Alcohol and drug screening of adolescent trauma alert patients at a level 1 pediatric trauma center

Noffsinger, Dana; Wurster, Lee Ann; Cooley, Jane; Buchanan, Lindsay; Wheeler, Krista K.; Shi, Junxin; Xiang, Henry; Groner, Jonathan I.

doi:10.1016/j.ajem.2018.11.043

Cited by 6 publications

(4 citation statements)

References 15 publications

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“…Consistent with other epidemiological data (Bromberg et al, 2019;Ehrlich et al, 2010;Johnson et al, 2014;Nicolson, Lank, & Crandall, 2014;Noffsinger et al, 2019;Robinson et al, 2020), we found rates of AOD use varying from 13.8% to 32.5% among admitted adolescents. The low rate of screening across centers highlights a missed opportunity to intervene with these at-risk youth and prevent further escalation of AOD use.…”

Section: Discussionsupporting

confidence: 91%

Screening Adolescent Trauma Patients for Substance Use at 10 Pediatric Trauma Centers

2020

Journal of Trauma Nursing

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Background:The American College of Surgeons Committee on Trauma recommends universal alcohol screening be part of the evaluation of admitted trauma patients. Yet, suboptimal screening rates have been reported for admitted adult and adolescent trauma patients. This lack of screening, in turn, has limited the ability of trauma services to provide patients with brief interventions during their hospital admission and subsequent referrals to treatment after discharge. The primary aim of this study was to examine current rates of alcohol and other drug screening with admitted injured adolescents across a national cohort of 10 pediatric trauma centers.Methods: This retrospective observational study was nested within a larger adolescent screening, brief intervention, and referral to treatment implementation study (Clinicaltrials.gov

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Section: Discussionsupporting

confidence: 91%

Screening Adolescent Trauma Patients for Substance Use at 10 Pediatric Trauma Centers

2020

Journal of Trauma Nursing

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“…This likely reflects the increased risk-taking behavior seen in adolescent males relative to other age and gender categories. Accordingly, a similar study in Illinois found that higher age and male gender were strong predictors for a positive toxicology screen among their pediatric trauma cases [12]. Additional data are needed to determine if this is true for our population, but it is important to consider the relationship between drug use, male gender, and age and how it could contribute to the trend seen in our study population.…”

Section: Discussionmentioning

confidence: 77%

“…Thirty-one percent of these tests were positive, with 38% of the positive tests in the 11-18-year-old age group. Several other studies have demonstrated a similar proportion of positive drug screens [11][12][13][14]. One study demonstrated positive tests in 39% of the 12-18-year-old trauma group who met the criteria for drug screening while another revealed a 34% positive rate in 13-19-year-old trauma patients [13][14].…”

Section: Discussionmentioning

confidence: 81%

Incidence, Prevalence, and Outcomes of Pediatric Trauma in Rural Appalachia (West Virginia) From 2017 to 2019

Ellison¹,

Cifarelli²,

Pearce³

et al. 2021

Cureus

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BackgroundAppalachian rural pediatric trauma has its unique incidence, presentation, and distribution due to the mechanisms of injury, geographic location, access to care, and social issues. PurposeTo review, analyze, and understand pediatric trauma in West Virginia during the period 2017-2019. Materials and methodsAfter institutional review board approval, the statewide trauma database was queried and analyzed in a retrospective cohort study for all pediatric trauma ages zero to 18 from 2017-2019 in the Appalachian regions one through four in West Virginia.The following were analyzed: gender, injury mechanism, Glasgow Coma Scale Score (GCS) at admission, injury severity score (ISS), toxicology screen results, hospital length of stay, duration of ventilatory support, number of procedures performed during admission, presence of non-accidental trauma, cardiac arrest, patient discharge disposition, and mortality. ResultsOne-thousand eighty-two (1182) patients between the ages of zero to 18 were admitted to the trauma center. An average of 37% was female and 63% male. In the 11-18 age group, 24% were female and 76% were male. Most injuries were due to blunt force (89%), followed by penetrating injuries (7.2%) and burns (1.4%). The majority had minor or moderate injuries with 95% receiving a Glasgow Coma Scale (GCS) >13 and 72% listed as minor on the injury severity score (ISS). Children in ages 0-2 years had the highest proportion of poor (0-8) GCS scores, high ISS (>14) scores, most hospital admission days, most days on a ventilator, highest mortality, most pre-hospital cardiac arrests, child abuse, burns, and placement with child protective services. An average of 31% of children tested, and 17% in the age group of 0-2 had a positive toxicology screen. There were 3670 procedures done in total and the most common procedure performed was an ultrasound of the abdomen. Procedures were performed in 90% of the patients. Conclusions and relevanceBased on our study, the zero to two-year-old pediatric trauma patients are most vulnerable to poor outcomes and may need targeted preventative interventions. Toxicology screens may need to be more widely implemented in pediatric trauma in the Appalachian region.Rural trauma in Appalachia has endemic issues related to substance abuse, poverty, and a lower degree of social support as compared to urban areas. Although the distribution of injury may follow a national distribution, mechanism, management, and outcomes can vary.

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“…Our findings revealed an overall positive drug screening rate of 7.2% from 2017 to 2019 in the region, which was similar to the positive screening rate of 8% in an Illinois study composed of over 12,000 patients [ 14 ]. Additionally, another previous study showed that trauma cases associated with a violent injury mechanism were more likely to screen positive for alcohol or drugs, most commonly THC or opioids [ 15 ]. Patients with violent injury mechanisms in our center's study suffered more severe head and neck injuries and were more likely to screen positive for opioids or benzodiazepines.…”

Section: Discussionmentioning

confidence: 99%

Substance Abuse and Rural Appalachian Pediatric Trauma in West Virginia

Rawson

Thevenin

Balko

et al. 2022

International Journal of Pediatrics

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Introduction. Rural Appalachia is endemic to issues such as substance abuse, poverty, and lack of community support, all of which negatively influence health outcomes. The incidence of pediatric trauma as it relates to substance abuse is of concern in the region, where the rate of positive drug screens in pediatric trauma cases is higher than national average. Methods. The West Virginia statewide pediatric trauma database was analyzed in a retrospective cohort study for the years 2009-2019. Variables of interest included injury severity (assessed using Abbreviated Injury Scale (AIS)), drug screening results, and various measures of patient outcome. Results. The sample was divided into 2009-2016 presentations ( n = 3,356 ) and 2017-2019 presentations ( n = 1,182 ). Incidence of critical (AIS 5) head injuries ( p = 0.007 ) and serious (AIS 3) neck injuries ( p = 0.001 ) increased as time progressed. Days requiring ventilation increased from 3.1 in 2009–2016 to 6.3 in 2017–2019 ( p < 0.001 ). Drug screens were obtained at a rate of 6.9% in 2009–2016 versus 23.3% in 2017–2019 ( p < 0.001 ). Benzodiazepine use increased from 0.8% to 1.8% ( p < 0.001 ), and opioid use increased from 1% to 4.9% ( p < 0.001 ). Conclusion. The increasing severity of pediatric trauma and substance abuse in Appalachia is of significant concern. The use of respiratory drive-depressing drugs has risen, just as the severity of head and neck traumas has increased. These results emphasize the importance of targeted interventions in the rural pediatric population.

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Alcohol and drug screening of adolescent trauma alert patients at a level 1 pediatric trauma center

Cited by 6 publications

References 15 publications

Screening Adolescent Trauma Patients for Substance Use at 10 Pediatric Trauma Centers

Screening Adolescent Trauma Patients for Substance Use at 10 Pediatric Trauma Centers

Incidence, Prevalence, and Outcomes of Pediatric Trauma in Rural Appalachia (West Virginia) From 2017 to 2019

Substance Abuse and Rural Appalachian Pediatric Trauma in West Virginia

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