Introduction: Substance use disorder (SUD) is prevalent in trauma and has impacts throughout the continuum of care, including initial injury, patient presentation, recovery, and risk of recidivism. In 2022 the American College of Surgeons (ACS) issued new trauma quality improvement program (TQIP) guidelines calling for treatment of SUD. Patients receiving Intensive Care Unit (ICU) level of care have complex medical needs which may be complicated by SUD. In this study, we examined the receipt of inpatient SUD treatment among this trauma ICU population with positive drug or alcohol screen upon admission.
Methods: We used data from the ACS TQIP 2020 registry, representing over 750 hospitals; we included trauma patients 18 years or older, in ICU for 3 or more days and alive at discharge who had positive drug or alcohol screen; cases positive only for substances administered as part of care were excluded. We defined our outcome variable of inpatient SUD treatment as receiving inpatient psychotherapy, counseling, or pharmacotherapy. We used multivariable logistic regression to identify patient- and hospital-level factors associated with inpatient SUD treatment.
Results: Of the 37,301 traumas with positive drug or alcohol screen, 755 (2.0%) received inpatient SUD treatment. Black patients were less likely to receive inpatient SUD treatment (adjusted odds ratio (aOR): 0.60; 95% confidence interval (CI): 0.47, 0.77) as were men (aOR: 0.80 (95% CI: 0.67, 0.97)). Patients with substance use diagnosis prior to admission were more likely to receive inpatient SUD treatment (aOR: 1.20 (95% CI: 1.02, 1.41) as were self-pay versus privately insured (aOR: 1.68 (95% CI: 1.33, 2.12) and patients treated at private versus non-profit hospitals (aOR: 1.32 (95% CI: 1.06, 1.67). There was no association between treatment and age, polysubstance use, injury severity or trauma center level.
Conclusions: An overwhelming majority of trauma patients in the ICU who have positive drug or alcohol screen do not receive inpatient SUD treatment. This represents an area of great unmet need and potential intervention. Greater efforts by clinicians, healthcare systems and payers to link this group of patients to effective SUD treatment are needed.
