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Screening for alcohol problems in the emergency department

C J Cherpitel1

  • 1Western Consortium for Public Health, Alcohol Research Group, Berkeley, California, USA.

Annals of Emergency Medicine
|August 1, 1995
PubMed
Summary

The AUDIT and TWEAK screening tools effectively identified alcohol dependence in emergency department patients. However, their accuracy varied by gender, race, and injury status, indicating a need for tailored approaches.

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Area of Science:

  • Emergency medicine
  • Addiction psychiatry
  • Diagnostic test evaluation

Background:

  • Alcohol screening is crucial in emergency departments.
  • Existing screening instruments may have variable performance across different patient demographics.

Purpose of the Study:

  • To assess the sensitivity and specificity of multiple alcohol screening tools.
  • To compare these instruments against ICD-10 criteria for harmful drinking and alcohol dependence.
  • To analyze performance variations based on gender, race, and injury status.

Main Methods:

  • A probability sample of 1,330 emergency department patients was recruited.
  • Patients underwent breath alcohol analysis and were interviewed using various screening instruments.
  • Diagnostic criteria from the Composite International Diagnostic Interview (CIDI) and ICD-10 were used as a reference standard.

Main Results:

  • The TWEAK and AUDIT instruments demonstrated the highest sensitivity for detecting alcohol dependence (84% and 81%, respectively).
  • Sensitivity was lower for females, white patients, and those without injuries.
  • Breath alcohol analysis and self-reported pre-event drinking showed low sensitivity (20% and 29%).

Conclusions:

  • The efficacy of alcohol screening tools is influenced by patient demographics and injury status.
  • Breath alcohol readings and self-reported drinking are unreliable indicators of alcohol dependence in this ED population.

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