Substance use screening in Injured Children: How do you achieve the gold standard
Jenny Oliver, RN, BSN1; Christy Cervera, RN, BSN1; Lillian F. Liao, MD2
1University Health Systems, San Antonio, TX; 2University of Texas Health San Antonio, San Antonio, TX
Background: Substance use can alter reaction time and may contribute to injuries amongst children. Substance abuse screening and brief intervention should be an integral part of a trauma program. Achieving a high rate of screening and intervention requires resource commitment and team education.
Methods: All patients ages twelve and up should have substance screening at our Level 1 Trauma Center. Substance abuse screening and intervention for injured children between 2015 to 2017 were reviewed for effectiveness of guideline adherence after a nurse was added to the pediatric trauma program in 2015 for complex care coordination.
Results: A total of 2109 patients between ages 12-18 were found in the trauma registry between 2014 and 2017. The rate of alcohol screening was 84% in 2014, 82% in 2015, 83% in 2016, and 88% in 2017. Positive alcohol screening was found in 2-4% of those tested. The rate of drug screening was 57% in 2014 and 2015, 75% in 2016, and 85% in 2017. Positive drug screening was seen in 20% of patients tested in 2014 but rose to 25% in 2017. The most common substance used was marijuana. The number of patients receiving brief intervention increased from 73% in 2015 to 91% in 2017.
Conclusions: Urine drug screening should be performed on every patient over the age of 12. Effective substance screening requires additional resources to assist with guideline adherence. Complex care coordinators are an essential part of Pediatric Trauma Programs.
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