Soderstrom C A, Smith G S, Dischinger P C, McDuff D R, Hebel J R, Gorelick D A, Kerns T J, Ho S M, Read K M
R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore 21201-1595, USA.
JAMA. 1997 Jun 11;277(22):1769-74.
To assess the prevalence of psychoactive substance use disorders (PSUDs) among a large, unselected group of seriously injured trauma center patients, using a standardized diagnostic interview and criteria.
Prevalence study.
A level I regional trauma center.
Trauma center patients fulfilling the following criteria were eligible subjects: aged 18 years or older, admission from injury scene, length of stay of 2 days or longer, and intact cognition.
The PSUDs were diagnosed using the Structured Clinical Interview (SCID) for the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition (DSM-III-R) and were categorized as abuse or dependence and past or current (within past 6 months). The SCID results were analyzed with respect to demographic factors, injury type, and blood alcohol concentration and urine toxicology results, using chi2 and logistic regression techniques.
Of the 1220 patients approached for study, 1118 (91.6%) consented. More than half (54.2%) had a diagnosis of a PSUD in their lifetime. Approximately 90% of alcohol and other drug use diagnoses were for dependence and more than 62% were current. Overall, 24.1% of patients were currently alcohol dependent (men, 27.7%; women, 14.7%; P<.001), and 17.7% were currently dependent on other drugs (men, 20.2%; women, 11.2%; P<.001). Current alcohol dependence rates were not associated with race; rates of dependence on other drugs were higher among nonwhites and victims classified with intentional injuries. While 54.3% of blood alcohol-positive patients were currently alcohol dependent and 38.7% of patients with positive urine screening test results for drugs other than alcohol and nicotine were currently drug dependent, 11.7% of blood alcohol-negative and 3.9% of drug-negative patients, respectively, had current diagnoses of dependence on psychoactive substances.
A high percentage of seriously injured trauma center patients are at risk of having current PSUDs. Patients with positive toxicology screening test results and/or positive screening questionnaire responses should be referred for formal evaluation and treatment.
采用标准化诊断访谈和标准，评估一大批未经挑选的严重受伤创伤中心患者中精神活性物质使用障碍（PSUDs）的患病率。
患病率研究。
一级区域创伤中心。
符合以下标准的创伤中心患者为合格受试者：年龄18岁及以上，从受伤现场入院，住院时间2天或更长，且认知完整。
使用针对《精神疾病诊断与统计手册》第三版修订本（DSM-III-R）的结构化临床访谈（SCID）诊断PSUDs，并将其分类为滥用或依赖以及过去或当前（过去6个月内）。使用卡方检验和逻辑回归技术，就人口统计学因素、损伤类型、血液酒精浓度和尿液毒理学结果对SCID结果进行分析。
在邀请参加研究的1220例患者中，1118例（91.6%）同意参与。超过一半（54.2%）的患者在其一生中被诊断患有PSUDs。酒精和其他药物使用诊断中约90%为依赖，超过62%为当前存在。总体而言，24.1%的患者当前存在酒精依赖（男性为27.7%；女性为14.7%；P<0.001），17.7%的患者当前依赖其他药物（男性为20.2%；女性为11.2%；P<0.001）。当前酒精依赖率与种族无关；非白人和被归类为故意伤害受害者的其他药物依赖率更高。虽然54.3%血液酒精呈阳性的患者当前存在酒精依赖，38.7%除酒精和尼古丁外药物尿液筛查试验结果呈阳性的患者当前存在药物依赖，但分别有11.7%血液酒精呈阴性和3.9%药物呈阴性的患者当前被诊断为依赖精神活性物质。
很大比例的严重受伤创伤中心患者存在当前患有PSUDs的风险。毒理学筛查试验结果呈阳性和/或筛查问卷回答呈阳性的患者应被转诊进行正式评估和治疗。
