Study finds inconsistencies in hospital toxicology screening protocols following serious motor vehicle collisions

(Boston)—In 2010, Massachusetts adopted legislation that amended the Safe Driving Law, encouraging health care providers to report patients to the state Registry of Motor Vehicles (RMV) if there was “reasonable cause to believe that an operator is not physically or medically capable of safely operating a motor vehicle.” In response to this new legislation, trauma physicians at two Boston academic medical centers initiated a reporting policy that stipulates patients admitted after a serious motor vehicle collision that may have been caused by intoxicated driving, are to be reported to the RMV by the attending trauma physician for potential license suspension.

A new study by researchers at Boston University Chobanian & Avedisian School of Medicine, Boston Medical Center, Tufts Medical Center and UMass Memorial Medical Center has found that drug screening practices may be inconsistent with potential downstream effects in reporting to the RMV.

“This inconsistency raises concerns about fairness and effectiveness in preventing impaired driving and highlights disparities in policy implementation; there is a need for standardized, equitable reporting protocols across hospitals,” explains corresponding author Neil Singh Bedi, a fourth-year medical student at Boston University.

The researchers analyzed data from two large trauma centers to see how often alcohol and drug screenings were done after serious car crashes. They linked these hospital records with the Massachusetts RMV database to track if patients who were reported had their licenses suspended. They then compared suspension rates across different groups to check for inconsistencies or disparities.

They found toxicology and ethyl alcohol or ethanol (EtOH) screening rates differed significantly between trauma centers. Across all patients, 11.5% of the patients had neither urine or serum toxicology screening done and 47% only had EtOH screening performed. Both EtOH and toxicology screening were completed in 41% of patients, and 1% of patients had only toxicology screening completed. While the screening rates varied based on the type of screenings performed (EtOH and/or toxicology), there were no differences by race or whether patients had any screening, either EtOH or toxicology.

According to the researchers, all serious motor vehicle collision patients should have blood drawn, and serum EtOH and toxicology screening should be part of the standard protocol, even if urine is not immediately collected. “The stark differences in hospital practices surrounding screening for EtOH and toxicology creates a challenge for analysis and offers an opportunity for improvement in the initial trauma assessment and emergency room screening practices,” adds Bedi.

These findings appear online in the journal Academic Emergency Medicine.