Expanding the Public Health Role of Pediatric Trauma Centers: Drug Screening for Adolescent Trauma Patients

Injury and overdose are leading causes of adolescent death in the United States, with high rates of problematic substance use among injured adolescents. We sought to determine whether drug screening prevalence and positivity at pediatric trauma centers have changed with the ongoing adolescent overdose crisis.

This study evaluated trends in biochemical drug screening prevalence and positivity among injured adolescents (12-17 years) from the 2017-2022 Trauma Quality Improvement Program dataset. These were compared with contemporaneous trends in national adolescent overdose deaths from the Centers for Disease Control and Prevention. Trends were assessed with linear and logistic regression. We evaluated the association of clinical characteristics with drug positivity using multivariable logistic regression.

Across 125,745 adolescents treated at 134 pediatric trauma centers, 21.5% (n=27,232) received a biochemical drug screen. From 2017-2022, screening rates declined from 22.9% to 21.0% (p<0.001). Contemporaneously, among 25 million US adolescents, the incidence of drug overdose death increased from 1.0 deaths/100,000 adolescents to 2.8 deaths/100,000 (p=0.004).Screened adolescents (n=27,232) most often tested positive for cannabis (28.8%; n=7,857), opioids (4.5%; n=1,228), benzodiazepines (4.5%; n=1,217), meth/amphetamine (2.0%; n=545), and cocaine (1.6%; n=434). Increasing age was associated with drug positivity for all substances, including opioids (OR=1.06; 95%CI=1.02-1.10; p=0.004) and meth/amphetamine (OR=1.31; 95%CI=1.22-1.39; p<0.001). This correlated with national overdose deaths which increased from 0.3 deaths/100,000 12-year-olds to 4.6 deaths/100,000 17-year-olds (p=0.004).

Despite increasing overdose deaths, drug screening at pediatric trauma centers is decreasing. Expanded trauma center drug screening may identify problematic substance use, preventing future overdose deaths.