88 Substance Use Testing Upon Burn Admission: Insights from the National Burn Repository

Abstract

Abstract Introduction Knowledge of substance use history is important for treating patients with burn injuries due to increased risk of mortality, complications, and poor outcomes. Yet, there has been little research on how admitting medical providers make the determination of who to test for alcohol or drug use. Burn severity, etiology, and circumstances surrounding the burns are important factors that should be considered when determining who should be tested. The race of the victim should not. This study analyzed data from the National Burn Repository for years 2008–2017 to ascertain if there were associations between race and decisions to do alcohol and drug testing upon burn center admission, controlling for other demographics, burn severity, and circumstances surrounding burn injuries. Methods This study was a secondary analysis of 37,355 cases from the National Burn Data Repository (American Burn Association). The dependent variables were whether a burn victim was tested for alcohol or drug use. These were dichotomous dependent variables, so a binary logit regression analysis was used. Missing data were handled with full information maximum likelihood. The independent variables were age, gender, whether physical abuse was reported, mental health comorbidity, marital status, severity of burns, whether the injury was work related, injury circumstances, and etiology of injury. Race was the independent variable of focus. The hypothesis was that race was associated with whether a burn victim was tested for drug or alcohol use. Results Controlling for independent variables, race was associated with whether a victim was tested for alcohol use, X2(5) = 71.3, p < .0001; race was also associated with whether a burn victim was tested for drug use, X2(5) = 66.5, p < .0001. Odds ratios for comparing the likelihoods of victims of different racial categories being tested ranged from .69 to 2.3 for alcohol testing, and from .79 to 2.4 for drug testing. These results were consistent with racial bias in decisions to test burn victims for alcohol and/or drug use. Conclusions Because there is little written about criteria for alcohol or drug testing on admission for critical burn injuries, it is unclear what prompts admitting health care providers to test. Our study found several racial groups had differential likelihoods of being tested upon admission to a burn center. Using Critical Race theory as a framework, these findings suggest racial bias may have influenced decisions to test for substance use in reported burn admissions. There is a need to establish a protocol for alcohol and drug use testing upon burn center admission that is equitable across all populations.