Factors Associated With Substance Use Screening Among Injured Adolescents

Substance use screening for injured adolescents is recommended but not mandated, and interview-based evaluations are not tracked nationally. This study examines factors associated with substance use screening among injured adolescents.

This single-center retrospective cohort study evaluated adolescents of 12-17 y presenting as trauma activations from January 2021 to June 2024. Sociodemographic and clinical data were abstracted from the electronic medical record and trauma registry. Receipt of biochemical or Screening, Brief Intervention, and Referral to Treatment (SBIRT) screening was captured. Factors associated with substance use screening were analyzed using multivariable logistic regression.

A total of 683 injured adolescents were identified. Overall, 81 (11.9%) received urine toxicology screens, 24 (3.5%) received blood alcohol tests and 406 (59.4%) received interview-based screening. Among all adolescents screened, 50 (61.7%) had a positive urine toxicology result and 55 (13.5%) had a positive SBIRT. On regression analyses, older age was associated with increased odds of receiving a urine toxicology (P < 0.01) or SBIRT (P < 0.05). Higher Glasgow Coma Scale scores were associated with increased likelihood of urine toxicology (P < 0.05) and lower likelihood of SBIRT (P < 0.001). Adolescents with hospital stays of >24 h were more likely to undergo urine toxicology (adjusted odds ratio [AOR]: 1.97, 95% confidence interval [CI]: 1.05-3.70) and SBIRT (AOR: 2.61, 95% CI: 1.74-3.92). Adolescents with low acuity injuries were less likely to receive SBIRT (AOR: 0.10, 95% CI: 0.05-0.22).

SBIRT was the most common substance use screening method for injured adolescents. Younger adolescents and those with low acuity injury were less likely to be screened. Efforts to increase substance use screening among injured youth should track SBIRT and include lower acuity injuries.