3:00pm - 4:00pm (CDT) | 2116.0 - An assessment of bias in driver’s license revocation based on toxicology screening of patients in serious motor vehicle collisions.

Session: Late Breaker Poster Session I

Program: Injury Control and Emergency Health Services

Author: Dolma Tsering, MPH

Abstract

Background & Purpose

Massachusetts (MA) adopted legislation in 2010 that amended the Safe Driving Law, enabling physicians to report patients to the state Registry of Motor Vehicles (RMV) if there is “reasonable cause to believe that an operator is not physically or medically capable of safely operating a motor vehicle.” Trauma physicians at two large academic medical centers initiated a reporting policy for patients who arrived after serious motor vehicle collisions (MVC)that may have been caused by intoxicated driving related to patients operating vehicles under the influence of alcohol or other substances. Prior research shows no racial or ethnic disparities in Emergency Department (ED) alcohol or toxicology screens after serious MVC. However, we aim to understand if there are disparities in hospital-associated license suspension, and whether testing and reporting protocols are standardized.

Methods

All serious MVC admissions between 2016 and 2020 were identified at two Level I trauma centers in Boston, MA. Sociodemographic data, alcohol and toxicology screening data, hospitalization data, and outpatient follow-up data were extracted. Drivers were included if they had an MA license, drove a standard vehicle (motorcycles and passengers in vehicles were excluded), and had a trauma consult once in the ED. Any patients discharged from the hospital with a life-altering injury where future driving would not be possible, or if they were deceased, were also excluded. State data on driving records for included individuals were requested from RMV. Hospital-associated license suspension data was manually abstracted from each driving record. A suspension was defined as hospital-associated if it occurred within six months of a patient’s discharge date. Logistic regression models were used to determine relationships between sociodemographic data and hospital-associated license suspension.

Results

The final dataset included 915 patients, of which 65.1% were male. Male patients had increased odds of a hospital-associated license suspension (OR: 1.52 (1.05 – 2.20)). Patients with public insurance had higher odds of a hospital-associated license suspension than those with private insurance (OR: 1.86 (1.22 – 2.85)). Black and Hispanic/Latinx patients were less likely to undergo hospital-associated license suspension than White patients (Black OR 0.53; (0.35 – 0.81), Hispanic/Latinx OR: 0.38; (0.21 – 0.69)). Toxicology screening protocols differed significantly across academic medical centers. Of the total study set, 11.5% of the patients had neither urine or serum toxicology screening done, and 46.7% only had alcohol screening performed.

Conclusions

The fact that more than half of patients did not receive a urine toxicology screen, and more than 10% received no serum or urine screening for alcohol or toxicology, highlights an intrinsic disparity in the trauma assessment protocol. The stark differences in hospital practices surrounding screening both with alcohol and toxicology screens created a challenge for analysis. Wherein the screening results would determine if someone is potentially reported for driving under the influence, standardized protocols for drug and alcohol screening after a serious MVC should be prioritized.