Williams Felicia N, Chrisco Lori, Strassle Paula D, Laughon Sarah L, Sljivic Sanja, Nurczyk Kamil, Nizamani Rabia, King Booker T, Charles Anthony
Department of Surgery, University of North Carolina School of Medicine 101 Manning Drive Chapel Hill, North Carolina, 27599, United States of America.
North Carolina Jaycee Burn Center 101 Manning Drive Chapel Hill, North Carolina, 27599, United States of America.
Int J Burns Trauma. 2020 Aug 15;10(4):146-155. eCollection 2020.
Alcohol and illicit drug use are common among burn-injured patients. Urine toxicology and alcohol screens are a part of our admission order sets and automatically ordered for all adult patients. Our objective was to determine the impact of bias in screening compliance and compare those results to patients who test positive. All adult patients admitted between January 1, 2014 and December 31, 2018 were eligible for inclusion. Multivariable logistic regression was used to identify potential predictors for compliance in obtaining samples for screens, and patient characteristics associated with testing positive. Four thousand nine hundred ninety-eight patients were included in the study. The biggest predictors for compliance in obtaining samples for screens were inhalation injury, intensive care unit stay, length of stay, burn size, and current smoking status. No differences in compliance with screens were seen across age, race, or ethnicity. Current smokers and patients with a history of major psychiatric illness were more likely to test positive for alcohol and illicit drugs. Non-Hispanic Black patients were more likely to test positive for illicit drugs. Male sex and pre-existing psychiatric conditions were significant predictors for compliance for alcohol screens, and, positive tests. Implicit bias based on age, race, or ethnicity played no predictive role in compliance for either screen, however, non-Hispanic Blacks were more likely to test positive for illicit drugs. More studies are needed to understand the effect of selection bias related to sample collection, and the significance of positive test results.
酒精和非法药物的使用在烧伤患者中很常见。尿液毒理学和酒精筛查是我们入院医嘱的一部分，所有成年患者都会自动进行此项检查。我们的目的是确定筛查依从性偏差的影响，并将这些结果与检测呈阳性的患者进行比较。2014年1月1日至2018年12月31日期间入院的所有成年患者均符合纳入标准。采用多变量逻辑回归来确定筛查样本采集依从性的潜在预测因素，以及与检测呈阳性相关的患者特征。该研究纳入了4998名患者。筛查样本采集依从性的最大预测因素是吸入性损伤、重症监护病房停留时间、住院时间、烧伤面积和当前吸烟状况。在年龄、种族或民族方面，筛查依从性没有差异。当前吸烟者和有重大精神疾病史的患者酒精和非法药物检测呈阳性的可能性更高。非西班牙裔黑人患者非法药物检测呈阳性的可能性更高。男性和既往存在的精神疾病状况是酒精筛查依从性和阳性检测结果的重要预测因素。基于年龄、种族或民族的隐性偏见在任何一项筛查的依从性中都没有预测作用，然而，非西班牙裔黑人非法药物检测呈阳性的可能性更高。需要更多的研究来了解与样本采集相关的选择偏差的影响，以及阳性检测结果的意义。
