A Pilot Sentinel Surveillance System for Drug Use by Drivers in Crashes—Lessons Learned and Recommendations

Abstract

Introduction

Impaired driving continues to be a significant source of injury, death, and financial burden on society. Alcohol-impaired driving alone accounts for one-third of traffic deaths. Unlike alcohol, however, the prevalence of non-alcohol drugs among drivers remains relatively unknown. With the legalization of marijuana, emergence of the opioid epidemic, and results from National Roadside Surveys, it has become increasingly clear that there is a strong societal need to quantify the scope of drugged driving and its associated negative consequences. Unfortunately, the numerous publicly available traffic databases are notoriously flawed for assessing drugged driving. In 2018, the AAA Foundation commissioned a study to assess the feasibility of developing a sentinel surveillance system for drug use by drivers in crashes. Optimal standards for a database that could form a nationwide sentinel surveillance system were identified and included. Trauma center–related data was ultimately deemed to be the most feasible and viable approach for the development and creation of a sentinel surveillance system. The second phase of this project entailed pilot testing the implementation of this sentinel surveillance system at two trauma centers. This brief describes the pilot test, related lessons learned, and barriers encountered in the development and implementation of such a surveillance system. Additionally, a guidebook on how to implement a sentinel surveillance system for drug use by drivers in crashes was developed.

Key Findings

Methodology

For the pilot testing phase, two Level I trauma centers were recruited: Carilion Roanoke Memorial Hospital (CRMH) in Roanoke, VA, and Wake Forest Baptist Health Medical Center (WFMC) in Winston-Salem, NC. A small number of designated personnel available to work on the pilot study at each trauma center underwent training. These designated sentinel personnel were responsible for acquiring the blood specimens and associated information prior to de-identifying and storing the specimen for future shipment.

The population of interest in this study were trauma patients identified as a driver involved in a motor vehicle crash (MVC) or a motorcycle crash. Upon arrival at the hospital, as a part of standard care, multiple vials of blood are collected from patients for diagnostics and testing. An additional vial of blood was collected at this time for inclusion in the sentinel surveillance system. Basic information about the patient was also collected at the time the blood specimen was taken after which the specimen was de-identified and stored until it was sent out for comprehensive drug testing. Data were collected from December 2019 through November 2020. However, data collection was put on hold for five months during the COVID-19 pandemic as hospital procedures did not allow research personnel in the trauma bay. An independent toxicology lab was selected to conduct comprehensive testing. This included confirmation testing on blood for alcohol and a broad range of over-the-counter (OTC), prescription, and illicit drugs. These data formed the basis of the sentinel surveillance system.

Results

An implementation guidebook was developed based on the pilot study. These materials articulate the benefits of participation in a sentinel surveillance system, and create an easy, streamlined pathway for trauma centers to participate.

The development and implementation of the pilot sentinel surveillance system at two regional trauma centers highlighted a small number of elements that are crucial for success. Despite the differences between the two pilot sites, the lessons learned provide an invaluable resource for other agencies to build on in order to create a nationwide sentinel surveillance system. The factor that stood out above all others was the importance of effective communication. Establishing an open line of communication early on in the preparation phase, as well as scheduling regular meetings with all stakeholders, is vital for success. The importance of communication also increases as the number of sentinel sites increases.

Additionally, streamlining the data collection and storage process is strongly advised. This reduces the chance of errors and mix-ups, especially at sentinel sites where there are a large number of personnel involved in data collection. The pilot data collection protocol was developed in close collaboration with the principal investigator at each pilot site with some elements tailored specifically to each site to mitigate any sources of potential errors.

One of the benefits of working with trauma centers is the inherent understanding of the value of research and the importance of collecting high-quality data. This makes it easier to argue the case for changing patient procedures or finding workarounds to current procedures in order to collect the required data. The staff and trauma surgeons at these facilities see first-hand the impact of drug-involved driving and have a strong desire to reduce its impact on the surrounding communities and society as a whole; thus, it will likely not be difficult to convince them of the benefits of participating in a sentinel surveillance system for drug use.