Characterization of the drug-positive adolescent trauma population: should we, do we, and does it make a difference if we test?

Abstract

Purpose Substance abuse (SA) is a significant cofactor for adolescent injury. Characterization of this population will help define a list of variables that are critical for designing interventions. The purpose of this study is to determine the frequency of SA testing and describe the injury characteristics of the adolescent trauma SA population. Methods A urine drug screening (alcohol, cannabis, and opiates) protocol for all injured adolescents (14-17 years old) was used. Four years of data were analyzed. Three groups were defined: not tested (NT), negative (NEG), and positive (POS). Transfers from an outside hospital and those who received opiate pain medication before drug screening were excluded. A patient may have had more than one positive test. Tests were analyzed to compare sex, injury severity score (ISS), survival, mechanism, and length of stay (LOS). Results Four hundred forty-three patients met the criteria (308 males and 135 females). Mean ISS was 13.5 ± 0.5 SEM with a 2.9% mortality rate. One hundred ninety-three of 443 (44%) were screened ( m = 120, f = 73) with 39% testing positive in each group. Twenty-nine percent of positive tests were opiates, 11.2% alcohol, and 20% cannabis. No sex differences for alcohol, cannabis, or opiate use were noted. There were no differences between the NT and the NEG/POS groups with respect to sex, LOS, or mechanism of injury. Fourteen-year olds were less likely to be drug screened. Mean ISS score was lower in the NT group (11.4 ± 0.6 vs 15.7 ± 1.0, P< .005). For the NEG and POS group analysis, a positive drug screen was not predicted by age, sex, ISS score, outcome, or LOS. Bicycle crashes were predictive of a positive drug screen ( P < .005). Survival rates were not different between any of the groups. Conclusions Forty percent of the patients screened positive, thus, supporting screening in adolescent trauma patients. Selective criteria based on injury characteristics are not justified.