Nationwide Survey of Trauma Center Screening and Intervention Practices for Posttraumatic Stress Disorder, Firearm Violence, Mental Health, and Substance Use Disorders

Bulger, Eileen M.; Johnson, Peyton; Parker, Lily; Moloney, Kathleen; Roberts, Michelle; Vaziri, Natalie; Seo, Sara; Nehra, Deepika; Thomas, Peter; Zatzick, Douglas

doi:10.1097/xcs.0000000000000064

Cited by 35 publications

(22 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Hospital variability in adoption of substance use screening practices among injured patients thus remains poorly understood. 12,13 Given that quality improvement efforts would likely be made at the hospital level, such as by implementing screening protocols, it is vital to understand current hospital-level practices.…”

mentioning

confidence: 99%

Hospital variability in adoption of alcohol and drug screening in adult trauma patients

Silver

Visenio

Thomas

et al. 2023

J Trauma Acute Care Surg

View full text Add to dashboard Cite

BACKGROUND:Despite recommendations to screen all injured patients for substance use, single-center studies have reported underscreening. This study sought to determine if there was significant practice variability in adoption of alcohol and drug screening of injured patients among hospitals participating in the Trauma Quality Improvement Program. METHODS:This was a retrospective observational cross-sectional study of trauma patients 18 years or older in Trauma Quality Improvement Program 2017-2018. Hierarchical multivariable logistic regression modeled the odds of screening for alcohol and drugs via blood/ urine test while controlling for patient and hospital variables. We identified statistically significant high and low-screening hospitals based on hospitals' estimated random intercepts and associated confidence intervals (CIs). RESULTS:Of 1,282,111 patients at 744 hospitals, 619,423 (48.3%) were screened for alcohol, and 388,732 (30.3%) were screened for drugs. Hospital-level alcohol screening rates ranged from 0.8% to 99.7%, with a mean rate of 42.4% (SD, 25.1%). Hospital-level drug screening rates ranged from 0.2% to 99.9% (mean, 27.1%; SD, 20.2%). A total of 37.1% (95% CI, 34.7-39.6%) of variance in alcohol screening and 31.5% (95% CI, 29.2-33.9%) of variance in drug screening were at the hospital level. Level I/II trauma centers had higher adjusted odds of alcohol screening (adjusted odds ratio [aOR], 1.31; 95% CI, 1.22-1.41) and drug screening (aOR, 1.16; 95% CI, 1.08-1.25) than Level III and nontrauma centers. We found 297 low-screening and 307 high-screening hospitals in alcohol after adjusting for patient and hospital variables. There were 298 low-screening and 298 high-screening hospitals for drugs. CONCLUSION:Overall rates of recommended alcohol and drug screening of injured patients were low and varied significantly between hospitals. These results underscore an important opportunity to improve the care of injured patients and reduce rates of substance use and trauma recidivism.

show abstract

mentioning

confidence: 99%

Hospital variability in adoption of alcohol and drug screening in adult trauma patients

Silver

Visenio

Thomas

et al. 2023

J Trauma Acute Care Surg

View full text Add to dashboard Cite

show abstract

“…Further, survivors of firearm violence are at higher risk of being shot again with severity of injury and risk of mortality increasing with subsequent injury . Poverty, neighborhood stress, and community violence disproportionately affect racial and ethnic minority groups . This was underscored in the 2019 Medical Summit, which proposed screening for those at higher risk for experiencing firearm injury (Box 1).…”

Section: Discussionmentioning

confidence: 99%

Comprehensive Framework of Firearm Violence Survivor Care

et al. 2023

View full text Add to dashboard Cite

ImportanceFirearm violence is a public health crisis placing significant burden on individuals, communities, and health care systems. After firearm injury, there is increased risk of poor health, disability, and psychopathology. The newest 2022 guidelines from the American College of Surgeons Committee on Trauma require that all trauma centers screen for risk of psychopathology and provide referral to intervention. Yet, implementing these guidelines in ways that are responsive to the unique needs of communities and specific patient populations, such as after firearm violence, is challenging.ObservationsThe current review highlights important considerations and presents a model for trauma centers to provide comprehensive care to survivors of firearm injury. This model highlights the need to enhance standard practice to provide patient-centered, trauma-informed care, as well as integrate inpatient and outpatient psychological services to address psychosocial needs. Further, incorporation of violence prevention programming better addresses firearm injury as a public health concern.Conclusions and RelevanceUsing research to guide a framework for trauma centers in comprehensive care after firearm violence, we can prevent complications to physical and psychological recovery for this population. Health systems must acknowledge the socioecological context of firearm violence and provide more comprehensive care in the hospital and after discharge, to improve long-term recovery and serve as a means of tertiary prevention of firearm violence.

show abstract

“…A recent national survey documented that approximately 30% of US trauma center sites were routinely screening for PTSD symptoms after injury admission. 35 Over half of sites that were conducting PTSD screening were building PTSD services on existing alcohol screening and intervention services. The results of the current investigation suggest that building PTSD screening and intervention services on existing trauma center alcohol service delivery is an optimal approach, given the very high rates of PTSD and alcohol comorbidity.…”

Section: Discussionmentioning

confidence: 99%

“…These observations have important implications for the development screening, intervention, and referral procedures for patients with elevated levels of PTSD symptoms at US trauma centers. A recent national survey documented that approximately 30% of US trauma center sites were routinely screening for PTSD symptoms after injury admission 35. Over half of sites that were conducting PTSD screening were building PTSD services on existing alcohol screening and intervention services.…”

Section: Discussionmentioning

confidence: 99%

“…The ACS-COT has previously required alcohol screening and intervention at US level I and II trauma centers 50. Recent investigation has established widespread adherence among trauma centers nationally to the ACS-COT alcohol requirement 35. Orchestrated ACS-COT policy and trauma center service delivery development should incorporate the key finding that a substantial majority of patients with high levels of psychological distress (eg, elevated PTSD symptoms) may have alcohol and drug use comorbidities.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Post-traumatic stress disorder (PTSD) symptoms and alcohol and drug use comorbidity at 25 US level I trauma centers

Nguyen

Whiteside

Bulger

et al. 2022

Trauma Surg Acute Care Open

Self Cite

View full text Add to dashboard Cite

BackgroundQuestions regarding the extent to which post-traumatic stress disorder (PTSD) is comorbid with alcohol and drug use are particularly germane in an era when the American College of Surgeons Committee on Trauma (ACS-COT) is considering policy requiring screening, intervention and/or referral services for patients presenting with psychological sequalae of traumatic injury. Literature review revealed few multisite trauma-center-based investigations that have assessed the association between PTSD symptoms and alcohol and drug use comorbidities in injured patients.MethodsThis investigation was a secondary analysis of baseline data collected prior to randomization in a 25-site trauma center pragmatic clinical trial. All 635 patients included in the investigation had elevated PTSD symptom levels at the time of trauma center admission. Self-report questionnaire screening, laboratory toxicology results, and electronic health record data were combined to assess the frequencies of alcohol, stimulant (i.e., amphetamine and cocaine), opioid and marijuana use comorbidities for injured patients. Logistic regression was used to assess the associations between demographic and injury characteristics and alcohol and drug use comorbidity.ResultsThe frequency of patients with one or more alcohol or substance use comorbidity was between 62% and 79%. Over 50% of patients were positive for one or more alcohol or cannabis comorbidity. Approximately 26% of patients were positive for stimulants and 10% for opioid comorbidity.DiscussionThis multisite investigation suggests that between 62% and 79% of hospitalized injury survivors with elevated PTSD symptoms have one or more alcohol or drug use comorbidity. Orchestrated ACS-COT policy and trauma center service delivery development should incorporate the key finding that a substantial majority of patients with high levels of psychological distress (eg, elevated PTSD symptoms) may have alcohol and drug use comorbidities.Level of evidenceLevel II (epidemiological investigation of untreated controls from a multisite randomized clinical trial)Trial registration numberNCT02655354.

show abstract

Nationwide Survey of Trauma Center Screening and Intervention Practices for Posttraumatic Stress Disorder, Firearm Violence, Mental Health, and Substance Use Disorders

Cited by 35 publications

References 40 publications

Hospital variability in adoption of alcohol and drug screening in adult trauma patients

Hospital variability in adoption of alcohol and drug screening in adult trauma patients

Comprehensive Framework of Firearm Violence Survivor Care

Post-traumatic stress disorder (PTSD) symptoms and alcohol and drug use comorbidity at 25 US level I trauma centers

Contact Info

Product

Resources

About