Factors Associated with Referrals After Substance Use Screening in Adolescent Trauma Patients.

PURPOSE: Substance use screening for injured adolescents is recommended but not required by the American College of Surgeons and little is known about referral for substance use support services. This study aimed to identify factors associated with referral to substance use support services among injured adolescents. METHODS: This retrospective cohort study examined injured adolescents 12-17y at a level I pediatric trauma center from January 2021-June 2024. Sociodemographic and clinical data were abstracted from electronic medical record and trauma registry. Screening included receipt of biochemical tests (urine toxicology and blood alcohol test) and receipt of a Screening, Brief Intervention, and Referral to Treatment (SBIRT). Factors associated with referral after positive screening were analyzed using bivariate and multivariable logistic regressions. RESULTS: Of 683 injured adolescents, 434 (63.4%) underwent substance use screening and 88 (20.3%) had at least one positive substance use screening result. Only 32 (36.4%) adolescents with positive screening results had a documented referral to substance use support services. In bivariate analysis, cannabis and alcohol use were significantly associated with referrals (p<0.05). In multivariable logistic regression analysis, positive alcohol test was significantly associated with higher odds of referral (AOR 4.14, 95% CI: 1.49-11.53), whereas demographic or injury-related characteristics were not. CONCLUSION: Substance use screening among injured adolescents remains underutilized. Referral for treatment remains infrequent, even for those with a positive drug screen. These findings highlight a critical gap in connecting the high-risk injured adolescents to appropriate treatment and support services. LEVEL OF EVIDENCE: Level IV STUDY TYPE: Retrospective cohort.