Drugs, guns, and kids: The association between substance use and injury caused by interpersonal violence

doi:10.1053/jpsu.2001.21599

Journal of Pediatric Surgery

Volume 36, Issue 3, March 2001, Pages 440-442

https://doi.org/10.1053/jpsu.2001.21599 Get rights and content

Abstract

Background: Drug and alcohol uses have been linked to the frequency of injury events, recurrent hospital admission for injury, and interpersonal violence. Data regarding the association of recent substance use and injury type and frequency in children and young adults are not available. Such data probably would be valuable in planning interventions to prevent substance use and reduce the risks of injuries. Methods: Evidence of substance use was assessed in trauma patients presenting to the authors' level 1 trauma center over a 6-month interval. Demographic data, mechanisms of injury, revised trauma scores (RTS), injury severity scores (ISS), hospital days, and mortality rate were evaluated. Chi square analysis and 2-tailed, paired t tests were used for statistical analysis. Multivariate logistic regression was utilized to determine the influence of individual variables. Results: From a total group of 743 patients with life-threatening injuries, trauma registry records of 186 patients less than 21 years old were eligible for evaluation, and 126 of these had complete blood and urine drug assessments completed on admission to the trauma center. Forty-two percent (53 of 126) patients tested positive for alcohol or drugs. No patients less than 14 years of age (n = 61) had positive drug screen results. However, in the cohort of patients aged 14 and 15 (n = 17), 71% tested positive. Also, 72% of adolescents (age < 18) who were victims of injuries from gunshot wounds had evidence of substance use. Multivariate analysis showed gunshot wounds (P <.003) to be associated independently with positive drug screens. No statistical differences were observed in ethnic distribution, ISS, RTS, hospital days, or mortality rate when patients with positive screen results were compared with those without evidence of substance use. Conclusions: Trauma victims had evidence of substance use in early teen age years especially in the 14 and 15-year-old age groups. Toxicology screening disclosed that substance use is associated strongly with gunshot wounds. Substance use, along with poverty, inadequate family support, and peer pressure are factors that influence injury risk. Interventions to prevent substance use in young children may reduce the risk of injury. J Pediatr Surg 36:440-442. Copyright © 2001 by W.B. Saunders Company.

Section snippets

Materials and methods

The Medical Center of Louisiana at New Orleans (Charity campus) trauma registry was used to identify patients sustaining life-threatening injuries who presented to our American College of Surgeons verified level 1 trauma center over a 6-month interval. These injuries were classified by prehospital care providers and emergency department triage staff as life threatening. Advanced Trauma Life Support (ATLS) guidelines were followed during resuscitations, which were supervised by attending

Results

During the 6-month study period there were 743 total patients with life-threatening injuries admitted to the trauma center. A total of 576 patients (78%) had complete serum and urine toxicology studies available. Three hundred sixty-eight (64%) patients tested positive for alcohol or drugs.

We focused our attention on the cohort of patients aged less than 21 years. The following results are drawn from our review of this subset of patients. Of the 186 patients in this age group, 126 (68%) had

Discussion

Our data indicate that there is ample evidence of alcohol and drug use in children and adolescents who suffer life-threatening injuries. Moreover, more than two thirds of the injured children aged 14 or 15 tested positive for alcohol or drugs. There was a strong association between interpersonal violence as a cause of injury and positive blood and urine testing for alcohol and drugs. Although we did not observe positive drug and alcohol tests in children less than 14 years old, there is no

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Cited by (30)

Social risk behaviors for firearm violence
2023, Encyclopedia of Child and Adolescent Health, First Edition
Firearm violence is a significant cause of morbidity and mortality among children and adolescents in the United States and a complex public health problem. Researchers have explored social risk and protective factors at the level of the individual, relationship, community, and societal level which tend to vary by intent. However, further research is needed in this area to aid the development of targeted public health interventions.
Penetrating trauma: Relationships to recreational drug and alcohol use
2022, American Journal of Emergency Medicine
Citation Excerpt :
In a level one trauma setting in California in 2004 penetrating trauma was more likely to be associated with drug and alcohol use than blunt trauma and 42.7% of trauma deaths had a positive drug screen [35]. Madan et al. showed that gunshot wounds in adolescents are independently associated with positive drug screens and that 72% of gunshot wound victims had some evidence of substance abuse [36]. Another study found that among homicide victims in 9 states, alcohol (37.5%) and marijuana (31.0%) were frequently identified [37].
The incidence of alcohol and recreational drug use is increasing. The impact on penetrating trauma is unknown. This study was undertaken to identify the incidence of alcohol and recreational drug use prior to penetrating trauma, and to identify ISS and outcomes among patients with penetrating trauma.
In this retrospective study, eligible subjects included trauma patients age 18 and older, with major trauma (admitted or evaluated by the Trauma Team) from 2017 to 2021. A chart review was conducted to identify data including mechanism of injury, ISS, alcohol level, toxicologic testing, length of stay, and final disposition.
Among 1270 adult subjects with penetrating trauma during 2017 through 2020, the majority were male (N = 1071; 84%), and African American (N = 679; 54.3%) or White (N = 537; 42.9%). Mechanisms of injury included gunshot wound (GSW) (N = 973; 76.6%) or stab wound (N = 297; 23.4%). Injury severity score (ISS) ranged from 1 to 75. Among 426 subjects (33.5%) tested for recreational drugs, 395 (93%) were positive for at least one substance. The most common recreational drugs identified included marijuana (N = 280; 65.7%), benzodiazepine ((N = 131;30.8%), alcohol ((N = 248; 25.3%), opiate ((N = 116; 27.2%), cocaine (N = 87; 20.4%), and amphetamine ((N = 84; 19.7%). Subjects with an ISS of 9 to 15 had higher odds of testing positive for opiates compared to subjects with an ISS of 1 to 3 (OR 2.3). Most patients were ultimately discharged home ((N = 912;71.8%) and a minority expired (N = 142; 11.2%).
Positive screens for alcohol and recreational drugs were common among penetrating trauma patients in this setting. The most common identified recreational drugs included marijuana, benzodiazepine, opiates, alcohol, cocaine, and amphetamine.
Factors associated with pediatric firearm injury and enrollment in a violence intervention program
2021, Journal of Pediatric Surgery
Citation Excerpt :
This study both reinforces and expands upon the current literature on pediatric firearm violence. Several of the psychosocial and behavioral factors we found to be significantly associated with FI were consistent with prior research on firearm injured youths, including older adolescence [6–15], male sex [6–13], separated or divorced parents [18], being on probation [22], illicit substance use [22–24], and lack of enrollment in school [19,21]. While previous studies have shown gang affiliation [40,41] and violence exposure [42,43] to be associated with interpersonal violence, this is the first study to our knowledge that demonstrates a significant association between acute firearm injury and both gang membership and losses in family/social network due to violence in a pediatric population.
To identify factors associated with firearm injury (FI) and willingness to enroll in a violence intervention program amongst pediatric victims of violence.
Cross-sectional study of victims of violence age 6–19 years presenting to a children's hospital emergency department from 2014 to 2017. Participants were interviewed by social workers prior to being offered enrollment in a violence intervention program. We used multivariate logistic regression analyses to identify factors associated with FI and enrollment in the violence intervention program.
Four hundred seven patients were analyzed, 156 (38%) of which were victims of FI and 251 (62%) were victims of non-firearm-related physical assaults (PA). Multiple factors were associated with FI including older adolescent age, male sex, separated/divorced parents, losses in family/social network due to violence, being on probation, illicit substance use, gang affiliation, and lack of school enrollment. One hundred four patients (26%) enrolled in the violence intervention program. There was no difference in enrollment between FI and PA. However, older adolescent age, illicit substance use and probation were associated with significantly decreased odds of enrolling in the program.
Multiple identifiable and potentially actionable risk factors exist amongst pediatric victims of acute FI. More specific targeting of at-risk groups may improve enrollment in violence interventions programs.
This is a prognostic study, investigating the natural history of pediatric firearm injuries, factors associated with firearm injuries as well as those associated with patient propensity to enroll in a violence intervention program. This study is observational in nature and utilizes patients with non-firearm-related physical assaults as a control group, making this study Level III evidence.
Bridging the Gap: Drug and Alcohol Screening in Adolescent Trauma Patients
2018, Journal of Emergency Nursing
Citation Excerpt :
In 2014, more than 1.6 million people between the ages of 12 and 20 reported driving under the influence of alcohol in the past year.8,9 Attempts to characterize the adolescent trauma population and define variables to hone screening have revealed that patient age is a consistent predictor of a positive screen, with the rate of positive screening increasing exponentially as adolescents approach adulthood.10–13 Variables such as gender, race, revised trauma score, injury severity score, mechanism of injury, presence of violent mechanism, and mental status at presentation had no correlation between a positive and negative screen.10–13
Pediatric trauma patient alcohol screening: A 3 year review of screening at a Level i Pediatric Trauma Center using the CRAFFT tool
2014, Journal of Pediatric Surgery
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.
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.
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.
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.
Gunshot wounds to the spine in post-Katrina New Orleans
2013, Injury
Citation Excerpt :
While the main cause of GSW varies with geographical location [31], within the urban setting in the USA, gang and drug-related violence far exceeds all other etiologies [19,22]. Furthermore, there is a direct association between drug-use and injury caused by interpersonal violence [7,10,11,24,25]. Previous studies conducted in New Orleans have described the association between substance use and traumatic injury within the urban population [24,25].
Gunshot wounds (GSW) to the spine represent a major health concern within today's society. Our study assessed the epidemiologic characteristics of patients with GSW to the spine treated in New Orleans.
A retrospective chart review was performed from January 2007 through November 2011 on all the patients who were seen in the emergency room and diagnosed with a gunshot wound to the spine. Epidemiologic factors, as well as the results of admission toxicology screening, were noted. Outcome analysis was performed on patients undergoing conservative versus operative management for their injuries. Clinical outcomes were assessed using the ASIA classification system. Complications related to initial injury, neurosurgical procedures, and hospital stay were noted.
A total of 147 patients were enrolled. Of those diagnosed with a GSW to the spine, 88 (59.8%) received an admission toxicology screen. Seventy-three (83%) patients out of those tested had a positive screen, with the most common substances detected being cannabis, cocaine, and alcohol. In regards to management, 127 (87%) patients were treated conservatively and only one (0.7%) patient improved clinically from ASIA D to E. Of the 20 patients who underwent surgery, one (5%) patient had clinical improvement post-operatively from ASIA C to D.
This study evaluates the largest number of patients with GSW to the spine per year treated in a single centre, illustrating the violent nature of New Orleans. In this urban population, there was a clear correlation between drug use and suffering a GSW to the spine. Surgical intervention was seldom indicated in these patients and was predominately used for fixation of unstable fractures and decompression of compressive injuries, particularly below T11. Minimally invasive techniques were used successfully at our institution to minimize the risk of post-operative CSF leak.

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^☆: Address reprint requests to Lewis Flint, MD, FACS, Regional Trauma Center, Tampa General Hospital, PO Box 1289, Suite E-220, Tampa, FL 33601.

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Drugs, guns, and kids: The association between substance use and injury caused by interpersonal violence☆

Abstract

Section snippets

Materials and methods

Results

Discussion

Obstet Gynecol Clin North Am

Alcohol and drug use in victims of life-threatening trauma

Journal of Trauma: Injury, Infection, and Critical Care

Correlation of alcohol intoxication with life-threatening assaults

J Nat Med Assoc

Drug use in trauma victims

Journal of Trauma; Injury, Infection, and Critical Care

Alcohol interventions in a trauma center as a means of reducing the risk of injury recurrence

Ann Surg

Violence: homicide, assault, and suicide