Departments of Emergency Medicine (Drs Mello, Zonfrillo, and Baird and Ms Bromberg), Psychiatry and Human Behavior (Dr Spirito), and Surgery (Dr Wills), Alpert Medical School of Brown University, Providence, Rhode Island; Departments of Health Services, Policy and Practice (Dr Mello) and Behavioral and Social Sciences (Drs Becker and Scott), Brown University School of Public Health, Providence, Rhode Island; Injury Prevention Center of Rhode Island Hospital-Hasbro Children's Hospital, Providence, Rhode Island (Drs Mello, Wills, Zonfrillo, and Baird and Mss Bromberg and Nimaja); Dell Children's Trauma and Injury Research Center, Dell Children's Medical Center, Austin, Texas (Dr Barczyk); Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts (Dr Lee); Division of Pediatrics, Intermountain Primary Children's Hospital, Salt Lake City, Utah (Dr Pruitt); Department of Pediatrics, Harborview Medical Center, Seattle, Washington (Dr Ebel); Department of Pediatrics, Hennepin County Medical Center, Minneapolis, Minnesota (Dr Kiragu); Department of Pediatric Surgery, Johns Hopkins Children's Center, Baltimore, Maryland (Dr Nasr); Department of Pediatric Surgery, UMass Memorial Medical Center, Worcester, Massachusetts (Dr Aidlen); and Department of Pediatric Surgery, Arkansas Children's Hospital, Little Rock (Dr Maxson).
J Trauma Nurs. 2020 Nov/Dec;27(6):313-318. doi: 10.1097/JTN.0000000000000537.
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.
This retrospective observational study was nested within a larger adolescent screening, brief intervention, and referral to treatment implementation study (Clinicaltrials.gov NCT03297060). Ten pediatric trauma centers participated in a retrospective chart review of a random sample of adolescent trauma patients presenting for care between March 1, 2018, and November 30, 2018.
Three hundred charts were abstracted across the 10 participating trauma centers (n = 30 per site). Screening rates varied substantially across centers from five (16.7%) to 28 (93.3%) of the 30 extracted charts. The most frequent screening type documented was blood alcohol concentration (BAC) (N = 80, 35.2% of all screens), followed by the CRAFFT (N = 79, 26.3%), and then the urine drug screen (UDS) (N = 77, 25.6%). The BAC test identified 11 patients as positive for recent alcohol use. The CRAFFT identified 11 positive patients.
Alcohol and drug screening is underutilized for adolescents admitted to pediatric trauma centers. More research is warranted on how best to utilize the teachable moment of the pediatric trauma visit to ensure comprehensive screening of adolescent alcohol or other drug (AOD) use.
美国外科医师学会创伤委员会建议将普遍的酒精筛查纳入接受创伤患者的评估中。然而，成人和青少年创伤患者的接受程度的筛查率并不理想。这种筛查的缺乏反过来限制了创伤服务在患者住院期间提供简短干预的能力，并在出院后将患者转介到治疗。这项研究的主要目的是在全国 10 个儿科创伤中心的一个国家队列中，检查当前对接受的受伤青少年进行酒精和其他药物筛查的情况。
这项回顾性观察性研究是在一项更大的青少年筛查、简短干预和转介治疗实施研究（Clinicaltrials.gov NCT03297060）中嵌套进行的。10 个儿科创伤中心参与了对 2018 年 3 月 1 日至 2018 年 11 月 30 日期间接受护理的青少年创伤患者的随机样本的回顾性图表审查。
在 10 个参与的创伤中心中，共提取了 300 份图表（每个中心 30 份）。筛查率在中心之间差异很大，从 5 个（16.7%）到 28 个（93.3%）。记录的最常见的筛查类型是血液酒精浓度（BAC）（N = 80，所有筛查的 35.2%），其次是 CRAFFT（N = 79，26.3%），然后是尿液药物筛查（UDS）（N = 77，25.6%）。BAC 测试发现 11 名患者最近有饮酒行为。CRAFFT 测试发现 11 名阳性患者。
儿科创伤中心对接受治疗的青少年的酒精和药物筛查使用率不足。需要更多的研究来探讨如何最好地利用儿科创伤就诊的可教时刻，以确保对青少年酒精或其他药物（AOD）使用进行全面筛查。
