Screening for alcohol problems in the emergency room: a rapid alcohol problems screen

Area of Science:

• Emergency Medicine
• Addiction Psychiatry
• Public Health Screening

Background:

• Early identification of alcohol use disorders is crucial for effective intervention.
• Existing screening tools vary in sensitivity and specificity across diverse patient populations.
• Emergency departments present a unique opportunity for alcohol problem screening.

Purpose of the Study:

• To compare the sensitivity and specificity of the five-item Rapid Alcohol Problems Screen (RAPS) against other established screening instruments.
• To evaluate the performance of RAPS across different demographic subgroups (gender, ethnicity, injury status).
• To assess RAPS's utility in identifying patients who could benefit from brief interventions for problem drinking.

Main Methods:

• A probability sample of 1330 emergency room patients at the University of Mississippi Medical Center was recruited.
• The Rapid Alcohol Problems Screen (RAPS) was compared with CAGE, brief MAST, AUDIT, TWEAK, History of Trauma Scale, and breathalyzer readings.
• Performance was assessed against ICD-10 criteria for alcohol dependence or harmful drinking.

Main Results:

• The RAPS demonstrated superior performance in the total sample (sensitivity 90%, specificity 78%) compared to all other instruments.
• RAPS consistently outperformed other single instruments across all evaluated demographic subgroups.
• The instrument's brevity and straightforward administration enhance its clinical applicability.

Conclusions:

• The Rapid Alcohol Problems Screen shows significant promise as an effective tool for identifying problem drinking in emergency settings.
• Its high sensitivity and specificity, coupled with ease of use, support its potential for routine clinical implementation.
• Further research is warranted to validate RAPS performance in diverse healthcare settings and patient demographics.