Underage drinking, brief interventions, and trauma patients

Abstract

Background While the relationship between underage drinking and injury has been well established, few studies have examined whether presenting for an acute injury moderates the efficacy of a brief intervention (BI) on alcohol misuse. Method Patients (aged 14-20) in the emergency department screening positive for risky drinking (AUDIT-C score) completed a baseline assessment, were randomized to conditions [a stand-alone computer-delivered BI (n=277), a therapist-delivered BI (n=278), or a control condition (n=281)], and completed a 3-month follow-up. This secondary analysis of Project U connect examined regression models (controlling for baseline values) to examine the main effects of injury, and the interaction effects of injury by BI condition, on alcohol consumption and consequences. Results Among 836 youth enrolled in the randomized controlled trial (mean age = 18.6, 51.6% male, 79.4% Caucasian), 303 (36.2%) had a primary complaint of intentional or unintentional injury. At baseline, injured patients were more likely to be male (p <0.001) and have higher alcohol consumption (p <0.01), but were less likely to misuse prescription drugs (p=0.02) than those presenting for medical reasons. Regression models (controlling for baseline values) demonstrated that injury presentation predicted greater alcohol consumption prior to a BI. The computer BI was more effective at reducing alcohol consequences among those presenting with injury than those presenting for other reasons. Injury did not affect the efficacy of the computer BI on alcohol consumption, and injury did not affect the efficacy of the therapist BI on alcohol outcomes. Conclusion A therapist or computer BI reduced alcohol consumption and consequences among risky drinkers regardless of reason for ED presentation highlighting the opportunity to reach a broad array of youth. Although the therapist BI was not moderated by injury presentation, the computer BI was particularly effective at reducing alcohol consequences among those presenting with injury at three month follow-up. Level of Evidence Level 1 Type of Study Criteria

Mental Health Care Following Firearm and Motor Vehicle-related Injuries

“…Hospitalized children may represent a particularly vulnerable group who may benefit from focused real time behavioral health assessment and intervention programs after firearm injuries 26. The results of this study can be used to guide future interventions, as previous research suggests MH services after firearm injuries may be inadequate 27,28…”

“…MH screening and diagnostic assessments can be incorporated during admission to trauma centers 31. Targeted screens need to be developed and validated, building on the success of widely implemented screening tools for alcohol misuse among trauma patients 27,28,31–33. One possibility may be to adapt the Traumatic Events Screening Inventory (TESI), which predicts the need for behavioral health services in primary care settings, to the inpatient setting 34.…”

“…26 The results of this study can be used to guide future interventions, as previous research suggests MH services after firearm injuries may be inadequate. 27,28 MH disorders can lead to long-term disability and reduced quality of life. 6,29 Secondary prevention efforts can mitigate and improve outcomes.…”

“…31 Targeted screens need to be developed and validated, building on the success of widely implemented screening tools for alcohol misuse among trauma patients. 27,28,[31][32][33] One possibility may be to adapt the Traumatic Events Screening Inventory (TESI), which predicts the need for behavioral health services in primary care settings, to the inpatient setting. 34 Our study results suggest that hospitals, particularly Level I and II pediatric trauma centers should consider a broader approach for the care of the injured pediatric patient that includes real time behavioral health interventions, that compliments the physical health treatments from bullets.…”