105 - Adolescent Substance Users are at Increased Risk of Intentional Injury

Publication Number: 105.3853

Laura Mercurio, The Warren Alpert Medical School of Brown University, Seekonk, MA, United States; Karla M. Monge, The Warren Alpert Medical School of Brown University, Providence, RI, United States; Timmy Lin, The Warren Alpert Medical School of Brown University, Providence, RI, United States; Janette Baird, The Warren Alpert Medical School of Brown University, St. John, Virgin Islands, United States

Background: Injury remains a leading cause of morbidity and mortality among adolescents. Injury has also been strongly linked to substance use, which reached an all time high for adolescents in 2021. In response, the American College of Surgeons mandated substance use screening among all patients undergoing trauma evaluation. A 2018 study evaluated pediatric trauma centers’ compliance with this requirement through the ‘Implementation Of Alcohol Misuse Screening, Brief Intervention and Referral to Treatment’ (IAMSBIRT) policy for trauma patients aged 12-17 years.

Objective: Examine the association between illicit substance use and type of injury among adolescents presenting for trauma evaluation

Design/Methods: Secondary analysis of the IAMSBIRT registry included patients with a documented external injury code (E-code) who underwent toxicologic screening (N=6,119). Illicit substance use was defined as breath, serum, or urine toxicology positive for alcohol, cannabis, cocaine, amphetamines, hallucinogens or ‘other’; substances likely to have resulted from a hospital-administered medication - eg. opiates, were excluded. E-codes were aggregated into 4 main injury categories: ‘athletics & recreation’, conveyance-related, ‘intentional injury to self/others’, and ‘other/undetermined’. Multinomial logistic regression was performed and adjusted for age, sex, insurance status, race, and ethnicity.

Results: Illicit substance use was identified in 10% of the study population (N=661). With ‘athletics & recreation’ as the reference injury category, adolescents positive for illicit substances demonstrated 3.93 times the odds of receiving a diagnosis in the ‘intentional injury to self/others’ category (CI 3.00, 5.14) and 1.34 times the odds of receiving a conveyance-related injury diagnosis (CI 1.09, 1.64). Female sex was associated with 1.5 times the odds, and Black race 0.59 times the odds, of experiencing conveyance-related injury compared to the male sex and White race, respectively. Older age (14-17 years), male sex, Black race, ‘other’ race, and Hispanic ethnicity were also associated with increased odds of an ‘intentional injury to self/others’ diagnosis.

Conclusion(s): Adolescents with illicit substance use were significantly more likely to sustain injuries involving ‘intent to harm themselves/others’; sociodemographic analysis highlights the unequal burden of substance use and intentional injury among Black and Hispanic adolescents. Further study is needed to explore potential bias in substance use screening and injury subtypes.