Assistant Professor Thereasa Abrams, Professor William Nugent, Assistant Professor Andrea Joseph-McCatty, and PhD student Aritra Moulick recently published an article in the Journal of Burn Care & Research titled “Examining Disparities in Alcohol Use Testing on Burn Patient Admissions: A Call for Association Guidance.”
Traumatic burns remain a significant medical concern in the U.S., with recent studies highlighting the increased incidence of care hours and intensity associated with alcohol related emergency department visits. Burn injuries are not just physical but have complex psychosocial implications. How burn care providers approach alcohol screening upon admission can have ramifications on the treatment, outcomes, and the broader perception of equity in care. While the American Burn Association (ABA) emphasizes the importance of evaluating patients for potential premorbid conditions, including alcohol consumption, there has been little research on how admitting burn care providers determine which patients to test for alcohol intoxication on admission. In the present study, data was analyzed from the ABA’s National Burn Repository (NBR) for the years 2008-2017 to ascertain if there were associations between race or ethnicity
and decisions to test patients for alcohol use upon admission to an ABA reporting burn center, controlling for other demographics, burn severity (degree/s of burn), and circumstances surrounding burn injuries. The hypothesis was that race and ethnicity were associated with whether burn patients were screened/tested for alcohol intoxication on admission, controlling for other variables related to burn injury. Data reflecting alcohol screening/testing results were not included in the analyses. Findings from this study suggest that provider bias, either implicit or explicit, may have influenced providers’ decisions to screen for alcohol intoxication in NBR-reported cases and that all burn patients would benefit from alcohol screening on admission, given the knowledge that patients’ history of alcohol misuse/abuse has a direct impact on patient outcomes.
Inconsistent evaluation of alcohol intoxication in trauma patients may indicate a lack of protocols and/or provider cognitive biases, both of which can lead to inaccurate assessment and
care. Cognitive biases (CB), known as heuristics, are mental shortcuts that one subconsciously applies to complex situations that make decision-making easier. However, CB-driven choices and tendencies may be factually wrong or potentially suboptimal, with the potential for significant errors. Providers practicing in emergency medicine must make time-sensitive decisions for multiple patients without the benefit of doctor–patient relationships and may be prone to rely on heuristics that incorporate biases and stereotyping with patients who are racial or ethnic minorities. Based on study results, it is proposed that a position statement and/or definitive protocol regarding alcohol testing be initiated by the ABA, the professional organization dedicated to the care of burn injuries, research, education, and prevention, indicating equitable and systematic guidelines for
providers when admitting burn trauma patients.