5.1 Chemical Dependence Screening

(Download as PDF)

Description of Indicator

Relationship to Quality Medical care should be effective
Type of Indicator Secondary prevention, Hospital level
Proposed Data Source ED Records, Trauma Registry
Definition Number of patients with a primary diagnosis of injury who are screened for chemical dependency using a validated tool* per 100 patients
Numerator All patients age 18 years and older admitted to hospital or the ED with a primary diagnosis of injury AND screened for chemical dependency‡ using a validated tool*
Denominator All patients age 18 years and older admitted to hospital or the ED with a primary diagnosis of injury
Benchmark Not specified at present
Risk Adjustment Not applicable

* Validated tools refer to screening instruments previously validated (e.g. CAGE, Michigan Alcoholism Screening Test [MAST])104.
‡ Chemical dependency is defined as the subjective sense of a need for a psychoactive substance (e.g. alcohol) either for its positive effects or to avoid negative effects associated with its absence104.

 

Summary
This indicator is intended to monitor hospital-based screening for chemical dependency among patients admitted with an injury diagnosis.

 

Panel Review
The panel noted that a large number of patients with injury diagnoses admitted to hospital have chemical dependence. Hospital presentation represents an excellent opportunity to identify and intervene for secondary prevention purposes. Panelists indicated that this was an important indicator and provided a basic platform for institutions to evaluate the effectiveness of their trauma care programs. Panelists debated whether the indicator should be restricted to screening (panel decision) or also include intervention for chemical dependence among patients who screen positive.

 

Trauma Center Review
Centers reported that it is important, but may be difficult to implement because current documentation practices may not capture this information. Some trauma centers expressed preference for the term “chemical dependence” as opposed to “substance use”.

 

Review of Literature & Evidence
Face Validity: No studies identified.
Construct Validity: One study demonstrated that trauma patients with positive toxicology results have an injury mortality rate that is twice that of patients with negative results105. When patients received a single, brief alcohol intervention during hospitalization, trauma recidivism was reduced by as much as 50%106.
Reliability: No studies identified.
Risk Adjustment: Not applicable.
Utilization: Chemical Dependency Screening and/or Intervention is used as a quality indicator by a small number of trauma centers: USA 9% (17/200), Canada 0% (0/35), Australasia 0%.
Evidence from the literature suggests that chemical dependence screening and intervention could provide opportunity for secondary injury prevention and is an avenue that many trauma systems have either not considered or have yet to implement105,106,107. The majority of the literature is focused on alcohol consumption and there is limited evidence for screening and intervention for other substances commonly resulting in chemical dependence108. This initiative has been shown to be feasible, is supported by trauma surgeons109 and many valid screening measures for different types of injury having been identified104,106.

 

Source
The indicator, “Substance Abuse Screening” was proposed by the Trauma Quality Indicator Consensus Panel and subsequently revised to “Chemical Dependency Screening” based on panel member and trauma center feedback.

 

References
104. Arenth PM, Bogner JA, Corrigan JD, Schmidt L. The utility of the Substance Abuse Subtle Screening Inventory-3 for use with individuals with brain injury. Brain Inj. 2001;15(6):499-510.
105. Dischinger PC, Mitchell KA, Kufera JA, Soderstrom CA, Lowenfels AB. A longitudinal study of former trauma center patients: the association between toxicology status and subsequent injury mortality. J Trauma. 2001;51(5):877-884; discussion 884-876.
106. Charbonney E, McFarlan A, Haas B, Gentilello L, Ahmed N. Alcohol, drugs and trauma: Consequences, screening and intervention in 2009. Trauma. 2010;12(1):5-12.
107. Worrell SS, Koepsell TD, Sabath DR, Gentilello LM, Mock CN, Nathens AB. The risk of reinjury in relation to time since first injury: a retrospective population-based study. J Trauma. 2006;60(2):379-384.
108. Nilsen P, Baird J, Mello MJ, et al. A systematic review of emergency care brief alcohol interventions for injury patients. J Subst Abuse Treat. 2008;35(2):184-201.
109. Schermer CR. Feasibility of alcohol screening and brief intervention. J Trauma. 2005;59(3 Suppl):S119-S123.