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Maxwell BG, Lin S, Greene NH, Jafri MA. Kids grow up so fast: national patterns of positive drug/alcohol screens among pediatric trauma patients. Pediatr Res 2021; 89:767-769. [PMID: 32947605 DOI: 10.1038/s41390-020-01163-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 08/14/2020] [Accepted: 08/25/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND National guidelines recommend screening all trauma patients for drug and alcohol use beginning at age 12, but no national data have examined rates of screening or positive results in this population. METHODS We examined national testing rates and results among all trauma patients under 21 years old in the 2017 American College of Surgeons Trauma Quality Programs (TQP) database. RESULTS Of a cohort of n = 157,450 pediatric and adolescent trauma patients, n = 45,443 (28.9%) were screened, and n = 16,662 (36.7%) of those had a positive result. While both testing and positive results increased with age, testing rates were only 61.7% by age 20 and the prevalence of positive results was significant even at younger ages. Cannabinoids were the most commonly detected substance, followed by alcohol, and then opioids. CONCLUSIONS These national data support the need for further efforts to increase screening rates and provide structured interventions to mitigate the consequences of substance abuse. IMPACT These data provide the first national evidence of underutilization of drug and alcohol screening in pediatric and adolescent trauma patients, with substantial rates of positive screens among those tested. Cannabinoids were the most commonly detected substance, followed by alcohol and then opioids. These data should guide physicians' and policymakers' efforts to improve screening in this high-risk population, which will amplify the potential benefits of using the trauma admission as a critical opportunity to intervene with structured programs to mitigate the consequences of substance abuse.
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Affiliation(s)
- Bryan G Maxwell
- Department of Anesthesiology, Randall Children's Hospital at Legacy Emanuel Medical Center, Portland, OR, USA.
| | - Saunders Lin
- Department of Surgery, Oregon Health and Sciences University, Portland, OR, USA
| | - Nathaniel H Greene
- Department of Anesthesiology, Randall Children's Hospital at Legacy Emanuel Medical Center, Portland, OR, USA
| | - Mubeen A Jafri
- Division of Pediatric Surgery, Randall Children's Hospital at Legacy Emanuel Medical Center, Portland, OR, USA.,Division of Pediatric Surgery, Doernbecher Children's Hospital, Oregon Health and Sciences University, Portland, OR, USA
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Yurtseven A, Turan C, Yuncu Z, Annette Akgur S, Saz EU. Substance use frequency and related characteristics among adolescents presenting to an emergency department in Turkey. J Ethn Subst Abuse 2019; 20:614-624. [PMID: 31686623 DOI: 10.1080/15332640.2019.1685048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
It has been reported that drug-related visits to emergency department (ED) by youth have been increased in recent years. We aimed to determine the frequency of, and associated risk factors for, substance abuser adolescents presenting to the emergency department. We conducted a biphasic (retrospective-prospective), observational study of all adolescents, presenting to our emergency department with complaints related to recreational drug use and having a positive urine drug screening from January, 2013 to December 2016. To obtain some spesific data, a telephone interview was done. Baseline demographic and clinical data were obtained. During the study period urine toxicology screen was positive for illicit drugs in 131 (0.9%) patients. The total of substance users by years were respectively 17 (13%) in 2013, 27 (20%) in 2014, 39 (30%) in 2015 and 48 (37%). The median age was 16 years and 65% were male. Majority of substance users (61%) had neuropsychiatric complaint. Amphetamine type stimulants (60%) were the most commonly used substance. Rate of cigarette and alcohol use in this adolescent group was respectively 95% and 88%. This group also had some specific features such as low income (59%) and single-parent family (54%). Our findings suggest that the number of illicit drug use has been steadily increasing among adolescents. The most common identified substance was amphetamine type stimulants. They had poor socioeconomic conditions.
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Affiliation(s)
- Ali Yurtseven
- Department of Pediatrics, Division of Emergency Medicine, School of Medicine, Ege University, İzmir, Turkey
| | - Caner Turan
- Department of Pediatrics, Division of Emergency Medicine, School of Medicine, Ege University, İzmir, Turkey
| | - Zeki Yuncu
- Department of Child and Adolescent Mental Health and Diseases, School of Medicine, Ege University, İzmir, Turkey
| | - Serap Annette Akgur
- Institute on Drug Abuse, Toxicology and Pharmaceutical Science, Ege University, İzmir, Turkey
| | - Eylem Ulas Saz
- Department of Pediatrics, Division of Emergency Medicine, School of Medicine, Ege University, İzmir, Turkey
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Grigorian A, Lester E, Lekawa M, Figueroa C, Kuza CM, Dolich M, Schubl SD, Barrios C, Nahmias J. Marijuana use and outcomes in adult and pediatric trauma patients after legalization in California. Am J Surg 2019; 218:1189-1194. [PMID: 31521241 DOI: 10.1016/j.amjsurg.2019.08.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 08/20/2019] [Accepted: 08/27/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Marijuana has become legal in eight states since 2012. We hypothesized the incidence of marijuana-positive trauma patients and rate of mortality has increased post-legalization. METHODS A single level-I trauma center was used to identify patients screening positive for marijuana on urine-toxicology. Patients in the pre-legalization and post-legalization periods were compared. RESULTS In the pre-legalization cohort 9.4% were marijuana-positive versus 11.0% in the post-legalization cohort (p = 0.001). Marijuana-positive patients post-legalization had higher rates of critical trauma activation (20.0% vs. 15.0%, p = 0.01) and mortality (2.6% vs. 1.2%, p = 0.03). In the pediatric (age 12-17) subgroup, the incidence of marijuana-positive patients did not change after legalization (pre: 39.3%, post: 46.4%, p = 0.24). CONCLUSION The incidence of marijuana-positive trauma patients increased post-legalization. Adult marijuana-positive trauma patients post-legalization were more likely to meet criteria for critical trauma activation and have a higher mortality rate. A subgroup of pediatric patients had an alarmingly high rate of marijuana use. SUMMARY The rate of marijuana use among trauma patients increased post-legalization in California. The rate of critical trauma activation also increased as well as the mortality rate.
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Affiliation(s)
- A Grigorian
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA.
| | - E Lester
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - M Lekawa
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - C Figueroa
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - C M Kuza
- University of Southern California, Department of Anesthesia, Los Angeles, CA, USA
| | - M Dolich
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - S D Schubl
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - C Barrios
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - J Nahmias
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
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Noffsinger DL, Wurster LA, Cooley J, Buchanan L, Wheeler KK, Shi J, Xiang H, Groner JI. Alcohol and drug screening of adolescent trauma alert patients at a level 1 pediatric trauma center. Am J Emerg Med 2018; 37:1672-1676. [PMID: 30551939 DOI: 10.1016/j.ajem.2018.11.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 11/26/2018] [Accepted: 11/29/2018] [Indexed: 11/18/2022] Open
Abstract
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.
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Affiliation(s)
- Dana L Noffsinger
- Trauma Program, Department of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States of America; Center for Pediatric Trauma Research, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States of America.
| | - Lee Ann Wurster
- Trauma Program, Department of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States of America; Center for Pediatric Trauma Research, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States of America.
| | - Jane Cooley
- Trauma Program, Department of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States of America; Department of Social Work, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States of America.
| | - Lindsay Buchanan
- Trauma Program, Department of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States of America; Department of Social Work, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States of America.
| | - Krista K Wheeler
- Center for Pediatric Trauma Research, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States of America; Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States of America.
| | - Junxin Shi
- Center for Pediatric Trauma Research, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States of America; Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States of America.
| | - Henry Xiang
- Trauma Program, Department of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States of America; Center for Pediatric Trauma Research, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States of America; Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States of America; The Ohio State University College of Medicine, 370 West 9(th) Avenue, Columbus, OH 43210, United States of America.
| | - Jonathan I Groner
- Trauma Program, Department of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States of America; Center for Pediatric Trauma Research, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States of America; The Ohio State University College of Medicine, 370 West 9(th) Avenue, Columbus, OH 43210, United States of America.
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Falvo F, Schmid A. Bridging the Gap: Drug and Alcohol Screening in Adolescent Trauma Patients. J Emerg Nurs 2018; 44:325-330. [DOI: 10.1016/j.jen.2018.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 09/23/2017] [Accepted: 01/03/2018] [Indexed: 11/16/2022]
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Maung AA, Becher RD, Schuster KM, Davis KA. When should screening of pediatric trauma patients for adult behaviors start? Trauma Surg Acute Care Open 2018; 3:e000181. [PMID: 29766143 PMCID: PMC5905833 DOI: 10.1136/tsaco-2018-000181] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 03/21/2018] [Indexed: 11/24/2022] Open
Abstract
Background Care of patients with trauma is not only limited to the sustained physical injuries but also requires addressing social issues, such as substance abuse and interpersonal violence, which are responsible for trauma-related recidivism. This study investigates whether there are age-related variations in these problematic social behaviors to analyze whether there is an age cut-off at which point adolescents should be screened for adult social behaviors. Methods Retrospective review of patients with trauma aged 12–21 admitted to an urban Level 1 adult and pediatric trauma center between February 2013 and April 2016. Demographics, mechanisms of injury, Injury Severity Score, outcomes, toxicology and social history evaluations were abstracted from the electronic medical record. Results 756 patients were admitted during the 39-month period. Most patients were male (73.9%) without significant variation by age. The mechanisms of injury varied by age (p<0.001) with the incidence of sports and bicycle injuries decreasing and the incidence of motor vehicle/motorcycle crashes, assaults and gunshot injuries increasing with increasing patient age. In a logistic regression, risks of positive toxicology tests, injuries due to violence as well as overall use of drugs, tobacco and alcohol also significantly increased with age starting with the youngest age included in the study. Conclusions As pediatric trauma patients get older, they have increasing risks of social issues typically associated with adults. Our study underscores the need to evaluate and address these issues even in young adolescents. Level of evidence Level IV—epidemiological.
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Affiliation(s)
- Adrian A Maung
- Department of Surgery, Section of General Surgery, Trauma and Surgical Critical Care, Yale School of Medicine, New Haven, Connecticut, USA
| | - Robert D Becher
- Department of Surgery, Section of General Surgery, Trauma and Surgical Critical Care, Yale School of Medicine, New Haven, Connecticut, USA
| | - Kevin M Schuster
- Department of Surgery, Section of General Surgery, Trauma and Surgical Critical Care, Yale School of Medicine, New Haven, Connecticut, USA
| | - Kimberly A Davis
- Department of Surgery, Section of General Surgery, Trauma and Surgical Critical Care, Yale School of Medicine, New Haven, Connecticut, USA
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McAllister P, Laverick S, Makubate B, Jones DC. Alcohol consumption and interpersonal injury in a pediatric oral and maxillofacial trauma population: a retrospective review of 1,192 trauma patients. Craniomaxillofac Trauma Reconstr 2015; 8:83-7. [PMID: 26000076 DOI: 10.1055/s-0034-1393730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 03/04/2014] [Indexed: 10/24/2022] Open
Abstract
The social, financial, and health implications of adult alcohol-related oral and maxillofacial trauma have been recognized for several years. Affordability and widespread accessibility of alcohol and issues of misuse in the pediatric trauma population have fostered concerns alcohol may be similarly implicated in young patients with orofacial trauma. The aim of this study was to review data of pediatric facial injuries at a regional maxillofacial unit, assess the prevalence of alcohol use, and review data of patients sustaining injury secondary to interpersonal violence. This study is a retrospective, 3-year review of a Regional Maxillofacial Unit (RMU) trauma database. Inclusion criterion was consecutive facial trauma patients under 16 years of age, referred to RMU for further assessment and/or management. Alcohol use and injuries sustained were reviewed. Of 1,192 pediatric facial trauma patients, 35 (2.9%) were associated with alcohol intake. A total of 145 (12.2%) alleged assault as the mechanism of injury, with older (12-15 years) (n = 129; 88.9%), male (n = 124; 85.5%) (p < 0.001) patients commonly involved and alcohol use implicated in 26 (17.9%) presentations. A proportion of vulnerable adolescents misuse alcohol to the risk of traumatic facial injury, and prospective research to accurately determine any role of alcohol in the pediatric trauma population is essential.
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Affiliation(s)
- Peter McAllister
- Department of Oral and Maxillofacial Surgery, NHS Tayside, Ninewells Hospital, Dundee, United Kingdom
| | - Sean Laverick
- Department of Oral and Maxillofacial Surgery, NHS Tayside, Dundee, United Kingdom
| | - Boikanyo Makubate
- Department of Statistics, College of Applied Sciences, Botswana International University of Science and Technology, Botswana
| | - David Carl Jones
- Department of Oral and Maxillofacial Surgery, University Hospital, Liverpool, United Kingdom
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Psoter KJ, Roudsari BS, Mack C, Vavilala MS, Jarvik JG. Outcomes and resource utilization associated with underage drinking at a level I trauma center. J Adolesc Health 2014; 55:195-200. [PMID: 24661737 DOI: 10.1016/j.jadohealth.2014.01.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 12/22/2013] [Accepted: 01/28/2014] [Indexed: 11/17/2022]
Abstract
PURPOSE To examine the association of blood alcohol content (BAC) on hospital-based outcomes and imaging utilization for patients <21 years admitted to a level I trauma center. METHODS Retrospective analysis of alcohol-involved injuries in patients 13-20 years, admitted to a level I trauma center from 1996 to 2010. An injury was considered alcohol involved if the patient had a BAC > 0. Multivariable logistic regression was used to compare mortality, discharge destination (home and skilled nursing facility), intensive care unit admission, and operating room use between patients with and without positive BAC for patients 13-15, 16-17, and 18-20 years. Multivariable linear regression was used to compare length of hospitalization. Finally, multivariable negative binomial regression evaluated radiology resource utilization (x-ray, computed tomography [CT], and magnetic resonance imaging). RESULTS A total of 7,663 patients, 13-20 years old, were admitted over the study period. A positive BAC was reported in 19% of these patients. In general, the presence of alcohol was not associated with mortality rate, length of hospitalization, intensive care unit, and operating room use or discharge status for any age group. However, the presence of alcohol was associated with higher utilization of head (incidence rate ratio [IRR] 1.13, 95% confidence interval [CI] 1.02-1.26), cervical spine (IRR 1.10, 95% CI 1.01-1.22), and thoracic (IRR 1.30, 95% CI 1.05-1.63) CTs in young adults 18-20 years. No differences in CT use were observed in patients 13-15 or 16-17 years. CONCLUSIONS Positive BAC was not significantly associated with adverse outcomes or resource utilization in younger trauma patients. However, the use of certain body region CTs was associated with positive BAC in patients 18-20 years.
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Affiliation(s)
- Kevin J Psoter
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
| | - Bahman S Roudsari
- Department of Radiology, University of Washington, Seattle, Washington; Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, Seattle, Washington
| | - Christopher Mack
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington
| | - Monica S Vavilala
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington; Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington; Department of Pediatrics, University of Washington, Seattle, Washington
| | - Jeffrey G Jarvik
- Department of Radiology, University of Washington, Seattle, Washington; Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, Seattle, Washington; Department of Neurological Surgery, University of Washington, Seattle, Washington
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Emergency department alcohol and drug screening for Illinois pediatric trauma patients, 1999 to 2009. Am J Surg 2014; 208:531-5. [PMID: 25096261 DOI: 10.1016/j.amjsurg.2014.06.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Revised: 05/29/2014] [Accepted: 06/09/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Recent guidelines recommend universal substance abuse screening for all trauma patients aged 12 years and older because brief interventions can help prevent future trauma. However, little is known about actual rates of screening in this setting. METHODS The Illinois State Trauma Registry was queried for severely injured patients from 1999 to 2009. Multivariate logistic regression was used to characterize, according to demographic and physiologic parameters, which patients were screened with blood alcohol and urine toxicology and which screened positive. RESULTS Of the 12,264 pediatric patients, 40% were tested for alcohol and 37% for drugs. Nine percent of patients screened positive for alcohol and 8% for drugs. Age strongly predicted positive tests, as did male sex. Black and Hispanic patients were screened for alcohol most frequently, but only Hispanics were more likely to test positive. CONCLUSION Although current guidelines recommend screening all trauma patients 12 years and older, current practice falls far short of this goal.
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Johnson KN, Raetz A, Harte M, McMahon LE, Grandsoult V, Garcia-Filion P, Notrica DM. Pediatric trauma patient alcohol screening: a 3 year review of screening at a Level I pediatric trauma center using the CRAFFT tool. J Pediatr Surg 2014; 49:330-2. [PMID: 24528979 DOI: 10.1016/j.jpedsurg.2013.10.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 10/10/2013] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Alcohol use is a risk factor for adult trauma. Alcohol may significantly influence pediatric trauma risk, but literature is sparse. The aim of this study was to examine the impact of alcohol use screening in pediatric trauma patients. METHODS A retrospective review was performed of all trauma patients to identify those undergoing CRAFFT alcohol screening assessment between July 1, 2009, and January 31, 2011. Inclusion criteria involved screening of level 1 or 2 trauma activations for patients greater than 12 years. RESULTS During the study period, 232 patients were eligible for screening, of which 51% (n=118) were screened. Among the patients screened, 21 (18%) had a positive screen (mean age 14.6 years, range 13-16). Twenty patients were referred for further counseling. Sixteen males and 5 females screened positive during the study. The most common mechanism of injury in the positive screen patients was motor vehicle or ATV accident (n=9), followed by assault (n=6), and motor versus pedestrian collision (n=2). Of the 21 patients who screened positive, 10 had positive blood alcohol content (BAC) or urine drug screen (UDS) at the time of injury. No patients with a positive screen returned during the study as a trauma patient. CONCLUSION Alcohol and drug screening for injured pediatric trauma patients is frequently omitted despite policy-required screening. Of those patients screened, 18% admitted to risky alcohol or drug-related behaviors or had positive BAL or UDS at presentation. Pediatric trauma screening for risky alcohol use identifies a significant number of children. Alcohol and drug screening in pediatric trauma appears over age 13 years to have a yield which justifies continued screening. Alcohol related trauma recidivism, however, does not seem common.
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Affiliation(s)
- Kevin N Johnson
- Department of General Surgery, Mayo Clinic, Phoenix, Arizona
| | - Alaina Raetz
- Trauma Center, Phoenix Children's Hospital, Phoenix, Arizona
| | - Melissa Harte
- Trauma Center, Phoenix Children's Hospital, Phoenix, Arizona
| | - Lisa E McMahon
- Department of General Surgery, Mayo Clinic, Phoenix, Arizona; Trauma Center, Phoenix Children's Hospital, Phoenix, Arizona; Department of Child Health, University of Arizona College of Medicine - Phoenix, Phoenix, Arizona
| | | | - Pamela Garcia-Filion
- Trauma Center, Phoenix Children's Hospital, Phoenix, Arizona; Department of Child Health, University of Arizona College of Medicine - Phoenix, Phoenix, Arizona
| | - David M Notrica
- Department of General Surgery, Mayo Clinic, Phoenix, Arizona; Trauma Center, Phoenix Children's Hospital, Phoenix, Arizona; Department of Child Health, University of Arizona College of Medicine - Phoenix, Phoenix, Arizona.
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11
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Guidelines for alcohol screening in adolescent trauma patients: a report from the Pediatric Trauma Society Guidelines Committee. J Trauma Acute Care Surg 2013; 74:671-82. [PMID: 23354268 DOI: 10.1097/ta.0b013e31827d5f80] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Alcohol misuse is an important source of preventable injuries in the adolescent population. While alcohol screening and brief interventions are required at American College of Surgeons-accredited trauma centers, there is no standard screening method. To develop guidelines for testing, we reviewed available evidence regarding adolescent alcohol screening after injury, focusing on the questions of which populations require screening, which screening tools are most effective, and at which time point screening should be performed. METHODS A comprehensive PubMed search for articles related to alcoholism, trauma, and screening resulted in 1,013 article abstracts for review. Eighty-five full-length articles were considered for inclusion. Articles were excluded based on study type, location (non-US), year of publication, and nonapplicability to the study questions. RESULTS Twenty-six articles met full inclusion criteria. Results support universal screening for alcohol misuse in the adolescent trauma population. Although adolescents 14 years and older are more likely to test positive for alcohol misuse, studies suggest screening may need to start at 12 years or younger. Both survey and biochemical screens can identify at-risk adolescents, with the Alcohol Use Disorders Identification Test and the two-question survey based on the Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition criteria for alcohol-use disorders being the most sensitive surveys available. CONCLUSION Injured adolescent trauma patients should be universally screened for alcohol misuse during their hospital visit. To maximize the number of at-risk adolescents targeted for interventions, screening should begin at minimum at 12 years. As no screen identifies all at-risk adolescents, a serial screening method using both biochemical tests and standardized questionnaires may increase screening efficacy.
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12
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Support for blood alcohol screening in pediatric trauma. Am J Surg 2012; 204:939-43; discussion 943. [PMID: 23026384 DOI: 10.1016/j.amjsurg.2012.05.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 05/22/2012] [Accepted: 05/22/2012] [Indexed: 11/22/2022]
Abstract
BACKGROUND Alcohol intoxication in pediatric trauma is underappreciated. The aim of this study was to characterize alcohol screening rates in pediatric trauma. METHODS The Los Angeles County Trauma System Database was queried for all patients aged ≤ 18 years who required admission between 2003 and 2008. Patients were compared by age and gender. RESULTS A total of 18,598 patients met the inclusion criteria; 4,899 (26.3%) underwent blood alcohol screening, and 2,797 (57.1%) of those screened positive. Screening increased with age (3.3% for 0-9 years, 15.1% for 10-14 years, and 45.4% for 15-18 years; P < .01), as did alcohol intoxication (1.9% for 0-9 years, 5.8% 10-14 years, and 27.3% for 15-18 years; P < .01). Male gender predicted higher mortality in those aged 15 to 18 years (adjusted odds ratio, 1.7; P < .01), while alcohol intoxication did not (adjusted odds ratio, .97; P = .84). CONCLUSIONS Alcohol intoxication is common in adolescent trauma patients. Screening is encouraged for pediatric trauma patients aged ≥10 years who require admission.
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Arnestad M. What is toxic in infants and children? Forensic Sci Med Pathol 2012; 9:94-5. [DOI: 10.1007/s12024-012-9371-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2012] [Indexed: 12/01/2022]
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