care between March 1, 2018, and November 30, 2018.
Results:
Three hundred charts were abstracted across the 10 participating trauma centers (n = 30 per site). Screening rates varied substantially across centers from five (16.7%) to 28 (93.3%) of the 30 extracted charts. The most frequent screening type documented was blood alcohol concentration (BAC) (N = 80, 35.2% of all screens), followed by the CRAFFT (N = 79, 26.3%), and then the urine drug screen (UDS) (N = 77, 25.6%). The BAC test identified 11 patients as positive for recent alcohol use. The CRAFFT identified 11 positive patients.
Conclusions:
Alcohol and drug screening is underutilized for adolescents admitted to pediatric trauma centers. More research is warranted on how best to utilize the teachable moment of the pediatric trauma visit to ensure comprehensive screening of adolescent alcohol or other drug (AOD) use.
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