CHICAGO: As trauma centers care for patients at risk for mental health and substance use issues, teams need resources to better identify these situations to deliver optimal care and improve outcomes. The American College of Surgeons (ACS) has released new guidelines this week to assist trauma centers in addressing mental health and substance use issues among patients who have experienced a traumatic injury.
“Research shows that alcohol and substance use problems are prevalent and increasing among trauma patients,” said Karen J. Brasel, MD, MPH, FACS, professor and vice-chair of the Department of Surgery at Oregon Health & Science University in Portland, who co-led the expert panel in creating the new guidelines. “These guidelines are an important step to help at-risk trauma patients receive necessary screenings and interventions to achieve the best possible outcomes.”
More than 50% of hospitalized trauma patients have reported an alcohol and/or drug use diagnosis during their lifetime. At the time of admission, approximately 20% have met the diagnostic criteria for an alcohol or drug use problem. As these problems increase,1,2,3,4 the new manual from the ACS Trauma Quality Programs (TQP), Best Practices Guideline for Screening and Treating Mental Health Disorders and Substance Use and Misuse in the Acute Trauma Patient, gives practitioners the tools they need to help identify patients with these needs early so that the care teams can create better treatment plans.
The guidelines can help trauma care providers achieve two important objectives: improve outcomes and reduce recurrent traumatic injury. Key elements addressed in the guidelines include:
- The four major trajectories of mental health wellness following trauma: resilience, recovery, delayed onset, and chronic distress.
- Trauma-informed care: An approach that recognizes the importance of understanding patients’ life experiences in delivery of care.
- Understanding the evidence that mental health and substance use disorders work in a combined manner to increase the risk of a patient’s recurrent hospitalization and mortality after an injury.
“Patients with unaddressed mental health issues and prior trauma are at increased risk for readmission and injury recidivism,” said Terri A. deRoon-Cassini, PhD, MS, co-leader of the expert panel that created the new guidelines, and professor of surgery, psychiatry, and behavioral medicine at the Institute for Health & Equity in the Medical College of Wisconsin in Milwaukee. “It is important for healthcare providers to understand best practices for trauma-informed care and to provide mental health screening and intervention to improve patients’ mental health recovery after injury.”
There are clear steps and resources outlined in the manual that will help trauma centers implement these guidelines. These resources include tools to screen adults, children, and adolescents, and also examples of how a trauma center can implement the screening process. The manual is part of a broader series of ACS TQP Best Practices Guidelines, which provide recommendations for managing patient populations or injury types with special considerations for trauma care providers. This manual was first unveiled during a special session at the 2022 ACS Trauma Quality Improvement Program (TQIP®) Annual Conference and was released this week.
“The goal of these guidelines is to identify patients most at risk for mental health and substance misuse issues, intervene to reduce their risk, and then to ensure patients who develop these issues receive needed treatment,” said Christine S. Cocanour, MD, FACS, Chair of the ACS Committee on Trauma’s (COT) Performance Improvement/Patient Safety (PIPS) Program and the TQP Best Practices Guidelines work group.
“The ACS COT has an increasing focus on prevention and improving the quality of life of trauma survivors. These guidelines go a long way in supporting this direction,” said Avery B. Nathens, MD, FACS, ACS TQP Medical Director.
The Best Practices Guideline for Screening and Treating Mental Health Disorders and Substance Use and Misuse in the Acute Trauma Patient is available on the ACS website.
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1Soderstrom CA, Smith GS, Dischinger PC, et al. Psychoactive substance use disorders among seriously injured trauma center patients. JAMA. 1997 Jun 11;277(22):1769-74.
2MacLeod JB, Hungerford DW. Alcohol-related injury visits: Do we know the true prevalence in U.S. trauma centres? Injury. 2011 Sep; 42(9): 922-926.
3Zatzick D, Donovan D, Dunn C, et al. Substance use and posttraumatic stress disorder symptoms in trauma center patients receiving mandated alcohol screening and brief intervention. J Subst Abuse Treat. 2012; 43(4): 410-417.
4Zatzick D, Donovan DM, Jurkovich G, et al. Disseminating alcohol screening and brief intervention at trauma centers: A policy relevant cluster randomized trial. Addiction. 2014; 109(5): 754-765.
