103 Screening for Alcohol and Drugs: Are We Under-testing Older Patients?

Abstract

Abstract Introduction Only a fraction of trauma patients are being tested for drugs of abuse, despite the evidence that abuse of these substances contributes to traumatic injuries. In the specific trauma patient population of burn victims, drug and alcohol intoxication at the time of the burn may alter prognosis for both morbidity and mortality. Younger populations tend to be thought of at higher risk for drug and alcohol intoxication, and this may bias testing in other age groups. This study examined drug and alcohol testing in burn patients presenting to an ABA-verified burn center to determine if testing biases existed based on age, sex, or burn severity, and what populations were high risk for abuse in order to optimize testing in the high risk populations. Methods The burn center’s inpatient database was queried for all admitted patients from January 2013 to December 2017. Patients whose charts lacked description of the burns or where no burn information could be found were excluded from the study. Age, sex, length of stay (LOS), and total body surface area (TBSA) burned were examined. Statistical analysis was then performed with t-tests and Fisher’s test. Results A total of 1032 patients were included in the study. 159 (15.4%) patients were tested for alcohol use and 146 (14.1%) were tested for drugs. Significant predictors of whether patients were tested or not were TBSA and LOS (P< 0.001 for both). There were no significant differences between sexes in testing positive for drugs or alcohol, although there was a trend for more aggressive screening in males than females. The age group most likely to test positive for drugs and/or alcohol was 51–60 year olds. This age group accounted for 25% and 20% of all burn patients tested for alcohol and substances of abuse, respectively; yet this group accounted for 53% and 23% of all positive alcohol and drug tests. Perhaps surprisingly, individuals in age groups up to 90s tested positive for both alcohol and drugs. Conclusions As expected, age extremes were not tested for drugs or alcohol. Only 15% of patients were screened on arrival. Of these and contrary to expectations, 51–60 year olds were the most likely group of burn patients to test positive for drugs and/or alcohol, and patients up to their 90s were testing positive for substances of abuse. However, these populations are not as rigorously screened as younger populations and the use of these substances may be missed, thus affecting patient outcomes. Age bias may be limiting screening and affecting care in older burn patient populations. Applicability of Research to Practice Older patients (51–60 year olds) when tested are more likely to test positive particularly for alcohol upon presentation. More rigorous testing of older patients for alcohol and drugs of abuse may capture more patients who are using these substances and help to guide early care in these populations.