Alcohol and mental health care integration in traumatically injured patients with elevated BAC: a retrospective chart review.

Abstract

Background: Alcohol is a well-documented risk factor for motor vehicle collisions (MVCs) and may also heighten post-trauma psychological symptoms. Given the frequent co-occurrence of MVC injury, alcohol use, and post-injury mental health sequelae, coordinated post-injury care is critical to support long-term psychological and physical recovery. The American College of Surgeons Committee on Trauma requires screening for and intervention on risky alcohol use and, more recently, to conduct mental health risk screening and referral. However, little is known about how established alcohol screening and intervention workflows interface with mental health services in routine practice.

Methods: We conducted a retrospective cohort study of adults (≥ 18 years) with traumatic injuries at a Level I Trauma Center in the U.S. Midwest from 2017 to 2022. Data were pulled from the trauma registry and electronic medical record. A chart review was completed on a subset of patients who were legally intoxicated at the time of admission to assess engagement with services using a structured abstraction template.

Results: From January 2017 to December 2022, 198 patients were admitted after MVC. Of the 154 patients tested for blood alcohol concentration (BAC), 78% were legally intoxicated (≥ 0.08 g/dL). 58% screened at high risk for PTSD or depression on the Injured Trauma Survivor Screen (ITSS). Of the patients legally intoxicated, 25 received at least one visit from trauma psychology. Alcohol use was discussed in 60% of these encounters, primarily regarding frequency and quantity. Eleven patients (45.8%) had alcohol use explicitly addressed and were provided resources by social work.

Conclusions: These findings suggest that alcohol use, despite its significance in this high-risk population, was minimally addressed across specialty services.