O3309: Evaluating the Impact of Trauma Center Drug Screening Practices on Disparities in Screening

Background: Research demonstrates that minoritized and socioeconomically disadvantaged adolescents are more often biochemically drug screened at pediatric trauma centers. It is unknown how institutional screening practices may exacerbate or diminish inequities in screening. We evaluated the association between the proportion of adolescents biochemically drug screened by trauma center and disparities in screening by sex, race, ethnicity, and insurance.

Methods: We included injured adolescents aged 12-17 years in the 2017-2022 American College of Surgeons Trauma Quality Programs dataset. Our primary exposure was hospital-level drug screening frequency defined as the proportion of adolescents biochemically drug screened by trauma center. Our outcome was disparate screening, defined as an increased likelihood of screening for American Indian, Black, Hispanic, female, Medicaid-insured, and uninsured adolescents. We stratified facilities into quartiles by screening frequency, comparing high-screening versus low-screening centers with bivariate statistical tests. To evaluate for disparities in screening and assess their relationship with screening practices, we utilized multivariable logistic regression with interaction terms between hospital-level screening frequency and sex, race and ethnicity, and insurance, with additional adjustment for clinical and hospital characteristics.

Results: For 237,802 adolescents at 474 trauma centers, median hospital-level drug screening frequency was 23.6% (IQR=11.5%-40.8%). Compared to high-screening centers, low-screening centers were more often ACS-verified pediatric trauma centers (36.1% vs 24.4%; p=0.002; Table). We identified higher odds of screening for female adolescents (AOR=1.2; 95%CI=1.1-1.3; p< 0.001) compared to male adolescents; American Indian adolescents (AOR=2.2; 95%CI=1.7-2.8; p< 0.001) and Hispanic adolescents (AOR=1.2; 95%CI=1.2-1.3; p< 0.001) compared to Non-Hispanic White adolescents; and Medicaid-insured adolescents (AOR=1.4; 95%CI=1.3-1.4; p< 0.001) and uninsured adolescents (AOR=1.1; 95%CI=1.0-1.2; p=0.009) compared to privately insured adolescents. Increasing hospital-level screening frequency was associated with less disparate screening for American Indian adolescents (AOR=0.3; 95%CI=0.1-0.6; p< 0.001), Hispanic adolescents (AOR=0.7; 95%CI=0.6-0.9; p< 0.001; Figure), and Medicaid-insured adolescents (AOR 0.8; 95%CI=0.7-0.9; p< 0.001) and more disparate screening for female adolescents (AOR=1.2; 95%CI=1.0-1.4; p=0.009).

Conclusion: Racial, ethnic, and insurance-based disparities in adolescent biochemical drug screening were diminished at high-screening trauma centers. Efforts to increase overall rates of drug screening, particularly at pediatric trauma centers, may reduce some, but not all disparities in screening. Future studies should evaluate universal screening protocols as a means of improving equity in screening for injured adolescents.