Comparison of Objective Screening and Self-Report for Alcohol and Drug Use in Traumatically Injured Patients

Abstract

Alcohol and drug use is prevalent in trauma patients. Concerns over the validity of self-reporting drug use could make non laboratory screening problematic. This study sought to validate patient self-report of substance use against objective screening to determine the reliability of self-report in trauma patients. Patients admitted to either the Trauma or Burn services who were at least 18 years old were screened for alcohol and drug use with validated screening tools. Exclusion criteria were altered mental status, non English speaking, inability to answer questions for other reasons, under police custody, or admission for < 24 hours. Results from admission Blood Alcohol Concentration BAC and Urine Drug Screen UDS were also collected and compared to self-reported use to determine its reliability. Alcohol use was queried in 128 patients, 101 of whom had a BAC drawn. Of those 101, 34 (33.7%) had a BAC > 0 mg%. Alcohol Use Disorder Identification Test AUDIT screening revealed 13 (12.9%) patients who were self-reported non drinkers, none of which had a BAC > 0 mg%. Drug use was queried in 133 patients, 93 of whom had a UDS. A positive was found in 26 (28.0%) of the patients, only 12 (46.2%) of whom reported drug use in the past year. Though substance use in trauma patients is prevalent, self-report screening techniques for drugs may be inadequate at determining those patients whom could benefit from brief interventions while in the hospital. Further investigation is needed to determine the discrepancy between alcohol and drug use screening in trauma patients and more acceptable means of drug use discussion.

Fig. 1

Eligible Patient Included in the Study. Numbers indicate n values.

Fig. 2

Self-Report of Alcohol and Drug Use by Positive Biochemical Screen. Rates of admission to the use of alcohol or drugs were compared in those with a positive biochemical screen (BAC or UDS). Positive biochemical screening groups were either positive BAC (n=34) or positive UDS (n=26) indicating 100% disclosure in the positive BAC group compared to a 46.2% disclosure in the positive UDS group. * p < 0.001 comparing percent who disclosed use between positive biochemical screens using Fisher’s Exact test.