Alcohol and Mental Health Care Integration in Traumatically Injured Patients with Elevated BAC: A Retrospective Chart Review

Alcohol and Mental Health Care Integration in Traumatically Injured Patients with Elevated BAC: A Retrospective Chart Review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Alcohol and Mental Health Care Integration in Traumatically Injured Patients with Elevated BAC: A Retrospective Chart Review Nicholas Schumann, Madeline Marks, Devi Jayan, Jorian Greenwood, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8331313/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Background Alcohol is a well-documented risk factor for motor vehicle collisions (MVCs) and may also heighten post-trauma psychological symptoms. Given the frequent co-occurrence of MVC injury, alcohol use, and post-injury mental health sequelae, coordinated post-injury care is critical to support long-term psychological and physical recovery. The American College of Surgeons Committee on Trauma requires screening for and intervention on risky alcohol use and, more recently, to conduct mental health risk screening and referral. However, little is known about how established alcohol screening and intervention workflows interface with mental health services in routine practice. Methods We conducted a retrospective cohort study of adults (≥ 18 years) with traumatic injuries at a Level I Trauma Center in the U.S. Midwest from 2017–2022. Data were pulled from the trauma registry and electronic medical record. A chart review was completed on a subset of patients to assess engagement with services using a structured abstraction template. Results From January 2017 to December 2022, 198 patients were admitted after MVC. Of the 154 patients tested for blood alcohol concentration (BAC), 78% were legally intoxicated (≥ 0.08 g/dL). Fifty-eight percent screened at high risk for PTSD or depression on the Injured Trauma Survivor Screen (ITSS). Only 25 intoxicated patients received at least one visit from trauma psychology. Alcohol use was discussed in 60% of these encounters, primarily regarding frequency and quantity. Eleven patients (45.8%) had alcohol use explicitly addressed and were provided resources by social work. Conclusions These findings suggest that alcohol use, despite its significance in this high-risk population, was minimally addressed across services. Figures Figure 1 Figure 2 Introduction Each year, an estimated 2.6 million patients are hospitalized for traumatic injuries in the United States, with alcohol contributing up to 62% of cases (MacLeod & Hungerford, 2011). Motor vehicle collisions (MVCs) are a particularly common alcohol-related injury (Won et al., 2024), with harmful alcohol use increasing risk for rehospitalization (Nunn et al., 2016). Addressing alcohol use is not only a public health priority—it is a clinical imperative to reduce preventable injuries and improve long-term recovery outcomes. Yet, sole focus on the intersection of alcohol use and the preventable physical injuries alone is insufficient for improving recovery-oriented outcomes. Comprehensive prevention and recovery requires attention to the psychological consequences that parallel physical injury. MVC survivors are at elevated risk for psychiatric morbidity, with 20-40% developing posttraumatic stress disorder (PTSD), major depressive disorder, or both (deRoon-Cassini et al., 2019; Shih et al., 2010; Zatzick et al., 2008). Population-based studies suggest that mental health concerns and substance use disorders cumulatively increase the risk for recurrent hospitalization and mortality (Wan et al., 2006; Zatzick et al., 2017), increasing the likelihood of both initial and repeated trauma exposure, disrupting the natural recovery process, and compounding vulnerability to PTSD and ongoing alcohol use (Zatzick et al., 2017). Existing evidence supports the effectiveness of interventions (e.g., motivational interviewing) focused on alcohol use in reducing re-injury and psychological interventions in improving post-injury health outcomes (American College of Surgeons, 2023; Gentilello, 2007). Considering the comorbidity of MVC-related injury, alcohol use, and post-injury psychological sequelae, there is a need for coordinated post-injury care approaches to improve patients' long-term psychological and physical recovery. The American College of Surgeons Committee on Trauma (COT) requires trauma centers to screen for and intervene on risky alcohol use and, more recently, to conduct mental health risk screening and referral (Bulger et al., 2022). Some trauma centers have utilized existing alcohol screening and referral protocols as a model for implementation of post-trauma mental health risk screening and referral protocols (Bulger et al., 2022; Love & Zatzick, 2014; McBain et al., 2019). However, little is known about how established alcohol screening and intervention programs interface with integrated psychological services in routine practice at trauma centers. Variability across trauma centers in implementing these requirements, combined with staggered mandates and siloed clinical oversight, may create gaps and fragmented care for trauma patients with co-occurring harmful alcohol use and mental health risk. To examine how these parallel protocols function in an institution with established independent alcohol and post-trauma mental health screening and intervention programs, we conducted a retrospective chart review of trauma patients in MVCs whose blood alcohol concentration (BAC) indicated legal intoxication (≥0.08 g/dL). Frequency of mental health screening and consultation, type of interventions delivered, and how alcohol use was addressed during admission were examined. By evaluating both access to and integration of care, this work aimed to identify opportunities to strengthen coordination of alcohol use- and mental health-related care for injured trauma survivors. Methods Setting This study was conducted at a Level 1 Trauma Center in the Midwestern United States. The hospital maintains an in-hospital integrated psychological service staffed by licensed clinical psychologists, post-doctoral fellows, and supervised advanced graduate students. The service provides bedside psychological assessment and intervention (e.g., brief cognitive-behavioral interventions) in the acute injury phase. Consults were initiated by automatic referral triggers (i.e., positive mental health screen on the Injured Trauma Survivor Screen [ITSS]; Hunt et al., 2017 ) or by request from the trauma surgery team. The ITSS is a nine-item yes/no screening tool used to identify potential risk for PTSD and major depressive episodes; a score of two or more indicates high risk. All patients receive standard trauma medical care, and the consult service functions as an adjunct intervention. The hospital-based social work service’s primary function is to support discharge planning, with additional clinical responsibilities that include conducting alcohol-use behavior screening, brief intervention, and referral to treatment (SBIRT) following a positive screen. Study Design and Population This retrospective cohort study included adults ≥ 18 years old with traumatic injuries admitted between 2017–2022. Data were obtained from the institution’s trauma registry and Electronic Medical Record (EMR). From the registry, we identified an eligible cohort of patients who met the following inclusion criteria: 1) age 18-years or older, 2) Glasgow Coma Scale (GCS) score > 13 upon admission, and 3) MVC as the mechanism of injury. Patients were excluded if they expired during their admission. From within this cohort, we identified a subsample of patients for detailed chart review. This subsample consisted of patients who underwent BAC screening at hospital admission, were determined to be legally intoxicated (≥ 0.08 g/dL) according to state law (Wisconsin Department of Transportation, n.d.), and received at least one integrated psychology service consult during admission. The study protocol was approved by Medical College of Wisconsin’s Institutional Review Board (IRB #PRO00047211). A waiver of consent was obtained as all data was collected as a part of a retrospective chart review. Demographic and Injury Characteristics Demographic characteristics included age, sex, and race/ethnicity. Injury characteristics included the injury severity score (ISS), and length of hospital stay. Descriptive statistics were used to characterize the sample. Chart Review Among the patients who were legally intoxicated ( N = 154), a retrospective chart review was conducted for the subsample of individuals who received a trauma psychology consultation ( n = 25). Reviewers abstracted data on alcohol-related interventions and psychological interventions documented during integrated psychology visits, as well as in clinical interactions with other services (e.g., social work, psychiatry). The chart review process involved the development of a structured abstraction template by the research team, data abstraction by a trained research assistant who was not involved in clinical care, and an iterative review of the extracted data by two clinical researchers with experience in qualitative methods and chart review (Siems et al., 2020 ). Domains of Review Integrated Psychology Service. For each psychology visit, we coded 1) alcohol-related themes (e.g., alcohol use disorder references, alcohol-related psychoeducation, withdrawal symptoms, motivational interviewing, harm reduction, abstinence), 2) psychological interventions targeting posttraumatic stress symptoms, depression, grief, adjustment, or emotional processing, and 3) the number and timing of follow-up visits. Each visit was then coded for its primary intervention target: alcohol-related concerns, post-trauma psychological distress, or concurrent focus on alcohol and psychological distress. Multidisciplinary Visits. We also reviewed documentation of patient engagement with other professionals (i.e., social work, psychiatry) regarding alcohol use and related concerns. Coding included documentation of withdrawal protocols (e.g., Clinical Institute Withdrawal Assessment for Alcohol; Sullivan et al., 1989 ), medical management for alcohol withdrawal, completion of SBIRT protocol, and provision of resources for alcohol use treatment. Results Between January 2017 and December 2022, 198 patients were identified with an MVC as the primary mechanism of injury and received a BAC laboratory test. Of the sample, 154 (77.8%) patients were legally intoxicated (≥ 0.08 g/dL) according to state statute ( M = 0.207; SD = 0.076; range 0.080–0.439). Table 1 describes the personal, injury, and mental health characteristics of those who received medical treatment for the MVC-related injury at the Level 1 Trauma Center. Characteristics are stratified by legal intoxication status. To support the aim of coordination of alcohol use- and mental health-related care, we focus the results on the patients who were legally intoxicated and received a psychological consultation while admitted to the hospital. Table 2 displays the characteristics of these patients. Table 1 Personal, Injury, and Mental Health Characteristics (N = 198) Characteristics Legally Intoxicated n = 154 Below Legal Intoxication n = 44 Personal Age Mean (SD) 40.12 (14.38) 40.05 (16.13) Sex, n(%) Male 112 (72.73%) 32 (72.73%) Female 42 (27.27%) 12 (27.27) Race, n(%) Black 70 (45.45%) 22 (50.00%) White 63 (40.91%) 17 (38.64%) Asian 4 (2.60%) 1 (2.27%) Not Reported 17 (11.04%) 4 (9.09%) Ethnicity, n(%) Not Hispanic 129 (83.77%) 40 (90.91%) Hispanic 23 (14.94%) 3 (6.82%) Not Reported 2 (1.30%) 1 (2.27%) Blood Alcohol Concentration Mean (SD), range 0.207 (0.076), 0.080–0.439 0.028 (0.023), 0.010–0.076 Injury Total Hospital Length of Stay (days) Mean (SD), median 8.15 (12.97), 12.97 7.34 (9.53) Intensive Care Unit, n(%) Yes 70 (45.45%) 25 (56.82%) No 84 (54.55%) 19 (43.18%) Length of Stay days yes ICU (Mean, SD), median 6.36 (8.40), 3.00 4.52 (3.72), 3.00 Injury Severity Score Mean (SD), range 15.22 (11.72), 1–75 14.61 (10.01), 1–42 Mental Health ITSS Screened Yes, n(%) 97 (77.60%) 24 (64.86%) No, n(%) 28 (22.40%) 13 (35.14%) Results, Yes Screened Positive PTSD, n(%) 8 (8.25%) 2 (8.33%) Positive Depression, n(%) 16 (16.49%) 5 (20.83%) Positive PTSD and Depression, n(%) 25 (25.77%) 7 (29.17%) Risk Negative, n(%) 48 (49.48%) 10 (41.67%) Number of Days from Injury to ITSS Mean (SD), median 2.505 (4.461), 1.00 2.625 (2.018), 2.00 Psychology Consultation Yes, n(%) 25 (16.23%) 6 (13.64%) No, n(%) 129 (83.77%) 38 (86.36%) Number of Days from injury to consult Mean (SD), median 5.760 (5.790), 3.00 3.167 (1.169), 3.00 Table 2 Personal, Injury, and Mental Health Characteristics for Chart Review: Patients with BAC above the legal limit who received a Trauma Psychology Consultation Characteristics n = 25 Personal Age Mean (SD) 38.28 (13.49) Sex, n(%) Male 16 (64.00%) Female 9 (36.00%) Race, n(%) Black 9 (36.00%) White 11 (44.00%) Not Reported 5 (20.00%) Ethnicity, n(%) Not Hispanic 19 (76.00%) Hispanic 4 (16.00%) Not Reported 2 (8.00%) Injury Total Hospital Length of Stay (days) Mean (SD), median 17.36 (23.03), 12.00 Intensive Care Unit, n(%) Yes 14 (56.00%) No 11 (44.00%) Length of Stay days yes ICU (Mean, SD), median 10.07 (11.79), 4.00 Injury Severity Score Mean (SD), range 21.36 (12.21), 4–50 Mental Health ITSS Screened Yes, n(%) 18 (78.26%) No, n(%) 5 (21.74%) Missing 2 Results, Yes Screened Positive PTSD, n(%) 1 (5.56%) Positive Depression, n(%) 2 (11.11%) Positive PTSD and Depression, n(%) 11 (61.11%) Risk Negative, n(%) 4 (22.22%) Number of Days from Injury to ITSS Mean (SD), median 4.667 (9.081), 1.00 Number of Days from Injury to Consult Mean (SD), median 5.760 (5.790), 3.00 See Fig. 1 for an overview of ITSS screening administration and consultation patterns. Content Analysis of Psychology Consultation Visits Integrated Psychology Initial and Follow-Up Visits. A total of 25 patients received an initial evaluation. Consults were primarily identified through a positive ITSS ( n = 14) followed by referral from the trauma team ( n = 11). The average duration was 26.6 minutes with a range of 5–50 minutes. Duration of visits was guided by patient or environmental factors (e.g., declining services, engagement, interruptions). A total of 15 (60%) unique patients had documentation of any alcohol-related assessment or intervention during an initial or follow-up visit. When alcohol was discussed, it included psychoeducation ( n = 2), assessment of alcohol use ( n = 9), and/or past or current outpatient alcohol use treatment ( n = 4). A total of 5 patients had a pre-existing history of AUD documented by the trauma psychologist. The primary focus of the intervention documented was adjustment to injury ( n = 25). A subset of initial visits also documented intervention related to PTSD ( n = 5), depression ( n = 4), traumatic grief ( n = 2), psychoeducation ( n = 3), and emotional processing ( n = 2). Harmful alcohol use was not documented as a primary focus of intervention in any initial consultations. A total of 14 patients (56%) received at least one follow-up visit, with follow-up visits ranging from 1–9. A total of 3 (21%) had documentation of intervention related to alcohol use or withdrawal in a psychology follow-up visit. When alcohol use or treatment was documented, it included psychoeducation about alcohol dependence ( n = 1), patient-reported treatment goals related to discontinuing alcohol use ( n = 1), past treatment or treatment referral ( n = 2), and documentation of alcohol use disorder ( n = 2). Psychological intervention in follow-up visits continued to be primarily focused on adjustment ( n = 10), along with intervention focused on depression ( n = 1), grief and/or emotional processing ( n = 3), and reference to specific emotional coping strategies ( n = 3). Social Work and Psychiatry Visits during Admission. Among the 24 patients with social work involvement, initial contact typically occurred within 1–3 days of admission, with the number of follow-up visits ranging from 2–50. Approximately half of patients ( n = 13) had no documentation of alcohol-related concerns or intervention. Eleven patients (45.8%) had alcohol explicitly addressed and received resources, most often through the SBIRT protocol ( n = 9), though one declined SBIRT and another received a formal inpatient consultation with a substance use counselor. In this one case, pharmacotherapy (naltrexone) was also discussed. Psychiatry consults were placed for six patients (24%) with visits primarily focused on withdrawal management in the context of AUD. Four patients received psychotropic medication management during admission, and two patients declined initiation of medication for withdrawal management. A total of 11 (45.8%) patients had a documented CIWA protocol during admission. Discussion The aim of the current study was to explore inpatient alcohol and psychological intervention for MVC-injured patients who were legally intoxicated at the time of admission. In this cohort of patients admitted after MVC over five years, 78% of those tested for BAC were legally intoxicated, highlighting the high prevalence of alcohol use in this population. Post-injury mental health risk was also common. Of the total sample, 52% of patients screened positive on the ITSS (including the 78% of those who were intoxicated), indicating a substantial subset of patients with co-occurring alcohol use and psychological risk. ITSS screening was not administered to 41 patients, most of whom were intoxicated, suggesting that acute intoxication may limit timely mental health assessment and a gap in the screening protocol for post-intoxication. Analyses focused on the subset of legally intoxicated MVC patients ( n = 25) who also received an inpatient trauma psychology consult, limiting the chart review to a small subset of patients. For these patients, per documentation, social work primarily focused on case management, trauma psychology concentrated on acute psychological adjustment to hospitalization and the secondary sequelae of MVC (e.g., traumatic grief, adjustment difficulties, acquired disability), and psychiatry emphasized medication management for AUD and withdrawal. In examining alcohol-related interventions, the psychology service addressed alcohol use in 60% of cases, primarily assessing alcohol frequency and quantity, with two patients receiving documented psychoeducation on alcohol-related post-injury mental health risks. Similarly, alcohol screening and intervention were minimally represented in social work documentation. Less than half of the sample had documented alcohol screening, and only about one-third had SBIRT administration recorded by social work. Psychiatry involvement largely focused on managing acute withdrawal, with limited documented counseling on medication-assisted treatment, even among those with documented AUD. While all three service lines engage in distinct, yet parallel, care, the limited alcohol-related treatment coordination represents a potential gap in protocols. Overall, these findings revealed lower than expected rates of alcohol-specific assessment and intervention across social work, trauma psychology, and psychiatry services for legally intoxicated patients. Our findings reflect the broader challenge of competing clinical demands faced by specialty services involved in trauma care and the need for early integrated alcohol interventions for legally intoxicated trauma patients involved in MVC. Increased risk for PTSD and/or depression seen in these patients highlights the necessity for interdisciplinary treatment models. Emphasis on integrating alcohol and mental health screening and referral protocols in high-acuity settings like trauma centers is driven by increasing recognition from the COT that alcohol use and mental health conditions are highly prevalent in this population and significantly impact both short-term outcomes and long-term recovery (Gentilello et al., 1995 ; Yaw et al., 2025 ). Adult MVC trauma patients who receive SBIRT during admission are more likely to engage in later alcohol treatment (Runge et al., 2002 ) and demonstrate greater alcohol-related behavior changes, including reduction of alcohol consumption and alcohol-related offenses, as well as fewer recurrent injuries (ACS, 2023; Kodadek et al., 2020 ). Despite the initial increased burden to implement these interventions, the prevention of future alcohol-related injuries reduces the toll on emergency services and trauma care, leading to potential economic (Barbosa et al., 2015 ) and public safety benefits (Kodadek et al., 2020 ). Intervention for alcohol intoxication in MVC patients could be a proactive strategy to promote safety for the individual and the broader community. COT Best Practice Guidelines (ACS, 2023) explicitly recommend the inclusion of a dedicated SBIRT clinician to address alcohol and other substance use concerns, recognizing the competing clinical demands faced by providers. At this study site, a substance use counselor was hired in 2022 within psychiatry to serve in this dedicated role. One case exemplifies the potential enhancement in care in which a patient with a significant alcohol use history was evaluated by the new dedicated substance use counselor. The documented screening, intervention, and referral processes in this case were substantially more comprehensive, spanning both psychopharmacological and behavioral domains, demonstrating their domain-specific expertise. This example underscores the potential benefits of institutional investment in dedicated personnel and integrated programming to ensure that the complex needs of patients’ high-risk comorbidities are adequately addressed. However, this was not representative of the majority of patients’ experiences and likely requires greater implementation efforts. These findings highlight the critical importance of moving beyond the current standard of parallel treatments and advancing toward fully integrated models of care. Screening and referral protocols for alcohol use and mental health risk have grown slowly and independently over time (Bulger et al., 2022 ). This staggered development and decentralization of implementation has likely contributed to siloed intervention protocols. While this approach meets institutional requirements, it does not always facilitate the delivery of fully integrated, comprehensive care, even within the context of interdisciplinary treatment teams. Findings from this study illustrate this challenge. The institution examined had long-established alcohol screening and referral protocols in place, as well as integrated psychology services. However, notable gaps emerged in the management of patients presenting with co-occurring alcohol use and mental health concerns during their hospitalization. This underscores the importance of ongoing efforts to evaluate the implementation of such services, thereby continually improving treatment and addressing potential gaps in care. Our findings are consistent with established best practice guidelines (ACS, 2023) and the existing literature emphasizing the critical importance of integrated services to address the complex needs of trauma patients with co-occurring mental health and substance use concerns (Kodadek et al., 2020 ; Zimmerman et al., 2018). In alignment with recommendations from the ACS (2023), our results highlight the need for systematic processes to ensure BAC assessment for all MVC patients as a key component of SBIRT protocols, enhancing both identification and intervention for patients with alcohol-related concerns. Integrated psychological services should receive targeted training in brief alcohol-related interventions appropriate for hospital settings to facilitate the incorporation of alcohol use assessment and intervention as a standard component of psychological consultation. Increased emphasis on interdisciplinary collaboration is also warranted, as greater integration among hospital-based services providing alcohol-related interventions may enhance the scope and depth of psychosocial intervention during admission and promote the development of comprehensive referral pathways for patients with co-occurring mental health and alcohol-related concerns. In this study, nearly half of the referrals to integrated psychological services originated directly from the trauma team. Trauma centers can leverage interdisciplinary relationships and provide additional training for trauma services, emergency medicine, and social work departments to strengthen identification and referral processes, thereby improving access to hospital-based psychological and psychiatric care for alcohol use assessment and intervention. Limitations and Future Directions This study was conducted at a single Level I trauma center with a relatively small subsample ( N = 25) of legally intoxicated patients receiving trauma psychology consultation. Findings may not generalize to other trauma centers, geographic regions, or patient populations with different demographic or clinical profiles or centers with different behavioral health service models. Given this was a retrospective chart review, the design inherently limits data accuracy to what was documented in the medical record. Documentation of alcohol screening, intervention content, and psychological symptoms may vary due to competing clinical priorities and the need to balance comprehensive documentation with patient confidentiality. As a result, some aspects of service delivery may not have been fully captured in the medical record. Further, chart abstraction relied on qualitative coding of clinical notes across multiple providers and disciplines. Despite the use of a structured abstraction template, differences in provider documentation style, terminology, and clinical focus may have introduced variability in coding and interpretation. Due to the inclusion requirements, an MVC as the mechanism of injury, a documented BAC ≥ 0.08 g/dL, and receipt of a psychology consult, the sample may reflect a subgroup of patients with higher clinical visibility or greater engagement with care. As a result, findings may not represent all intoxicated trauma patients, particularly those who were not screened or declined services. This study was further limited by a focused view on inpatient data and did not include follow-up assessments to evaluate post-discharge engagement with treatment, recurrence of alcohol use, or mental health outcomes. Future studies should explore the long-term impact of consultation and referral practices on recovery. Based on the data evaluated in this study, cross-collaboration is vital among social work, psychiatry, and psychology, and models of care should proactively address the potential gaps in patient care for those at risk. Furthermore, this data serves as a call to action to ensure that cross-disciplinary treatment teams have clearly defined roles, especially in high-risk patient encounters. By strengthening assessment and intervention for patients seriously injured in alcohol-impaired MVCs, multidisciplinary teams have a critical opportunity to improve outcomes and reduce the risk of re-injury. Beyond individual care, these enhanced efforts can also help mitigate the broader public health impact of impaired driving. Declarations Funding: The authors received no financial support for the research, authorship, and/or publication of this article. Author Contribution N.S. and S.M. made substantial contributions to the conception and design of the work, analysis and interpretation of data, drafted the work and approved the submitted version. M.M. and D.J made substantial contributions to the conception and design of the work, drafted the work and approved the submitted version. J.G. made contributions to the analysis and interpretation of data and approved the submitted version.S.T. and T.G. and C.B. and A.S. substantially revised the work and approved the submitted version. 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Journal of Trauma Nursing 25 (3), 196-200. DOI: 10.1097/JTN.0000000000000368 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 25 Feb, 2026 Reviews received at journal 25 Feb, 2026 Reviewers agreed at journal 20 Feb, 2026 Reviews received at journal 23 Jan, 2026 Reviewers agreed at journal 23 Jan, 2026 Reviewers invited by journal 22 Jan, 2026 Editor assigned by journal 13 Dec, 2025 Submission checks completed at journal 13 Dec, 2025 First submitted to journal 10 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8331313","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":580631794,"identity":"35746e7a-7634-4d4c-a4c8-351106d4624a","order_by":0,"name":"Nicholas Schumann","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4ElEQVRIiWNgGAWjYHACNgjF3kCyFp4DJGuRSCBSvTn/4WePeXPs8swlH2+T+FBxx56BvffxC3xaLGekmRvzbksutpydViY548yzxAae42YW+LQY3OBhk+bdxpy44XaOmTRv2+EEBok0NgO8Ws6fAWmpT9xw84yZ9N9/h+0JazmQA9JyOHHDDR4zacaGw4wNEmnMD/A7LM1Mcu6244kbzqQVW/YcO5zYxnOMDZ8OoMMOP5N4u606ccPxwxtv/Kg5bM/P3sb8Aa8eZO1gEmgFmwRpWoCAeFtGwSgYBaNgRAAAdFlIohm8ej0AAAAASUVORK5CYII=","orcid":"","institution":"The Queen’s Medical Center","correspondingAuthor":true,"prefix":"","firstName":"Nicholas","middleName":"","lastName":"Schumann","suffix":""},{"id":580631795,"identity":"2fd5924d-e5b3-46aa-af72-2c13dda09af8","order_by":1,"name":"Madeline Marks","email":"","orcid":"","institution":"University of Maryland","correspondingAuthor":false,"prefix":"","firstName":"Madeline","middleName":"","lastName":"Marks","suffix":""},{"id":580631796,"identity":"b98d080e-65c0-4f68-bd5d-445239c10d6a","order_by":2,"name":"Devi Jayan","email":"","orcid":"","institution":"University of Chicago","correspondingAuthor":false,"prefix":"","firstName":"Devi","middleName":"","lastName":"Jayan","suffix":""},{"id":580631797,"identity":"31b1296e-e387-4d8f-a105-d1044a6d060e","order_by":3,"name":"Jorian Greenwood","email":"","orcid":"","institution":"Medical College of Wisconsin","correspondingAuthor":false,"prefix":"","firstName":"Jorian","middleName":"","lastName":"Greenwood","suffix":""},{"id":580631798,"identity":"9a0b6a26-c920-4518-8849-aa60e8c982e1","order_by":4,"name":"Sydney Timmer-Murillo","email":"","orcid":"","institution":"Medical College of Wisconsin","correspondingAuthor":false,"prefix":"","firstName":"Sydney","middleName":"","lastName":"Timmer-Murillo","suffix":""},{"id":580631799,"identity":"dfbb8e09-4e75-4cbd-9ed5-d87ee07bd4d9","order_by":5,"name":"Timothy Geier","email":"","orcid":"","institution":"Medical College of Wisconsin","correspondingAuthor":false,"prefix":"","firstName":"Timothy","middleName":"","lastName":"Geier","suffix":""},{"id":580631800,"identity":"1d93564f-7bb1-41d9-bf1f-5a72609f138e","order_by":6,"name":"Claire Bird","email":"","orcid":"","institution":"Baylor University Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Claire","middleName":"","lastName":"Bird","suffix":""},{"id":580631801,"identity":"6e743d94-931e-4811-8b55-9d512a0be614","order_by":7,"name":"Andrew Schramm","email":"","orcid":"","institution":"Medical College of Wisconsin","correspondingAuthor":false,"prefix":"","firstName":"Andrew","middleName":"","lastName":"Schramm","suffix":""},{"id":580631802,"identity":"d5e85780-ab90-4875-b8ef-60e870195d30","order_by":8,"name":"Sacha McBain","email":"","orcid":"","institution":"Rush University Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Sacha","middleName":"","lastName":"McBain","suffix":""}],"badges":[],"createdAt":"2025-12-11 00:38:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8331313/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8331313/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":101785039,"identity":"0f3d5405-e2ad-46cc-99e8-8293feed4010","added_by":"auto","created_at":"2026-02-03 15:33:26","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":106838,"visible":true,"origin":"","legend":"\u003cp\u003eOverview of ITSS screening administration and consultation patterns (BelowLegalIntox)\u003c/p\u003e","description":"","filename":"BelowLegalIntox.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8331313/v1/0bc522e53062f465c73e8d2a.jpeg"},{"id":101785040,"identity":"1ff5dd2b-1a5c-49e3-814f-388e6e2fca64","added_by":"auto","created_at":"2026-02-03 15:33:26","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":109394,"visible":true,"origin":"","legend":"\u003cp\u003eOverview of ITSS screening administration and consultation patterns (LegalIntox)\u003c/p\u003e","description":"","filename":"LegalIntox.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8331313/v1/af8cacce55bff5dd056472d2.jpeg"},{"id":101881207,"identity":"52f61633-1f6c-4f39-bcfc-091ef189f98c","added_by":"auto","created_at":"2026-02-04 15:10:42","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1023189,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8331313/v1/c2400cda-7670-4499-b01d-234962d55823.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Alcohol and Mental Health Care Integration in Traumatically Injured Patients with Elevated BAC: A Retrospective Chart Review","fulltext":[{"header":"Introduction","content":"\u003cp\u003eEach year, an estimated 2.6 million patients are hospitalized for traumatic injuries in the United States, with alcohol contributing up to 62% of cases (MacLeod \u0026amp; Hungerford, 2011). Motor vehicle collisions (MVCs) are a particularly common alcohol-related injury (Won et al., 2024), with harmful alcohol use increasing risk for rehospitalization (Nunn et al., 2016). Addressing alcohol use is not only a public health priority—it is a clinical imperative to reduce preventable injuries and improve long-term recovery outcomes. Yet, sole focus on the intersection of alcohol use and the preventable physical injuries alone is insufficient for improving recovery-oriented outcomes. Comprehensive prevention and recovery requires attention to the psychological consequences that parallel physical injury. \u003c/p\u003e\n\u003cp\u003eMVC survivors are at elevated risk for psychiatric morbidity, with 20-40% developing posttraumatic stress disorder (PTSD), major depressive disorder, or both (deRoon-Cassini et al., 2019; Shih et al., 2010; Zatzick et al., 2008). Population-based studies suggest that mental health concerns and substance use disorders cumulatively increase the risk for recurrent hospitalization and mortality (Wan et al., 2006; Zatzick et al., 2017), increasing the likelihood of both initial and repeated trauma exposure, disrupting the natural recovery process, and compounding vulnerability to PTSD and ongoing alcohol use (Zatzick et al., 2017). Existing evidence supports the effectiveness of interventions (e.g., motivational interviewing) focused on alcohol use in reducing re-injury and psychological interventions in improving post-injury health outcomes (American College of Surgeons, 2023; Gentilello, 2007). Considering the comorbidity of MVC-related injury, alcohol use, and post-injury psychological sequelae, there is a need for coordinated post-injury care approaches to improve patients' long-term psychological and physical recovery. \u003c/p\u003e\n\u003cp\u003eThe American College of Surgeons Committee on Trauma (COT) requires trauma centers to screen for and intervene on risky alcohol use and, more recently, to conduct mental health risk screening and referral (Bulger et al., 2022). Some trauma centers have utilized existing alcohol screening and referral protocols as a model for implementation of post-trauma mental health risk screening and referral protocols (Bulger et al., 2022; Love \u0026amp; Zatzick, 2014; McBain et al., 2019). However, little is known about how established alcohol screening and intervention programs interface with integrated psychological services in routine practice at trauma centers. Variability across trauma centers in implementing these requirements, combined with staggered mandates and siloed clinical oversight, may create gaps and fragmented care for trauma patients with co-occurring harmful alcohol use and mental health risk. \u003c/p\u003e\n\u003cp\u003eTo examine how these parallel protocols function in an institution with established independent alcohol and post-trauma mental health screening and intervention programs, we conducted a retrospective chart review of trauma patients in MVCs whose blood alcohol concentration (BAC) indicated legal intoxication (≥0.08 g/dL). Frequency of mental health screening and consultation, type of interventions delivered, and how alcohol use was addressed during admission were examined. By evaluating both access to and integration of care, this work aimed to identify opportunities to strengthen coordination of alcohol use- and mental health-related care for injured trauma survivors.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003eSetting\u003c/h2\u003e \u003cp\u003eThis study was conducted at a Level 1 Trauma Center in the Midwestern United States. The hospital maintains an in-hospital integrated psychological service staffed by licensed clinical psychologists, post-doctoral fellows, and supervised advanced graduate students. The service provides bedside psychological assessment and intervention (e.g., brief cognitive-behavioral interventions) in the acute injury phase. Consults were initiated by automatic referral triggers (i.e., positive mental health screen on the Injured Trauma Survivor Screen [ITSS]; Hunt et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2017\u003c/span\u003e) or by request from the trauma surgery team. The ITSS is a nine-item yes/no screening tool used to identify potential risk for PTSD and major depressive episodes; a score of two or more indicates high risk. All patients receive standard trauma medical care, and the consult service functions as an adjunct intervention. The hospital-based social work service\u0026rsquo;s primary function is to support discharge planning, with additional clinical responsibilities that include conducting alcohol-use behavior screening, brief intervention, and referral to treatment (SBIRT) following a positive screen.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and Population\u003c/h2\u003e \u003cp\u003eThis retrospective cohort study included adults\u0026thinsp;\u0026ge;\u0026thinsp;18 years old with traumatic injuries admitted between 2017\u0026ndash;2022. Data were obtained from the institution\u0026rsquo;s trauma registry and Electronic Medical Record (EMR). From the registry, we identified an eligible cohort of patients who met the following inclusion criteria: 1) age 18-years or older, 2) Glasgow Coma Scale (GCS) score\u0026thinsp;\u0026gt;\u0026thinsp;13 upon admission, and 3) MVC as the mechanism of injury. Patients were excluded if they expired during their admission.\u003c/p\u003e \u003cp\u003e From within this cohort, we identified a subsample of patients for detailed chart review. This subsample consisted of patients who underwent BAC screening at hospital admission, were determined to be legally intoxicated (\u0026ge;\u0026thinsp;0.08 g/dL) according to state law (Wisconsin Department of Transportation, n.d.), and received at least one integrated psychology service consult during admission. The study protocol was approved by Medical College of Wisconsin\u0026rsquo;s Institutional Review Board (IRB #PRO00047211). A waiver of consent was obtained as all data was collected as a part of a retrospective chart review.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eDemographic and Injury Characteristics\u003c/h3\u003e\n\u003cp\u003eDemographic characteristics included age, sex, and race/ethnicity. Injury characteristics included the injury severity score (ISS), and length of hospital stay. Descriptive statistics were used to characterize the sample.\u003c/p\u003e\n\u003ch3\u003eChart Review\u003c/h3\u003e\n\u003cp\u003eAmong the patients who were legally intoxicated (\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;154), a retrospective chart review was conducted for the subsample of individuals who received a trauma psychology consultation (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;25). Reviewers abstracted data on alcohol-related interventions and psychological interventions documented during integrated psychology visits, as well as in clinical interactions with other services (e.g., social work, psychiatry). The chart review process involved the development of a structured abstraction template by the research team, data abstraction by a trained research assistant who was not involved in clinical care, and an iterative review of the extracted data by two clinical researchers with experience in qualitative methods and chart review (Siems et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eDomains of Review\u003c/h3\u003e\n\u003cp\u003e \u003cb\u003eIntegrated Psychology Service.\u003c/b\u003e For each psychology visit, we coded 1) alcohol-related themes (e.g., alcohol use disorder references, alcohol-related psychoeducation, withdrawal symptoms, motivational interviewing, harm reduction, abstinence), 2) psychological interventions targeting posttraumatic stress symptoms, depression, grief, adjustment, or emotional processing, and 3) the number and timing of follow-up visits. Each visit was then coded for its primary intervention target: alcohol-related concerns, post-trauma psychological distress, or concurrent focus on alcohol and psychological distress.\u003c/p\u003e \u003cp\u003e\u003cb\u003eMultidisciplinary Visits.\u003c/b\u003e We also reviewed documentation of patient engagement with other professionals (i.e., social work, psychiatry) regarding alcohol use and related concerns. Coding included documentation of withdrawal protocols (e.g., Clinical Institute Withdrawal Assessment for Alcohol; Sullivan et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e1989\u003c/span\u003e), medical management for alcohol withdrawal, completion of SBIRT protocol, and provision of resources for alcohol use treatment.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eBetween January 2017 and December 2022, 198 patients were identified with an MVC as the primary mechanism of injury and received a BAC laboratory test. Of the sample, 154 (77.8%) patients were legally intoxicated (\u0026ge;\u0026thinsp;0.08 g/dL) according to state statute (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.207; \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.076; range 0.080\u0026ndash;0.439). Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e describes the personal, injury, and mental health characteristics of those who received medical treatment for the MVC-related injury at the Level 1 Trauma Center. Characteristics are stratified by legal intoxication status. To support the aim of coordination of alcohol use- and mental health-related care, we focus the results on the patients who were legally intoxicated and received a psychological consultation while admitted to the hospital. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e displays the characteristics of these patients.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003ePersonal, Injury, and Mental Health Characteristics (N\u0026thinsp;=\u0026thinsp;198)\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eLegally Intoxicated\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003en\u0026thinsp;=\u0026thinsp;154\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eBelow Legal Intoxication\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003en\u0026thinsp;=\u0026thinsp;44\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePersonal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eAge\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e40.12 (14.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40.05 (16.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eSex, n(%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e112 (72.73%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32 (72.73%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e42 (27.27%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12 (27.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eRace, n(%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlack\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e70 (45.45%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22 (50.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e63 (40.91%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17 (38.64%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAsian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4 (2.60%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (2.27%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot Reported\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17 (11.04%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4 (9.09%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eEthnicity, n(%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot Hispanic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e129 (83.77%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40 (90.91%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHispanic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23 (14.94%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (6.82%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot Reported\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2 (1.30%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (2.27%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eBlood Alcohol Concentration\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean (SD), range\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.207 (0.076), 0.080\u0026ndash;0.439\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.028 (0.023), 0.010\u0026ndash;0.076\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInjury\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eTotal Hospital Length of Stay (days)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eMean (SD), median\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.15 (12.97), 12.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.34 (9.53)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eIntensive Care Unit, n(%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e70 (45.45%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25 (56.82%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e84 (54.55%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19 (43.18%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLength of Stay days yes ICU (Mean, SD), median\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6.36 (8.40), 3.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.52 (3.72), 3.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eInjury Severity Score\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean (SD), range\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15.22 (11.72), 1\u0026ndash;75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.61 (10.01), 1\u0026ndash;42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMental Health\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eITSS\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eScreened\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e97 (77.60%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24 (64.86%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28 (22.40%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13 (35.14%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eResults, Yes Screened\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive PTSD, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8 (8.25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (8.33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive Depression, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16 (16.49%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5 (20.83%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive PTSD and Depression, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25 (25.77%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7 (29.17%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRisk Negative, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e48 (49.48%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10 (41.67%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of Days from Injury to ITSS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean (SD), median\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.505 (4.461), 1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.625 (2.018), 2.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePsychology Consultation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25 (16.23%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6 (13.64%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e129 (83.77%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38 (86.36%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of Days from injury to consult\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean (SD), median\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5.760 (5.790), 3.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.167 (1.169), 3.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003ePersonal, Injury, and Mental Health Characteristics for Chart Review: Patients with BAC above the legal limit who received a Trauma Psychology Consultation\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003en\u0026thinsp;=\u0026thinsp;25\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c3\" namest=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePersonal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c3\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eAge\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c3\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38.28 (13.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c3\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eSex, n(%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c3\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (64.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c3\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (36.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c3\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eRace, n(%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c3\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlack\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (36.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c3\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (44.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c3\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot Reported\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (20.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c3\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eEthnicity, n(%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c3\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot Hispanic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 (76.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c3\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHispanic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (16.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c3\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot Reported\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (8.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c3\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInjury\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c3\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eTotal Hospital Length of Stay (days)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eMean (SD), median\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17.36 (23.03), 12.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eIntensive Care Unit, n(%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c3\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 (56.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c3\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (44.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c3\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLength of Stay days yes ICU (Mean, SD), median\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.07 (11.79), 4.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c3\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eInjury Severity Score\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c3\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean (SD), range\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21.36 (12.21), 4\u0026ndash;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c3\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMental Health\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c3\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eITSS\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c3\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eScreened\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c3\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18 (78.26%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c3\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (21.74%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c3\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMissing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c3\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eResults, Yes Screened\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c3\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive PTSD, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (5.56%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c3\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive Depression, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (11.11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c3\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive PTSD and Depression, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (61.11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c3\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRisk Negative, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (22.22%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c3\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of Days from Injury to ITSS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c3\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean (SD), median\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.667 (9.081), 1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c3\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of Days from Injury to Consult\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c3\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean (SD), median\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.760 (5.790), 3.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c3\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eSee Fig.\u0026nbsp;1 for an overview of ITSS screening administration and consultation patterns.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eContent Analysis of Psychology Consultation Visits\u003c/h2\u003e \u003cp\u003e \u003cb\u003eIntegrated Psychology Initial and Follow-Up Visits.\u003c/b\u003e A total of 25 patients received an initial evaluation. Consults were primarily identified through a positive ITSS (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;14) followed by referral from the trauma team (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;11). The average duration was 26.6 minutes with a range of 5\u0026ndash;50 minutes. Duration of visits was guided by patient or environmental factors (e.g., declining services, engagement, interruptions). A total of 15 (60%) unique patients had documentation of any alcohol-related assessment or intervention during an initial or follow-up visit. When alcohol was discussed, it included psychoeducation (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;2), assessment of alcohol use (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;9), and/or past or current outpatient alcohol use treatment (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;4). A total of 5 patients had a pre-existing history of AUD documented by the trauma psychologist.\u003c/p\u003e \u003cp\u003eThe primary focus of the intervention documented was adjustment to injury (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;25). A subset of initial visits also documented intervention related to PTSD (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;5), depression (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;4), traumatic grief (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2), psychoeducation (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3), and emotional processing (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2). Harmful alcohol use was not documented as a primary focus of intervention in any initial consultations.\u003c/p\u003e \u003cp\u003eA total of 14 patients (56%) received at least one follow-up visit, with follow-up visits ranging from 1\u0026ndash;9. A total of 3 (21%) had documentation of intervention related to alcohol use or withdrawal in a psychology follow-up visit. When alcohol use or treatment was documented, it included psychoeducation about alcohol dependence (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1), patient-reported treatment goals related to discontinuing alcohol use (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1), past treatment or treatment referral (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2), and documentation of alcohol use disorder (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2).\u003c/p\u003e \u003cp\u003ePsychological intervention in follow-up visits continued to be primarily focused on adjustment (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;10), along with intervention focused on depression (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1), grief and/or emotional processing (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3), and reference to specific emotional coping strategies (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3).\u003c/p\u003e \u003cp\u003e \u003cb\u003eSocial Work and Psychiatry Visits during Admission.\u003c/b\u003e Among the 24 patients with social work involvement, initial contact typically occurred within 1\u0026ndash;3 days of admission, with the number of follow-up visits ranging from 2\u0026ndash;50. Approximately half of patients (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;13) had no documentation of alcohol-related concerns or intervention. Eleven patients (45.8%) had alcohol explicitly addressed and received resources, most often through the SBIRT protocol (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;9), though one declined SBIRT and another received a formal inpatient consultation with a substance use counselor. In this one case, pharmacotherapy (naltrexone) was also discussed.\u003c/p\u003e \u003cp\u003ePsychiatry consults were placed for six patients (24%) with visits primarily focused on withdrawal management in the context of AUD. Four patients received psychotropic medication management during admission, and two patients declined initiation of medication for withdrawal management. A total of 11 (45.8%) patients had a documented CIWA protocol during admission.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe aim of the current study was to explore inpatient alcohol and psychological intervention for MVC-injured patients who were legally intoxicated at the time of admission. In this cohort of patients admitted after MVC over five years, 78% of those tested for BAC were legally intoxicated, highlighting the high prevalence of alcohol use in this population. Post-injury mental health risk was also common. Of the total sample, 52% of patients screened positive on the ITSS (including the 78% of those who were intoxicated), indicating a substantial subset of patients with co-occurring alcohol use and psychological risk. ITSS screening was not administered to 41 patients, most of whom were intoxicated, suggesting that acute intoxication may limit timely mental health assessment and a gap in the screening protocol for post-intoxication.\u003c/p\u003e \u003cp\u003eAnalyses focused on the subset of legally intoxicated MVC patients (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;25) who also received an inpatient trauma psychology consult, limiting the chart review to a small subset of patients. For these patients, per documentation, social work primarily focused on case management, trauma psychology concentrated on acute psychological adjustment to hospitalization and the secondary sequelae of MVC (e.g., traumatic grief, adjustment difficulties, acquired disability), and psychiatry emphasized medication management for AUD and withdrawal.\u003c/p\u003e \u003cp\u003eIn examining alcohol-related interventions, the psychology service addressed alcohol use in 60% of cases, primarily assessing alcohol frequency and quantity, with two patients receiving documented psychoeducation on alcohol-related post-injury mental health risks. Similarly, alcohol screening and intervention were minimally represented in social work documentation. Less than half of the sample had documented alcohol screening, and only about one-third had SBIRT administration recorded by social work. Psychiatry involvement largely focused on managing acute withdrawal, with limited documented counseling on medication-assisted treatment, even among those with documented AUD. While all three service lines engage in distinct, yet parallel, care, the limited alcohol-related treatment coordination represents a potential gap in protocols. Overall, these findings revealed lower than expected rates of alcohol-specific assessment and intervention across social work, trauma psychology, and psychiatry services for legally intoxicated patients.\u003c/p\u003e \u003cp\u003e Our findings reflect the broader challenge of competing clinical demands faced by specialty services involved in trauma care and the need for early integrated alcohol interventions for legally intoxicated trauma patients involved in MVC. Increased risk for PTSD and/or depression seen in these patients highlights the necessity for interdisciplinary treatment models. Emphasis on integrating alcohol and mental health screening and referral protocols in high-acuity settings like trauma centers is driven by increasing recognition from the COT that alcohol use and mental health conditions are highly prevalent in this population and significantly impact both short-term outcomes and long-term recovery (Gentilello et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e1995\u003c/span\u003e; Yaw et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Adult MVC trauma patients who receive SBIRT during admission are more likely to engage in later alcohol treatment (Runge et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2002\u003c/span\u003e) and demonstrate greater alcohol-related behavior changes, including reduction of alcohol consumption and alcohol-related offenses, as well as fewer recurrent injuries (ACS, 2023; Kodadek et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Despite the initial increased burden to implement these interventions, the prevention of future alcohol-related injuries reduces the toll on emergency services and trauma care, leading to potential economic (Barbosa et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2015\u003c/span\u003e) and public safety benefits (Kodadek et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Intervention for alcohol intoxication in MVC patients could be a proactive strategy to promote safety for the individual and the broader community. COT Best Practice Guidelines (ACS, 2023) explicitly recommend the inclusion of a dedicated SBIRT clinician to address alcohol and other substance use concerns, recognizing the competing clinical demands faced by providers.\u003c/p\u003e \u003cp\u003eAt this study site, a substance use counselor was hired in 2022 within psychiatry to serve in this dedicated role. One case exemplifies the potential enhancement in care in which a patient with a significant alcohol use history was evaluated by the new dedicated substance use counselor. The documented screening, intervention, and referral processes in this case were substantially more comprehensive, spanning both psychopharmacological and behavioral domains, demonstrating their domain-specific expertise. This example underscores the potential benefits of institutional investment in dedicated personnel and integrated programming to ensure that the complex needs of patients\u0026rsquo; high-risk comorbidities are adequately addressed. However, this was not representative of the majority of patients\u0026rsquo; experiences and likely requires greater implementation efforts. These findings highlight the critical importance of moving beyond the current standard of parallel treatments and advancing toward fully integrated models of care.\u003c/p\u003e \u003cp\u003eScreening and referral protocols for alcohol use and mental health risk have grown slowly and independently over time (Bulger et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). This staggered development and decentralization of implementation has likely contributed to siloed intervention protocols. While this approach meets institutional requirements, it does not always facilitate the delivery of fully integrated, comprehensive care, even within the context of interdisciplinary treatment teams. Findings from this study illustrate this challenge. The institution examined had long-established alcohol screening and referral protocols in place, as well as integrated psychology services. However, notable gaps emerged in the management of patients presenting with co-occurring alcohol use and mental health concerns during their hospitalization. This underscores the importance of ongoing efforts to evaluate the implementation of such services, thereby continually improving treatment and addressing potential gaps in care.\u003c/p\u003e \u003cp\u003eOur findings are consistent with established best practice guidelines (ACS, 2023) and the existing literature emphasizing the critical importance of integrated services to address the complex needs of trauma patients with co-occurring mental health and substance use concerns (Kodadek et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Zimmerman et al., 2018). In alignment with recommendations from the ACS (2023), our results highlight the need for systematic processes to ensure BAC assessment for all MVC patients as a key component of SBIRT protocols, enhancing both identification and intervention for patients with alcohol-related concerns. Integrated psychological services should receive targeted training in brief alcohol-related interventions appropriate for hospital settings to facilitate the incorporation of alcohol use assessment and intervention as a standard component of psychological consultation. Increased emphasis on interdisciplinary collaboration is also warranted, as greater integration among hospital-based services providing alcohol-related interventions may enhance the scope and depth of psychosocial intervention during admission and promote the development of comprehensive referral pathways for patients with co-occurring mental health and alcohol-related concerns. In this study, nearly half of the referrals to integrated psychological services originated directly from the trauma team. Trauma centers can leverage interdisciplinary relationships and provide additional training for trauma services, emergency medicine, and social work departments to strengthen identification and referral processes, thereby improving access to hospital-based psychological and psychiatric care for alcohol use assessment and intervention.\u003c/p\u003e\n\u003ch3\u003eLimitations and Future Directions\u003c/h3\u003e\n\u003cp\u003eThis study was conducted at a single Level I trauma center with a relatively small subsample (\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;25) of legally intoxicated patients receiving trauma psychology consultation. Findings may not generalize to other trauma centers, geographic regions, or patient populations with different demographic or clinical profiles or centers with different behavioral health service models. Given this was a retrospective chart review, the design inherently limits data accuracy to what was documented in the medical record. Documentation of alcohol screening, intervention content, and psychological symptoms may vary due to competing clinical priorities and the need to balance comprehensive documentation with patient confidentiality. As a result, some aspects of service delivery may not have been fully captured in the medical record. Further, chart abstraction relied on qualitative coding of clinical notes across multiple providers and disciplines. Despite the use of a structured abstraction template, differences in provider documentation style, terminology, and clinical focus may have introduced variability in coding and interpretation.\u003c/p\u003e \u003cp\u003eDue to the inclusion requirements, an MVC as the mechanism of injury, a documented BAC\u0026thinsp;\u0026ge;\u0026thinsp;0.08 g/dL, and receipt of a psychology consult, the sample may reflect a subgroup of patients with higher clinical visibility or greater engagement with care. As a result, findings may not represent all intoxicated trauma patients, particularly those who were not screened or declined services. This study was further limited by a focused view on inpatient data and did not include follow-up assessments to evaluate post-discharge engagement with treatment, recurrence of alcohol use, or mental health outcomes. Future studies should explore the long-term impact of consultation and referral practices on recovery.\u003c/p\u003e \u003cp\u003eBased on the data evaluated in this study, cross-collaboration is vital among social work, psychiatry, and psychology, and models of care should proactively address the potential gaps in patient care for those at risk. Furthermore, this data serves as a call to action to ensure that cross-disciplinary treatment teams have clearly defined roles, especially in high-risk patient encounters. By strengthening assessment and intervention for patients seriously injured in alcohol-impaired MVCs, multidisciplinary teams have a critical opportunity to improve outcomes and reduce the risk of re-injury. Beyond individual care, these enhanced efforts can also help mitigate the broader public health impact of impaired driving.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eThe authors received no financial support for the research, authorship, and/or publication of this article.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eN.S. and S.M. made substantial contributions to the conception and design of the work, analysis and interpretation of data, drafted the work and approved the submitted version. M.M. and D.J made substantial contributions to the conception and design of the work, drafted the work and approved the submitted version. J.G. made contributions to the analysis and interpretation of data and approved the submitted version.S.T. and T.G. and C.B. and A.S. substantially revised the work and approved the submitted version.\u003c/p\u003e"},{"header":"References","content":"\u003cp\u003eAmerican College of Surgeons. (2023). \u003cem\u003eBest practice guidelines: Screening and intervention for mental health disorders and substance use and misuse in the acute trauma patient\u003c/em\u003e. https://www.facs.org/media/nrcj31ku/mental-health-guidelines.pdf \u003c/p\u003e\n\u003cp\u003eBarbosa, C., Cowell, A., Bray, J., \u0026amp; Aldridge, A. (2015). The cost-effectiveness of alcohol screening, brief intervention, and referral to treatment (SBIRT) in emergency and outpatient medical settings. \u003cem\u003eJournal of Substance Abuse Treatment, 53\u003c/em\u003e, 1-8. https://doi.org/10.1016/j.jsat.2015.01.003\u003c/p\u003e\n\u003cp\u003eBulger, E. M., Johnson, P., Parker, L., Moloney, K. E., Roberts, M. 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DOI: 10.1097/JTN.0000000000000368\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"substance-abuse-treatment-prevention-and-policy","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"satp","sideBox":"Learn more about [Substance Abuse Treatment, Prevention, and Policy](http://substanceabusepolicy.biomedcentral.com)","snPcode":"13011","submissionUrl":"https://submission.nature.com/new-submission/13011/3","title":"Substance Abuse Treatment, Prevention, and Policy","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-8331313/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8331313/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eAlcohol is a well-documented risk factor for motor vehicle collisions (MVCs) and may also heighten post-trauma psychological symptoms. Given the frequent co-occurrence of MVC injury, alcohol use, and post-injury mental health sequelae, coordinated post-injury care is critical to support long-term psychological and physical recovery. The American College of Surgeons Committee on Trauma requires screening for and intervention on risky alcohol use and, more recently, to conduct mental health risk screening and referral. However, little is known about how established alcohol screening and intervention workflows interface with mental health services in routine practice.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe conducted a retrospective cohort study of adults (\u0026ge;\u0026thinsp;18 years) with traumatic injuries at a Level I Trauma Center in the U.S. Midwest from 2017\u0026ndash;2022. Data were pulled from the trauma registry and electronic medical record. A chart review was completed on a subset of patients to assess engagement with services using a structured abstraction template.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eFrom January 2017 to December 2022, 198 patients were admitted after MVC. Of the 154 patients tested for blood alcohol concentration (BAC), 78% were legally intoxicated (\u0026ge;\u0026thinsp;0.08 g/dL). Fifty-eight percent screened at high risk for PTSD or depression on the Injured Trauma Survivor Screen (ITSS). Only 25 intoxicated patients received at least one visit from trauma psychology. Alcohol use was discussed in 60% of these encounters, primarily regarding frequency and quantity. Eleven patients (45.8%) had alcohol use explicitly addressed and were provided resources by social work.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThese findings suggest that alcohol use, despite its significance in this high-risk population, was minimally addressed across services.\u003c/p\u003e","manuscriptTitle":"Alcohol and Mental Health Care Integration in Traumatically Injured Patients with Elevated BAC: A Retrospective Chart Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-03 15:33:20","doi":"10.21203/rs.3.rs-8331313/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-26T03:17:54+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-25T19:14:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"143165866090704305543113051745119220250","date":"2026-02-20T15:46:33+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-23T22:12:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"3624303962442029439359402964747309039","date":"2026-01-23T15:03:49+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-23T00:32:35+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-13T06:28:53+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-13T06:28:24+00:00","index":"","fulltext":""},{"type":"submitted","content":"Substance Abuse Treatment, Prevention, and Policy","date":"2025-12-11T00:32:55+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"substance-abuse-treatment-prevention-and-policy","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"satp","sideBox":"Learn more about [Substance Abuse Treatment, Prevention, and Policy](http://substanceabusepolicy.biomedcentral.com)","snPcode":"13011","submissionUrl":"https://submission.nature.com/new-submission/13011/3","title":"Substance Abuse Treatment, Prevention, and Policy","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e5cd5260-d68b-4cfb-af83-084687240627","owner":[],"postedDate":"February 3rd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-30T08:40:21+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-03 15:33:20","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8331313","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8331313","identity":"rs-8331313","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}