Process evaluation of serial screening criteria to identify injured patients that benefit from brief intervention: practical implications

Abstract

Background: The aim of the current study is to evaluate the effectiveness of serial screening methods for the identification of injured patients at risk for alcohol problems and are most likely to benefit from brief interventions. We hypothesize that blood alcohol concentration (BAC) alone is not sufficient to effectively identify at-risk drinkers in the trauma care setting.

Methods: During a 2-year period, patients admitted to an urban Level I trauma center for treatment of an injury were screened for alcohol problems. Screening consisted of four serial screening criteria: (1) clinical indication of acute intoxication including positive BAC; (2) self-reported drinking 6 hours before injury; (3) at-risk drinking as defined by National Institutes on Alcohol Abuse and Alcoholism or (4) by responding yes to one or more items on the CAGE within the last year.

Results: In all, 11,028 patients were seen. Fifty-eight percent were eligible for screening and 90% of eligible patients were screened. Of screened patients, 41% screened positive for an alcohol-related injury. Of patients that did not have a BAC drawn, 39% (n = 935) went on to screen positive using serial screening procedures. Additionally, 36% (n = 339) of patients with a negative BAC went on to screen positive using serial screening procedures.

Conclusions: This evaluation clearly suggests that BAC alone is not sufficient to identify patients who are most likely to benefit from brief alcohol interventions. Self-reported drinking in conjunction with BAC facilitates identification and intervention of injured patients with alcohol problems.

Fig. 1

Percent BAC drawn of total eligible patients.