Original Scientific Articles

Nationwide Survey of Trauma Center Screening and Intervention Practices for Posttraumatic Stress Disorder, Firearm Violence, Mental Health, and Substance Use Disorders

Bulger, Eileen M MD, FACS; Johnson, Peyton BA; Parker, Lea BA; Moloney, Kathleen E BA; Roberts, Michelle K MS; Vaziri, Natalie BA; Seo, Sara BA; Nehra, Deepika MD, FACS; Thomas, Peter JD; Zatzick, Douglas MD

Author Information

From the Department of Surgery (Bulger, Nehra), University of Washington School of Medicine, Seattle, WA

Department of Psychiatry and Behavioral Sciences (Johnson, Parker, Moloney, Roberts, Vaziri, Seo, Zatzick), University of Washington School of Medicine, Seattle, WA

Department of Rehabilitation Medicine (Roberts), University of Washington School of Medicine, Seattle, WA

Harborview Injury Prevention and Research Center (Bulger, Zatzick), University of Washington School of Medicine, Seattle, WA

Department of Psychology, Drexel University College of Arts and Sciences, Philadelphia, PA (Parker)

Department of Anthropology, University of Kentucky College of Arts and Sciences, Lexington, KY (Roberts)

Powers Pyles Sutter & Verville PC, Washington, DC (Thomas).

CME questions for this article available at http://jacscme.facs.org

Disclosure Information: Authors have nothing to disclose. Timothy J Eberlein, Editor-in-Chief, has nothing to disclose. Ronald J Weigel, CME Editor, has nothing to disclose.

Support: This research was supported within the National Institutes of Health (NIH) Health Care Systems Research Collaboratory by cooperative agreement 4UH3MH106338-02 from the NIH Common Fund and by UH3 MH 106338-05S1 from the National Institute of Mental Health (NIMH). Support was also provided by the NIH Common Fund through cooperative agreement (U24AT009676) from the Office of Strategic Coordination within the Office of the NIH Director. This investigation was also supported in part by the Patient-Centered Outcomes Research Institute (PCORI) Award (IH-1304-6319, IHS-2017C1-6151).

Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of NIH or PCORI or its Board of Governors or Methodology Committee. PCORI had no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for publication.

Received September 18, 2021; Revised October 22, 2021; Accepted October 25, 2021.

Correspondence address: Eileen M Bulger, MD, FACS, University of Washington Chief of Trauma, Harborview Medical Center, 325 Ninth Avenue, Box 359796, Seattle, WA 98104-2499. email: [email protected]

Journal of the American College of Surgeons 234(3):p 274-287, March 2022. | DOI: 10.1097/XCS.0000000000000064

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BACKGROUND

Posttraumatic stress disorder (PTSD) symptoms, firearm violence events, alcohol and drug use problems, and major depression and suicidal ideation are endemic among patients admitted to US trauma centers. Despite increasing policy importance, the current availability of screening and intervention services for this constellation of conditions in US trauma centers is unknown.

STUDY DESIGN

Trauma program staff at all Level I and Level II trauma centers in the US. (N = 627) were contacted to complete a survey describing screening and intervention procedures for alcohol and drug use problems, PTSD symptoms, depression and suicidality, and firearm violence. Additional questions asked trauma centers about the delivery of peer interventions and information technology capacity for screening and intervention procedures.

RESULTS:

Fifty-one percent of trauma centers (n = 322) responded to the survey. More than 95% of responding sites endorsed routinely screening and/or intervening for alcohol use problems. Routine services addressing PTSD were less common, with 28% of centers reporting routine screening. More than 50% of sites that screened for PTSD used previously established trauma center alcohol use services. Programmatic screening and intervention for firearm injury sequelae was occurring at 30% of sites.

CONCLUSION

Alcohol screening and intervention is occurring frequently at US trauma centers and appears to be responsive to American College of Surgeons Committee on Trauma verification requirements. Routine screening and intervention services for PTSD and firearm injury were occurring less frequently. Regular national surveys may be a key element of tracking progress in national mental health and substance use screening, intervention, and referral policy.