Alcohol and other drugs: an assessment of testing and clinical practices in U.S. trauma centers

The American College of Surgeons' (ACS) Committee on Trauma recommends drug and alcohol screening as "essential" for level I and II or "desirable" for level III trauma centers.

Trauma centers were surveyed concerning alcohol and other drug testing policies and clinical practices during fiscal year 1989.

Surveys were returned from 125 level I, 153 level II, and 38 other centers (n = 316; 47 states and the District of Columbia). Resources to measure blood alcohol concentrations (BAC) and perform urine drug screens were available in 99.4% and 96.8% of centers, respectively. In 63.7% of level I and level II and 47.4% of other centers, BACs were "routinely" obtained. The 63.7% testing rate for level I and level II centers was not significantly higher than a 55.2% rate for such centers documented in a survey conducted 5 years earlier. In 40.0% of level I and level II and 26.3% of other centers, drug screens were obtained routinely. The higher overall BAC testing policy compared with that for other drugs was significant (p < 0.001). Substance abuse counselors were employed at 59.3% of the trauma centers, a rate significantly higher than the 31.8% rate identified in a previous survey (p < 0.001).

Despite available resources and repeated ACS recommendations, measurements of BACs and drug screens are routine in only 63.7% of level I and 40.0% of level II trauma centers.