{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T17:40:13Z","timestamp":1792345213395,"version":"4.4.0"},"reference-count":23,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:00:00Z","timestamp":1792108800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The American Surgeon\u2122"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Firearm injury remains the leading cause of death among children and adolescents in the United States. Firearm-injured adolescents are at increased risk for substance use and behavioral disorders, yet toxicology testing remains inconsistent despite national recommendations. We evaluated toxicology testing among firearm-injured adolescents compared with adults and temporal trends.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively studied firearm-injured patients treated at an urban Level I trauma center from 2013-2024. Adolescents were classified as early (11-14), middle (15-17), or late (18-21) and compared with adults \u226522\u00a0years. Testing and substance-specific results were evaluated using multivariable logistic regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 10,853 patients, 2713 (25.0%) were adolescents. EtOH and illicit drug testing occurred in 37.7 and 15.5% of patients, respectively. Adolescents had lower rates of EtOH (33.9 vs 39.1%) and illicit drug testing (12.2 vs 16.6%) than adults, decreasing among younger adolescent age groups. After adjustment for sex, race, and clinical severity, adolescents remained less likely to undergo EtOH (aOR 0.77, 95% CI 0.70-0.85) and illicit drug (aOR 0.69, 95% CI 0.60-0.78) testing. White patients had higher odds of EtOH (aOR 1.67, 95% CI 1.44-1.95) and illicit drug testing (aOR 1.66, 95% CI 1.39-1.97) than Black\/African American patients. Among those tested for illicit drugs, 67.9% had at least one non-prescription substance detected. Adolescent testing declined substantially over time.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Biochemical toxicology testing remains inconsistent among firearm-injured adolescents, with persistent age- and race-based differences and declining testing. Standardized toxicology screening may improve identification of at-risk populations and facilitate linkage to evidence-based interventions following injury.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00031348261499835","type":"journal-article","created":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T00:00:56Z","timestamp":1792195256000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Missed Opportunities: Toxicology Screening Remains Incomplete Among Firearm-Injured Adolescents"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-8970-2749","authenticated-orcid":false,"given":"Amber N.","family":"Hannah","sequence":"first","affiliation":[{"name":"Emory University School of Medicine"},{"name":"Department of Surgery, Grady Memorial Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Abi-Karam","sequence":"additional","affiliation":[{"name":"Emory University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5573-1685","authenticated-orcid":false,"given":"Vignesh","family":"Jayaraman Muralidharan","sequence":"additional","affiliation":[{"name":"Emory University School of Medicine"},{"name":"Department of Surgery, Grady Memorial Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9915-395X","authenticated-orcid":false,"given":"Jasmin","family":"Strong","sequence":"additional","affiliation":[{"name":"Emory University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Randi N.","family":"Smith","sequence":"additional","affiliation":[{"name":"Emory University School of Medicine"},{"name":"Department of Surgery, Grady Memorial Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,10,16]]},"reference":[{"key":"e_1_3_3_2_2","volume-title":"Underlying Cause of Death 1999-2024. CDC WONDER Online Database","author":"Centers for Disease Control and Prevention, National Center for Health Statistics","year":"2025","unstructured":"Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 1999-2024. CDC WONDER Online Database. Centers for Disease Control and Prevention, National Center for Health Statistics; 2025."},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1053\/jpsu.2001.21599"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000005557"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2022.5299"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm7130a1"},{"key":"e_1_3_3_7_2","volume-title":"Resources for Optimal Care of the Injured Patient","author":"American College of Surgeons Committee on Trauma","year":"2022","unstructured":"American College of Surgeons Committee on Trauma. 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Screening and brief intervention for adolescent alcohol and drug use in primary care: SBIRT implementation issues. Pediatrics. 2012;130(6):e1612-e1619.","journal-title":"Pediatrics"},{"issue":"2","key":"e_1_3_3_22_2","first-page":"476","article-title":"Implementation of SBIRT in trauma centers: barriers and outcomes","volume":"76","author":"Havens JR","year":"2014","unstructured":"Havens JR, Leukefeld CG, Oser CB. Implementation of SBIRT in trauma centers: barriers and outcomes. 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