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Per E. Danielsson, MD; Frederick P. Rivara, MD, MPH; Larry M. Gentilello, MD; Ronald V. Maier, MD

Arch Surg. 1999;134:564-568.

Background  Alcohol screening and intervention have been recommended as routine components of trauma care but are rarely performed.

Hypothesis  An association exists between current screening and counseling practices and the trauma surgeon's knowledge, attitude, and perceived role and responsibility toward alcohol problems.

Participants  Random-sample survey (n=241) of members of the American Association for the Surgery of Trauma.

Main Outcome Measures  Reported screening and counseling practices.

Results  Fifty-four percent of respondents screened 25% or fewer patients, while only 29% screened most patients. The most common reason for not screening was "lack of time." Most (76%) were not familiar with the most common clinically used screening questionnaires, and 83% reported no training in alcohol screening. Screening was more likely if attending physicians perceived a major responsibility for screening (P<.001). Nonscreeners were twice as likely to state screening was "not what I was trained to do" and more frequently believed screening offends patients (P=.001). Independent predictors of screening were perceived major role responsibility (odds ratio [OR], 2.35; 95% confidence interval [CI], 1.38-4.01) and confidence in screening ability (OR, 1.96; 95% CI, 1.05-3.67) and counseling ability (OR, 2.27; 95% CI, 1.34-3.85). Eighty-eight percent of respondents would be willing to devote time to training if shown that counseling is effective.

Conclusions  Lack of screening and counseling appears to be due to cognitive factors, not lack of motivation. Skills on how to screen and counsel for alcohol abuse should be taught to trauma surgeons, because a strong correlation exists between screening and confidence in skills. There is a need for education regarding results of effective intervention trials in medical settings.

From the Harborview Injury Prevention and Research Center (Drs Danielsson, Rivara, Gentilello, and Maier) and the Departments of Pediatrics (Dr Rivara), Surgery (Dr Gentilello), and Epidemiology (Dr Maier), University of Washington, Seattle.

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