Alcohol and Drug Testing in the National Trauma Data Bank: Does it Matter?

Alcohol and drug abuse (A&DA) can play a role in unintentional and intentional injuries. Injury prevention professionals need A&DA data to plan, promote, and evaluate interventions. The National Trauma Data Bank (NTDB) is the national repository of injury information and an ideal source to obtain this data. According to a retrospective study of the NTDB with 1998–2003 data, a minority of patients in the nation's trauma centers are tested for A&DA.[1] In addition, the study found that the number of patients tested for A&DA was actually decreasing over the 6 years of the review.[1] Our goal was to evaluate alcohol and drug testing at the national level.

The 2013 National Sample Program (NSP) and the 2016 Research Data Set (RDS) of the NTDB were reviewed. A&DA indicators were evaluated for data completeness on all records. The NSP consisted of 172,386 observations and the RDS consisted of 968,665. In the NSP, there were 100,558/172,386 (58.33%) cases reported without alcohol testing information. The RDS totaled 571,567/968,665 (58.99%) cases without alcohol testing. Drug use testing also remained low in the NSP and RDS, with 75.70% and 75.58%, respectively, showing that the majority of patients were missing drug testing information.

Low levels of A&DA screening are a concern because the knowledge of whether a patient was under the influence contributes significantly to risk analysis, treatment options, outcomes, and prevention measures to decrease recidivism.[2] Alcohol-positive patients also contribute to health-care costs by requiring more invasive procedures, more diagnostic tests, longer hospitalization, and more frequent admissions to the intensive care unit.[3] This demonstrates that patients with known alcohol abuse may necessitate higher incurred costs for the trauma facility. Perversely, the Alcohol Exclusion Law of the Uniform Accident and Sickness Policy Provision Law allows insurance companies in some states to deny reimbursement for hospital care for injured patients if that injury was as a result of A&DA. To avoid loss of revenue and restrictions in postinjury care, hospitals are incentivized to avoid routine A&DA testing. Trauma as a result of A&DA has specific risks and associated complications could be prevented if the abuse is known. Further, having higher testing rates for A&DA in the NTDB data could assist in establishing successful preventative measures and health awareness programs. Hospitals should test trauma patients for A&DA to guide better public safety policies, enable better outcomes, and initiate opportunities for improved care. Best practices include capturing A&DA comorbidity and appropriate treatment referral. Routine testing and intervention for A&DA is an area that could benefit from targeted research.[4] Further research is needed to understand barriers to routine testing for A&DA. Our study concludes that the percentage of patients tested for A&DA has remained largely unchanged for 20 years. The majority of traumatized patients do not have A&DA testing, despite this being a risk factor. Trauma centers should consider routinely collecting and reporting data on A&DA.