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May 17, 2006

Intervention: Substance abuse screening may help teenage trauma patients curb risky behavior

U-M study finds value in routine screening for teen trauma patients with 11.2 percent tested positive for alcohol, 29 percent for opiates, and 20 percent for cannabis

ANN ARBOR, MI – Teenagers are known for testing their limits – coming home after curfew, swearing and skipping school. But some teens will go even further and engage in risk-taking behavior like reckless driving that, when combined with alcohol or drugs, can result in serious injury or even death.

Peter F. Ehrlich, M.D., MHSResearchers at the University of Michigan Health System believe one way to help curb such risky behavior is to do drug screening for all hospitalized pediatric trauma patients, and offer brief alcohol and substance abuse intervention programs to those who test positive.

Their study revealed that nearly 40 percent of the pediatric trauma patients ages 14 to 17 screened for substance abuse tested positive. Of those patients, 29 percent of positive tests were for opiates like opium or heroin, 11.2 percent for alcohol, and 20 percent for cannabis, or marijuana.

These findings, published in the May issue of the Journal of Pediatric Surgery, support the value of routine substance abuse screening for all injured teenage hospital patients regardless of age, gender or type of injury, says study lead author Peter F. Ehrlich, M.D., MHS, clinical associate professor, Department of Pediatric Surgery at the U-M Medical School.

“The two major preventable health issues facing adolescents are injuries that result in death or disability, and lifestyle choices that have long-term, adverse health consequences,” says Ehrlich. “To help alter this risk-taking behavior, it is essential that drug testing and brief substance abuse intervention programs be included in the treatment of all injured adolescents.”

As a Level 1 pediatric trauma center, routine drug screening for all injured patients ages 14 to 17 is part of the U-M Health System’s trauma protocol. Indeed, according to the National Institute on Alcohol Abuse and Alcoholism, trauma centers are an ideal site for alcohol screening and brief intervention programs. Previous studies have proven, too, the cost-effectiveness for such programs, with health care savings of $3.81 for every $1 spent for screening and intervention.

However, a recent survey of adult trauma surgeons found that fewer than 20 percent screened their patients for alcohol or drug problems – and even fewer screening and intervention projects have been conducted at pediatric trauma centers.

But to develop effective screening and intervention programs for adolescents, medical experts first must gain a better understanding of their target population, says Ehrlich.

By studying 443 patients ages 14 to 17 who were admitted to the hospital for treatment of a severe injury, Ehrlich and his colleagues worked to determine the frequency of pediatric substance abuse screening, as well as define the injury characteristics of those patients who tested positive for substance abuse.

The patients, who were admitted to the hospital between 1999 and 2003, were placed into three categories: eligible to be screened, but not tested; eligible to be screened and tested negative; and eligible to be screened and tested positive.

In all, only 40 percent of eligible adolescents were tested. While there were more 17 year olds with positive drug tests than 14 year olds, researchers found fewer 14 year olds were actually tested than older teens.

The rate of cannabis use among females was significantly higher, but there were no significant differences between the sexes for opiate or alcohol use. Among all three groups, researchers found no differences with respect to gender, length of stay in the hospital or type of injury. However, teens involved with bicycle crashes were more likely to test positive for drugs.

Of the patients who were screened and tested positive, most were referred to counseling after being discharged from the hospital.

“To really make an impact on the care of these adolescents, drug screening cannot be performed selectively and irregularly,” says Ehrlich.

“Those who drink under the age of 19 are significantly more likely to report driving after drinking or getting into car with someone who’s been drinking – and their odds of them being injured are two to three times greater than adults of legal drinking age. So we need to take the opportunity when adolescent patients are in our care, to intervene and help prevent risk-taking behavior that may lead to future injury or even death.”

Along with Ehrlich, co-authors from the UMHS Department of Pediatric Surgery were Joanna K. Brown, M.D., house officer, and Robert Drongowski, senior research associate.

Reference: Journal of Pediatric Surgery, May 2006, Vol. 41, Issue 5.

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Written by Krista Hopson

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