Drug screening in patients with depressed GCS: An evaluation of current practice and potential bias.

Abstract

Substance use contributes to trauma morbidity, mortality, and recidivism, yet screening practices among trauma patients are inconsistent. We examined urine drug screening (UDS) utilization among trauma patients presenting with depressed Glasgow Coma Scale (GCS). We retrospectively reviewed adult trauma activations (age ≥18) with admission GCS ≤ 12 at a Level I trauma center (2020-2022). The primary outcome was whether UDS was obtained. Secondary measures included demographic and clinical predictors, UDS results, and referral for screening, brief intervention, and referral to treatment (SBIRT). Logistic regression assessed associations with testing. Of 661 patients, 39% underwent UDS; 67% of these were positive. Patients aged 31-50 were more likely to be screened, while those ≥ 81 and those discharged from the emergency department were less likely. Cannabis was the most commonly detected drug. Nearly all patients with positive UDS were referred for SBIRT. Trauma patients with depressed GCS are under-screened despite high positivity. Standardized screening may improve detection and intervention.