Papers Presented at the 1st Western Pediatric Trauma Conference Pediatric trauma patient alcohol screening: A 3 year review of screening at a Level I Pediatric Trauma Center using the CRAFFT tool Kevin N. Johnson, MD a , Alaina Raetz b , Melissa Harte b , Lisa E. McMahon, MD a, b, c , Victoria Grandsoult b , Pamela Garcia-Filion, PhD, MPH b, c , David M. Notrica, MD a, b, c, ⁎ a Department of General Surgery, Mayo Clinic, Phoenix, Arizona b Trauma Center, Phoenix Children's Hospital, Phoenix, Arizona c Department of Child Health, University of Arizona College of Medicine – Phoenix, Phoenix, Arizona abstract article info Article history: Received 9 October 2013 Accepted 10 October 2013 Key words: Pediatric trauma Alcohol use CRAFFT tool Introduction: Alcohol use is a risk factor for adult trauma. Alcohol may significantly influence pediatric trauma risk, but literature is sparse. The aim of this study was to examine the impact of alcohol use screening in pediatric trauma patients. Methods: A retrospective review was performed of all trauma patients to identify those undergoing CRAFFT alcohol screening assessment between July 1, 2009, and January 31, 2011. Inclusion criteria involved screening of level 1 or 2 trauma activations for patients greater than 12 years. Results: During the study period, 232 patients were eligible for screening, of which 51% (n = 118) were screened. Among the patients screened, 21 (18%) had a positive screen (mean age 14.6 years, range 13–16). Twenty patients were referred for further counseling. Sixteen males and 5 females screened positive during the study. The most common mechanism of injury in the positive screen patients was motor vehicle or ATV accident (n = 9), followed by assault (n = 6), and motor versus pedestrian collision (n = 2). Of the 21 patients who screened positive, 10 had positive blood alcohol content (BAC) or urine drug screen (UDS) at the time of injury. No patients with a positive screen returned during the study as a trauma patient. Conclusion: Alcohol and drug screening for injured pediatric trauma patients is frequently omitted despite policy-required screening. Of those patients screened, 18% admitted to risky alcohol or drug-related behaviors or had positive BAL or UDS at presentation. Pediatric trauma screening for risky alcohol use identifies a significant number of children. Alcohol and drug screening in pediatric trauma appears over age 13 years to have a yield which justifies continued screening. Alcohol related trauma recidivism, however, does not seem common. © 2014 Elsevier Inc. All rights reserved. 1. Background Alcohol use is a well-known risk factor for trauma in the adult population. While alcohol may play a significant role in pediatric trauma, the exact influence and breadth of the problem are not well understood. Studies examining the influence of alcohol on injury severity, length of stay, and outcomes of pediatric trauma patients have found mixed results [1,2]. Prior studies have shown alcohol has been associated with risk-taking behaviors in pediatric patients and is involved in a large proportion of specific types of injuries, including gunshot wounds, physical altercations, and self-inflicted injuries [3–5]. In 2006 the American College of Surgeons Committee on Trauma mandated alcohol screening for all trauma patients at verified trauma centers, both adult and pediatric [6]. Despite this mandate, screening rates remained sporadic at many pediatric trauma centers [1]. Previous studies have shown that increasing age is the only reproducible factor for alcohol use. Since alcohol use often begins early in life, with most adolescents reporting first drinking alcohol before age 14, early screening appeared justified [1,2]. Previous studies failed to show gender and age as good predictors of positive screening and suggested expansion of screening to younger children believed to be at the highest risk [7]. Identifying pediatric trauma patients with risky alcohol use may do more than simply identify potential risk factor leading to injury. Studies in pediatric patients have shown decreased risk of future injury and death for those patients that have received a focused intervention [8]. Moreover, in the adult population intervention has lead to decreased rates of readmission to the trauma unit for patients [3]. The aim of this study was to examine the rates and results of an alcohol screening program at a single institution and determine the impact on care for pediatric trauma patients. Journal of Pediatric Surgery 49 (2014) 330–332 ⁎ Corresponding author. Level I Pediatric Trauma Center, Phoenix Children’s Hospital, 1919 E Thomas Road, Phoenix, AZ 85016. Tel.: +602 933 3000; fax: +602 254 2185. E-mail address: dnotrica@phoenixchildrens.com (D.M. Notrica). 0022-3468/$ – see front matter © 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jpedsurg.2013.10.012 Contents lists available at ScienceDirect Journal of Pediatric Surgery journal homepage: www.elsevier.com/locate/jpedsurg