Treatment-administered drugs are reported as positive screens in a trauma registry: an audit of compliance with the National Trauma Data Standard exclusion rule
Year: 2026
Type: preprint
Study design: Observational Study
Abstract: Background. The National Trauma Data Standard (NTDS) Drug Screen element instructs abstractors to report "None" when the only positive results are attributable to drugs administered during care, and to report only those drugs not administered when multiple are detected. Whether this exclusion rule is applied in practice has not been reported. Because opioid and benzodiazepine analgesia is given more often to older injured patients, unapplied exclusion could bias the recorded age distribution of substance use. Methods. We audited consecutive trauma registry records at a single Level II centre from 1 January 2023 to 31 December 2024. Prehospital and emergency-department medication administration was parsed from free-text registry fields and cross-tabulated against the recorded Drug Screen value. Records were classified as noncompliant under three definitions of increasing stringency: a liberal class-level definition, the rule as written (primary), and an assay-restrictive definition requiring pharmacologically plausible analyte-to-agent correspondence. Prevalence was recomputed with the rule applied and compared with recorded prevalence across age bands. Results. Of 2,538 registry encounters, 1,421 had a Drug Screen value other than "Not Tested," and 914 (64.3%) were recorded as positive for at least one analyte. Under the rule as written, 569 of 914 positive records (62.3%, 95% CI 59.1–65.3) contained at least one analyte the standard directs be excluded, and 350 (38.3%, 95% CI 35.2–41.5) should have been reported as "None." Applying the rule reduced positivity from 64.3% to 39.7%. Noncompliance increased monotonically with age, from 25.5% of positive records at ages 16–45 to 51.4% at 81 years and older (odds ratio 1.27 per decade, 95% CI 1.18–1.36). The recorded prevalence ratio for ages 16–45 versus 81 and older was 2.21 (95% CI 1.89–2.59); after applying the rule it was 3.39 (95% CI 2.61–4.40). Findings were directionally unchanged under both alternative definitions. Conclusions. At this centre the exclusion rule was not applied in most positive records, and the failure was concentrated among older patients, so the recorded element understates the age gradient in substance use. Verifying that abstractors apply the rule is a low-cost, testable data-quality target.
Source: Research Square
Authors: Akbar Ali, Christopher Potts, Shivam Gandhi, Usman Alizai, Dakota May, Mariam Ghafoor
Language: English
Subfield: Health Information Management
Field: Health Professions
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7204898360