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Are We Doing Enough?

Jason A. London, MD, MPH; Felix D. Battistella, MD

Arch Surg. 2007;142(7):633-638.

Hypothesis  Only a fraction of trauma patients are being tested for substance use, and the proportion of those tested may have decreased over time.

Design  Retrospective review of longitudinal data.

Setting  National Trauma Data Bank.

Patients  Individuals aged 15 to 50 years admitted with injuries from 1998 to 2003.

Main Outcome Measures  The primary outcomes of interest are the incidence of drug and alcohol testing and the results of these tests. The primary exposure of interest is year of admission.

Results  Half of patients admitted with injuries are being tested for alcohol use, and half of these patients have positive test results. Only 36.3% of patients admitted with injuries are tested for drug use, and 46.5% of these patients have positive test results. There have been no significant trends for either alcohol testing or results in the past 6 years. Compared with 1998, patients are significantly less likely to be tested for drugs, but more likely to have positive test results.

Conclusions  Only a small proportion of patients who are admitted with injuries are tested for substance use. The proportion of patients tested for drugs has decreased significantly during the past 6 years. Routine testing would maximize identification of patients who may benefit from interventions. Several obstacles exist to routine screening, including legal and physician-related barriers. Future efforts to facilitate routine testing of trauma patients for substance use should concentrate on protecting patient confidentiality and educating physicians on the techniques and benefits of brief interventions.

Author Affiliations: Division of Trauma and Emergency Surgery, Department of Surgery, University of California, Davis Medical Center, Sacramento.

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