Limited utility of routine drug screening in trauma patients

Background. Routine toxicology screening of seriously injured patients has become the standard of care in most trauma centers. However, the benefit of drug screening in acute trauma is unproven. We reviewed the impact of posi tive drug screening results on patient care within the first 3 days of trea tment. Methods, We retrospectively reviewed the charts of seriously injured patien ts admitted to an American College of Surgeons-certified level I trauma cen ter over a 5-year period. Modifications of therapeutic regimens based on po sitive toxicology results were noted. Using current financial data, charges for toxicology were calculated. Results. Between January 1, 1990, and December 31, 1995, 2,678 trauma patie nts had drug screening. Of these, 414 (15%) had detectable quantities of th e following intoxicants: opiates, barbiturates, amphetamines, phencyclidine hydrochloride (PCP), cocaine, marijuana, or benzodiazepines. Review of all 401 available charts failed to identify any cases in which treatment was a ltered by a positive toxicology result. Hospital costs related to routine s creening were $138,587, while charges to patients amounted to $538,278. Conclusions. Routine toxicology does not alter or improve the immediate car e of the injured patient. Routine drug screening is expensive, and benefits were not easily documented. The policy of routine toxicology screening in trauma centers should be reevaluated.