Association of the CAGE Questionnaire for Alcohol and Substance Misuse With Burn Patient Demographics and Outcomes

The burden of alcohol and substance use disorder is disproportionately high among patients with burn injuries and portends worse clinical outcomes. The Cut down, Annoyed, Guilty, and Eye-opener (CAGE) questionnaire is a validated 4-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 patients with burn injuries 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).