Alcohol and drug screening of adolescent trauma alert patients at a level 1 pediatric trauma center.

BACKGROUND: Adolescent trauma patients are reported to have increased incidence of alcohol and other drug (AOD) use, but previous studies have included inadequate screening of the intended populations. A Level 1 Pediatric Trauma Center achieved a 94% rate of AOD screening. We hypothesized that a positive AOD screening result is associated with males, increasing age, lower socioeconomic status, violent injury mechanism, higher Injury Severity Score (ISS), lower GCS, need for operation and increased hospital length of stay. METHODS: After achieving high rates of screening among admitted trauma alert patients 12-17 years old, we evaluated patients presenting during 2014-2015. Chi-square tests were used to compare the percentage of patients with positive test results across sociodemographic, injury severity measures and patient outcomes. RESULTS: Three hundred and one patients met criteria for AOD screening during the study period. Ninety-four percent of these patients received screening and 18% were positive. Males (21.4%) were more often positive than females (11.6%). Increasing age was directly correlated with AOD use. Race was associated with a positive screen. Black patients more often had positive screens (40.9%), as compared with White patients (13.8%) and other races (23.5%). Patients with commercial insurance (6.6%) were less likely to be positive than those with no insurance (19.0%) or Medicaid (30.9%). Lower median household income was associated with positive AOD screening. Patients with violent injury mechanisms were more likely to screen positive (36.2%) than those with non-violent mechanisms (18.0%). No statistical differences were found with injury severity scores, the need for operation, or hospital length of stay. CONCLUSIONS: With near universal screening of adolescent trauma alert admissions, positive AOD results were more often found with males, increasing age, lower socioeconomic status, and violent injury mechanism. LEVEL OF EVIDENCE: Level III, Retrospective comparative study without negative criteria. STUDY TYPE: Prognostic.

Screening, brief intervention, and referral to treatment in the adolescent trauma population: examining barriers to implementation.

Adolescence is a critical stage in human development in which individuals gain independence from parents. This vulnerable period of life often involves experimentation with intoxicating substances and other risky behaviors. This combination of factors may lead to traumatic injury that requires emergency department treatment and hospitalization. This scenario presents an opportunity for screening, education and treatment regarding substance abuse. Policies that support such measures have been shown to be poorly followed. The aim of this manuscript is to identify and discuss some of the barriers to implementation of an alcohol and drug screening policy for adolescent trauma patients admitted for inpatient hospital care.