Substance use among hospitalized adolescents infrequently documented in electronic health record

by Alex Gipsman, MD

Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

1. In a cross-sectional study of hospitalized adolescents, approximately one third reported ever using alcohol, marijuana, electronic cigarettes, or a combination of ≥2 substances.

2. Less than half of self-reported adolescent substance use was documented in the electronic health record (EHR).

Evidence Rating Level: 2 (Good)

Study Rundown:

Substance use among adolescents is associated with adverse long-term health effects. However, screening for substance use in this population is often inadequate. Because many adolescents do not regularly see primary care physicians, the hospital setting provides a unique opportunity for providers to screen for substance use. In this study of adolescents hospitalized at 2 tertiary children’s hospitals, researchers assessed both self-reported substance use as well as documentation of said substance use by clinicians in the EHR. Adolescents frequently reported substance use, with the most common substances being alcohol, marijuana, and electronic cigarettes. Less than half of adolescent substance use was documented in the EHR, highlighting a missed opportunity for early identification and intervention. Although limited by its use of convenience sampling and small sample size, this study’s findings emphasize the need for improved substance use screening among hospitalized adolescents.

In-Depth [cross-sectional study]:

This cross-sectional survey consisted of 306 adolescents aged 14-18 who were hospitalized between August 2019 – March 2020 at 2 hospitals in the Midwestern United States. Data collection consisted of EHR chart review as well as validated self-report surveys that screened for use of alcohol, marijuana, tobacco, electronic cigarettes, other illicit substances, non-prescribed medications, and combination of ≥2 of these substances. The most common substances used at least once were alcohol (39%, p = 0.002), followed by marijuana (33%, p < 0.01), and electronic cigarettes (31%, p = 0.23), with 34% (p = 0.009) of adolescents reporting that they had used more than one substance. All of the other substances included in the survey had ever-use prevalence of <10%. When asked specifically about use in the month prior to taking the survey, 7% (p = 0.393) of adolescents had used alcohol at least once, 11% (p = 0.384) had used marijuana, 13% (p = 0.415) had used electronic cigarettes, and 6% (0.417) had used ≥2 substances. In contrast to the prevalence of substance use found via self-report, only 11% (p = 0.658) of adolescents had any documentation of substance use in their electronic health records. Concordance between self-reports and documented substance use was also low, with 15% concordance for tobacco/electronic cigarette use, 18% for marijuana use, and 9% for alcohol use.

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