J Burn Care Res. 2026 Feb 20:irag003. doi: 10.1093/jbcr/irag003. Online ahead of print.
ABSTRACT
The burden of alcohol and substance use disorder is disproportionately high among burn patients and portends worse clinical outcomes. The CAGE questionnaire is a validated four-question screen for alcohol and drug use. This study aimed to identify demographic and clinical variables that predict positive CAGE screens or negative-to-positive screen conversion in burn survivors and to examine psychosocial and functional outcomes. The Burn Model System database was used to assess characteristics of burn patients who completed a CAGE screen at discharge (1994-2023). The relationship between CAGE scores and Satisfaction with Life Scale (SWLS), PROMIS (Patient Reported Outcomes Measurement Information System)-Anxiety, -Depression, -Pain Interference, and -Physical Function, were analyzed. Mean length of hospital stay was longer in patients with positive CAGE screens (34.0 vs 25.1 days, p<.001). Mean number of surgeries demonstrated a similar association (2.8 vs 2.2, p<.001). Significant differences were also observed by ethnicity, race, employment status, burn mechanism, marital status, and insurance type. Drug misuse at the time of injury was significantly higher in CAGE-positive patients (34.9 vs 6.6%, p<.001). Younger age (p=.004) and unemployment (p=.001) were significantly associated with transition to a positive CAGE screen within 24 months. At 12 months, a positive CAGE screen was associated with lower SWLS (p<.001) and higher (detrimental) PROMIS-Anxiety (p=.006) and -Depression (p=.019) scores. These data suggest significant associations between positive CAGE screens, as a surrogate for drug and alcohol misuse, and measures of burn severity (length of stay and number of surgeries), psychological stress (anxiety and depression), and social dysfunction (unemployment).
PMID:41717777 | DOI:10.1093/jbcr/irag003
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