Hospital variability in adoption of alcohol and drug screening in adult trauma patients. Issue 5 (20th May 2023)

• Record Type: Journal Article
• Authors: Silver, Casey M.; Visenio, Michael R.; Thomas, Arielle C.; Reddy, Susheel; Raven, Maria C.; Kanzaria, Hemal K.; Plevin, Rebecca E.; Stey, Anne M.
• Is Part Of: Journal of trauma and acute care surgery. Volume 94:Issue 5(2023)
• Page Start: 684
• Page End: 691
• Publication Date: 2023-05-20
• Subjects: Trauma -- alcohol screening -- drug screening -- substance use screening; Surgical intensive care -- Periodicals; Surgical emergencies -- Periodicals; Wounds and injuries -- Surgery -- Periodicals; 617.026
• DOI: 10.1097/TA.0000000000003928
• Languages: English
• ISSNs: 2163-0755

Abstract

Abstract : Substance use is a major risk factor for injury. Despite recommendations to screen all trauma patients for alcohol and drug use, rates of screening were low and varied significantly between hospitals. Abstract : BACKGROUND: Despite recommendations to screen all injured patients for substance use, single-center studies have reported underscreening. This study sought to determine if there was significant practice variability in adoption of alcohol and drug screening of injured patients among hospitals participating in the Trauma Quality Improvement Program. METHODS: This was a retrospective observational cross-sectional study of trauma patients 18 years or older in Trauma Quality Improvement Program 2017–2018. Hierarchical multivariable logistic regression modeled the odds of screening for alcohol and drugs via blood/urine test while controlling for patient and hospital variables. We identified statistically significant high and low-screening hospitals based on hospitals' estimated random intercepts and associated confidence intervals (CIs). RESULTS: Of 1, 282, 111 patients at 744 hospitals, 619, 423 (48.3%) were screened for alcohol, and 388, 732 (30.3%) were screened for drugs. Hospital-level alcohol screening rates ranged from 0.8% to 99.7%, with a mean rate of 42.4% (SD, 25.1%). Hospital-level drug screening rates ranged from 0.2% to 99.9% (mean, 27.1%; SD, 20.2%). A total of 37.1% (95% CI, 34.7–39.6%) of variance in alcohol screening and 31.5% (95% CI, 29.2–33.9%) of variance in drug screening were at the hospital level. Level I/II trauma centers had higher adjusted odds of alcohol screening (adjusted odds ratio [aOR], 1.31; 95% CI, 1.22–1.41) and drug screening (aOR, 1.16; 95% CI, 1.08–1.25) than Level III and nontrauma centers. We found 297 low-screening and 307 high-screening hospitals in alcohol after adjusting for patient and hospital variables. There were 298 low-screening and 298 high-screening hospitals for drugs. CONCLUSION: Overall rates of recommended alcohol and drug screening of injured patients were low and varied significantly between hospitals. These results underscore an important opportunity to improve the care of injured patients and reduce rates of substance use and trauma recidivism. LEVEL OF EVIDENCE: Prognostic and Epidemiological; Level III. Abstract :