A review of a journal article created by a Journal Watch contributor

Efficacy of an expanded preoperative survey during perioperative care to identify illicit substance use in teenagers and adolescents

Pediatric Anesthesia

Submitted December 2023 by Dr Su May Koh

Read by 150 Journal Watch subscribers

Illicit substance use is increasing in the teenage and adolescent population and relying on parental history alone is unlikely to be reliable. Illicit substance use and abuse not only has consequences in terms of acute toxicity but can also impact on perioperative care and morbidity. This study compared anonymous answers to a preoperative survey completed by the patient to history obtained from the parent or guardian.

This single site American study involved 250 patients aged 12-21 with a median age of 16. Not surprisingly the study showed higher reporting of substance use or abuse from the patient survey compared to the routine parental history. Alcohol use rates were highest with 27.6% of patients reporting alcohol use compared to 2% of parents reporting this. Alarmingly 2.9% reported using alcohol within 24 hours of coming in for their elective surgery and 6 patients reported marijuana use within 24 hours prior to surgery. 16% of adolescent patients reported vaping compared to only 4.4% of parents. Marijuana use was reported in 20.8% of patients but by only 4.4% of parents. With the increase in vaping, tobacco use rates were lowest with only 4.8% of patients reporting this and 2% of parents.

This study clearly highlights the discrepancies between parental knowledge and reporting of illicit substance use by their teenage or adolescent children. This is not surprising but is an important sign that the current practice of preoperative history taking from the parents is unlikely to be accurate. This is most likely also the current practice of many paediatric institutions.

The authors comment that identification of illicit substance use is not only important to prevent perioperative complications but also may allow for interventions to change behaviour and substance abuse in the longer term. This study sought to identify a more effective way of accurately identifying substance use in teenagers and adolescents using an iPad survey (without parental oversight) preoperatively on the day of surgery. The authors report that this was possible even within the busy workflow of the preoperative area in a tertiary paediatric hospital.

Take home message:
Illicit substance use is a common and increasing problem in teenage and adolescent patients presenting for surgery and current preoperative assessments which rely on parental history are likely to be inaccurate as shown by this study. Institutions need to find new ways of ascertaining more accurate substance use information from these patients in order to ensure more comprehensive perioperative care.

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