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Trauma Center Drug Screening Practices and Equity in Screening for Injured Adolescents
Jordan M Rook1, Whitney Orji1, Jenna S Lee2
1Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, CA.
Objective:
To evaluate the association between hospital-level screening frequency and disparities in screening by sex, race, ethnicity, and insurance. It is unknown how institutional screening practices contribute to known disparities in biochemical drug screening at pediatric trauma centers.
Methods:
We included injured adolescents (12-17 years) in the 2017-2022 Trauma Quality Improvement Program dataset. We assessed how hospital-level drug screening frequency (proportion of adolescents biochemically drug screened by trauma center) was associated with disparities in screening (increased likelihood of screening for American Indian, Black, Hispanic, female, Medicaid-insured, and uninsured adolescents). We compared high-screening (fourth-quartile) versus low-screening (first-quartile) centers. We used multivariable logistic regression with interaction terms between screening frequency and sociodemographic characteristics to evaluate for disparities in screening.
Results:
For 237,802 adolescents at 474 trauma centers, median hospital-level drug screening frequency was 23.6% (IQR=11.5%-40.8%). Compared to high-screening centers, low-screening centers were more often ACS-verified pediatric trauma centers (36.1% vs 24.4%; p=0.002). Among groups with disparately greater odds of undergoing biochemical drug screening, treatment at trauma centers with higher hospital-level screening frequencies was associated with narrowed disparities in screening for American Indian adolescents (AOR=0.29; 95%CI=0.1-0.6; p<0.001), Hispanic adolescents (AOR=0.73; 95%CI=0.6-0.9; p<0.001), Pacific Islander adolescents (AOR=0.71; 95%CI=0.51-1.00) and Medicaid-insured adolescents (AOR 0.76; 95%CI=0.7-0.9; p<0.001) and more disparate screening for female adolescents (AOR=1.19; 95%CI=1.0-1.4; p=0.009).
Conclusion:
Increasing drug screening rates at pediatric trauma centers may narrow some disparities in screening. Universal screening protocols may increase opportunities to intervene on substance use disorders and encourage equitable screening for injured adolescents.
