The cost of a checkbox

The urine drug screen persists as a routine checkbox in many trauma order sets. Derived and often unchanged from 40-year-old workplace drug testing panels, the urine drug screen rarely, if ever, informs trauma care and does not establish acute intoxication or impairment. Beyond low yield, the urine drug screen leads to unrecognized downstream harms. Clinically, the urine drug screen can contribute to diagnostic anchoring or false assurance of drug abstinence. Months or years later, when hospital records surface in litigation over insurance claims or civil suits, or in criminal proceedings, the urine drug screen may be misinterpreted to attribute fault, despite providing no evidence of impairment at the time of the injury or accident. Trauma protocols should retire routine urine drug screening from order sets and instead prioritize validated, interview-based screening methods, consistent with American College of Surgeons guidelines. In select cases in which a urine drug screen is warranted, confirmation testing should be the norm and is available at most institutions.