title: Age and gender differences in substance screening may underestimate injury severity: a study of 9793 patients at level 1 trauma center from 2006 to 2010.
abstract: BACKGROUND
  Although the relationship between psychoactive substance use and injury is known, evidence remains conflicting on the impact of substance use on clinical outcomes after injury. We hypothesized that preinjury substance use would negatively impact clinical outcomes.
  
  
  METHODS
  National Trauma Registry American College of Surgeons identified patients (n = 9793) presenting to Duke Hospital from 2006 to 2010. Logistic regression models assessed potential predictors of receiving substance screening, mortality, length of stay, ventilator requirement, intensive care admission, or emergency department disposition.
  
  
  RESULTS
  Forty-seven percent (4607/9793) of patients received blood alcohol screen (BAS) and 31% (3017/9793) received urine drug screen (UDS). Men were more likely to receive both BASs (P < 0.001) and UDSs (P = 0.001) than women after controlling for potential confounders. There was no significant difference between men and women over the legal limit for alcohol (OLLA; 27.2%, 95% confidence interval [CI]: 25.7%-28.8% versus 24.8%, 95% CI: 22.3%-27.5%). Similarly, younger patients more likely received both BASs (P < 0.001) and UDSs (P < 0.001) compared with older patients. The proportion of patients aged ≤45 y OLLA (26.5 %, 95% CI: 24.9%-28.2%) was similar to those aged >45 y OLLA (26.8%, 95% CI: 24.5%-29.3%). After controlling for potential confounders neither alcohol, nor tetrahydrocannabinol, nor cocaine was predictive of mortality, ventilator requirement, length of stay, or emergency department disposition, but a higher alcohol level (P = 0.0174) predicted intensive care admission.
  
  
  CONCLUSIONS
  Females and those aged >45 y are less likely to receive BASs and UDSs. Differential screening that is biased may place patients at risk for receiving inadequate care.
authors.affiliation: Department of Surgery, Duke University, Durham, North Carolina.
authors.forename: Georgia M
authors.initials: GM
authors.lastname: Beasley
authors.affiliation: Department of Community and Family Medicine, Duke University, Durham, North Carolina.
authors.forename: Truls
authors.initials: T
authors.lastname: Ostbye
authors.affiliation: Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina.
authors.forename: Lawrence H
authors.initials: LH
authors.lastname: Muhlbaier
authors.affiliation: Department of Surgery, Duke University, Durham, North Carolina.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Foley
authors.affiliation: Department of Surgery, Duke University, Durham, North Carolina.
authors.forename: John
authors.initials: J
authors.lastname: Scarborough
authors.affiliation: Department of Surgery, Duke University, Durham, North Carolina.
authors.forename: Ryan S
authors.initials: RS
authors.lastname: Turley
authors.affiliation: Department of Surgery, Duke University, Durham, North Carolina. Electronic address: ml.shapiro@dm.duke.edu.
authors.forename: Mark L
authors.initials: ML
authors.lastname: Shapiro
mesh_terms: D000328:Adult; D000367:Age Factors; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012042:Registries; D012737:Sex Factors; D015813:Substance Abuse Detection / Q000706:statistics & numerical data*; D019966:Substance-Related Disorders / Q000150:complications* / Q000453:epidemiology; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000150:complications*
keywords: Alcohol and drug use; Substance screening; Trauma