Nationwide Study Uncovers Disparities in Screening for Substance Use Among Injured Adolescents

Injuries and substance abuse are leading causes of adolescent deaths. Screening adolescents for substance use can reduce the risk of future drug and alcohol use and reinjury. But how are clinicians deciding who to screen?

A team of researchers from Children’s Hospital Los Angeles collaborating with Keck School of Medicine of USC, Stanford University, and the David Geffen School of Medicine at UCLA examined a national sample of 85,362 injured adolescents at 121 pediatric trauma centers. They wanted to identify any socio-economic disparities in biochemical screening for substance use. This screening is a key way to flag adolescents in trouble who targeted interventions could help.

Examining the 2017-2021 American College of Surgeons Trauma Quality Programs (TQP) dataset—the largest aggregation of U.S. trauma registry data ever assembled—the researchers found that rates of biochemical alcohol and drug screening were disproportionately higher in Black, American Indian and Hispanic adolescents than for White adolescents. Female adolescents and those with Medicaid or no insurance were also more likely to be screened than males. Their findings were published in JAMA Network Open.

Inconsistent screening

“These inequities were still there even after we adjusted for differences in clinical characteristics and screening practices between institutions,” says Lorraine Kelley-Quon, MD, MSHS, FACS, FAAP, Division of Pediatric Surgery at CHLA and senior author on the paper. “We know that screening for substance and alcohol use can uncover key red flags that prompt interventions. We don’t want to see kids fall through the cracks who we could help.”

The researchers recommended standardization of screening protocols and definition of criteria for biochemical as well as interview-based screening. They also suggested expanding the TQP dataset to include interview-based screening and to indicate whether subsequent treatment is conducted, which the dataset currently does not. “Connecting evidence-based screening protocols to treatment for substance use will help us get injured teens that we see in the emergency room the necessary follow-up,” says Dr. Kelley-Quon.