Underuse and Variability in Substance Use Screening Among Adult Trauma Patients in the U.S.: A Nationwide Retrospective Cohort Study.
Journal
Annals of surgery
ISSN: 1528-1140
Titre abrégé: Ann Surg
Pays: United States
ID NLM: 0372354
Informations de publication
Date de publication:
01 Jun 2023
01 Jun 2023
Historique:
medline:
29
11
2023
pubmed:
17
12
2021
entrez:
16
12
2021
Statut:
ppublish
Résumé
To characterize the rates and variability in substance screening among adult trauma patients in the U.S. Emergency Department trauma visits provide a unique opportunity to identify patients with substance use disorders. Despite the existence of screening guidelines, underscreening and variability in screening practices remain. Retrospective cohort study including adult trauma patients (18- 64-year-old) from the ACS-TQIP 2017-18 database. Multivariable logistic regressions were performed to adjust for demographics, clinical, and facility factors, and marginal probabilities were calculated using these multivariable models. The primary outcomes were substance screening and positivity, which were defined relative to the observation-weighted grand mean (mean). 2,048,176 patients were contained in the TQIP dataset, 809,878 (39.5%) were screened for alcohol (20.8% positive), and 617,129 (30.1%) were screened for drugs (37.3% positive). After all exclusion criteria were applied, 765,897 patients were included in the analysis, 394,391 (52.9%) were screened for alcohol (22.1% tested positive), and 279,531 (36.5%) were screened for drugs (44.3% tested positive). Among the patients included in our study, significant variability in screening rates existed with respect to demo-graphic, trauma mechanism, injury severity, and facility factors. Furthermore, in several cases, patient subpopulations who were less likely to be screened were in fact more likely to screen positive or vice versa. Effective substance-screening guidelines should be predicated on achieving universal screening. Current lapses in screening, along with the observed variability, likely affect different patient populations in disparate manners and lead to both under-detection as well as waste of valuable resources.
Sections du résumé
OBJECTIVE
OBJECTIVE
To characterize the rates and variability in substance screening among adult trauma patients in the U.S.
SUMMARY BACKGROUND DATA
BACKGROUND
Emergency Department trauma visits provide a unique opportunity to identify patients with substance use disorders. Despite the existence of screening guidelines, underscreening and variability in screening practices remain.
METHODS
METHODS
Retrospective cohort study including adult trauma patients (18- 64-year-old) from the ACS-TQIP 2017-18 database. Multivariable logistic regressions were performed to adjust for demographics, clinical, and facility factors, and marginal probabilities were calculated using these multivariable models. The primary outcomes were substance screening and positivity, which were defined relative to the observation-weighted grand mean (mean).
RESULTS
RESULTS
2,048,176 patients were contained in the TQIP dataset, 809,878 (39.5%) were screened for alcohol (20.8% positive), and 617,129 (30.1%) were screened for drugs (37.3% positive). After all exclusion criteria were applied, 765,897 patients were included in the analysis, 394,391 (52.9%) were screened for alcohol (22.1% tested positive), and 279,531 (36.5%) were screened for drugs (44.3% tested positive). Among the patients included in our study, significant variability in screening rates existed with respect to demo-graphic, trauma mechanism, injury severity, and facility factors. Furthermore, in several cases, patient subpopulations who were less likely to be screened were in fact more likely to screen positive or vice versa.
CONCLUSIONS
CONCLUSIONS
Effective substance-screening guidelines should be predicated on achieving universal screening. Current lapses in screening, along with the observed variability, likely affect different patient populations in disparate manners and lead to both under-detection as well as waste of valuable resources.
Identifiants
pubmed: 34913899
doi: 10.1097/SLA.0000000000005331
pii: 00000658-900000000-93152
doi:
Substances chimiques
Ethanol
3K9958V90M
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e1324-e1330Informations de copyright
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors report no conflicts of interest.
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