The accuracy of the CAGE, the Brief Michigan Alcoholism Screening Test, and the Alcohol Use Disorders Identification Test in screening trauma center patients for alcoholism.

R Adams Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore 21201-1595, USA.
The Journal of trauma (Impact Factor: 2.96). 12/1997; 43(6):962-9.
Source: PubMed


To evaluate the accuracy of questionnaire screening instruments to identify lifetime alcohol dependence among trauma center patients.
The study was conducted at a Level I trauma center between September 1994 and November 1996. Patients meeting eligibility requirements (> or = 18 years old, admission from injury scene, > or = 2 days of hospitalization, intact cognition) were evaluated for alcohol abuse and dependence. Screening instruments consisted of the CAGE, the Brief Michigan Alcoholism Screening Test, and the Alcohol Use Disorders Identification Test. Screening results were compared with lifetime alcohol dependence diagnoses made using the in-depth Psychoactive Substance Use Disorders section of the Structured Clinical Interview. Accuracy was quantified as sensitivity, specificity, positive/negative predictive values, and receiver operating characteristic curves (used to calculate area under the curve).
Of the 1,118 patients studied, lifetime alcohol dependence was diagnosed by Structured Clinical Interview in 397 (35.5%), and abuse was diagnosed in 90 (8.1%) others. The CAGE was the best predictor of lifetime alcohol dependence, i.e., had the largest area under the curve (93%) and the highest sensitivity (84%), specificity (90%), positive predictive value (82%), and negative predictive value (91%). Among patients testing positive for alcohol, 63% had a lifetime alcohol dependence diagnosis.
The CAGE is an efficient screening test to detect alcohol dependence in trauma center populations. It should be used in combination with alcohol testing to identify patients at risk of alcohol use problems.

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    • "Ethanol still remains the psychoactive substance most frequently identified in the blood of divers killed in RTA (5). Among a sample of 1,118 adult patients admitted to a trauma center in Baltimore, 44% met lifetime criteria for alcohol abuse or dependence and 32% met criteria for current alcohol abuse or dependence when assessed with a structured clinical interview exam (6). Opioids are other large groups of therapeutic drugs which are abused. "
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    ABSTRACT: Background: Motor vehicle collisions (MVC) comprise a majority cause of referral to the emergency department (ED). A large proportion of MVC appear to be preventable, if more effective measures against driving after substance abuse can be implemented. Objective: This study was aimed to investigate the prevalence of substance abuse among drivers of MVC, following road traffic accidents (RTA). Materials and Methods: This case-control research was conducted from July to October 2007. One hundred MVC drivers admitted in the ED were included as the case group and 110 hospitalized patients, due to nontraumatic causes were used as controls. History of substances abused was obtained and urine samples were tested for opium in both groups. Finally the history and laboratory results of the groups were compared using SPSS 18. Results: Of the 100 patients in the case group, 39 (39%) were positive for substance abuse (100% males). On the other hand, 49 (44.5%) patients in the control group had positive history or laboratory findings of substance abuse (73.9% male). Opioids were the most common agent abused in both groups. There was no significant difference between two groups regarding the prevalence of substance abuse (P = 0.92). Conclusions: The prevalence of substance abuse is high among victims of road traffic injury but in equal proportion to the control group. Health education and counseling is needed to reduce substance abuse in the general population although it was not significantly related to the cause of RTA.
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    • "The CAGE (cut down, annoyed, guilty, eye-opener) screener was used to ascertain alcohol abuse (Ewing, 1984). A score of 2 or more is considered positive for alcoholism (Soderstrom et al., 1997). Sensitivity and specificity range from 60% to 95% and 40 to 95%, respectively (Nilssen & Cone, 1994). "
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    ABSTRACT: Measurements of intimate partner violence (IPV) based on acts of violence have repeatedly found substantial bilateral violence between intimates. However, the context of this violence is not well defined by acts alone. The objective of this research was to compare differences in women and men within each IPV status category (victim, perpetrator, and both) with respect to levels of battering as defined by their scores on the Women's Experience With Battering Scale (WEB), which asks gender-neutral questions about the abuse of power and control and fear in an intimate relationship. In our study, women disclosed higher levels of battering on the WEB, despite IPV status (victimization or both victimization and perpetration). In addition, female IPV victims were 5 times more likely than their male counterparts to disclose high rates of battering on the WEB. Depressive symptoms, symptoms of posttraumatic stress disorder, African American race, and IPV victimization were independently associated with higher WEB scores.
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    • "Second, we identified high-risk drinkers in the CAGE and CAGE2 constructed variables as those respondents with positive responses to two or more of the individual items. Although this cutpoint has been used in many other studies and has performed well in identifying problem drinkers in various populations (Bush et al., 1987; Ewing, 1984; Mayfield et al., 1974; Smart et al., 1991; Soderstrom et al., 1997), some studies have suggested that at a traditional cutpoint of two, the CAGE performs less well in identifying problem drinking among women and among racial or ethnic minorities (Cherpitel, 1995; Cherpitel and Clark, 1995). Among the few studies evaluating the predictive utility of the CAGE in the context of the Army's HRA is a study by Fertig et al. (1993), who discovered that a single affirmative response to any of the four CAGE items was associated with high-risk self-reported drinking on the same survey. "
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    ABSTRACT: The reliability and validity of self-reported drinking behaviors from the Army Health Risk Appraisal (HRA) survey are unknown. We compared demographics and health experiences of those who completed the HRA with those who did not (1991-1998). We also evaluated the reliability and validity of eight HRA alcohol-related items, including the CAGE, weekly drinking quantity, and drinking and driving measures. We used Cohen's kappa and Pearson's r to assess reliability and convergent validity. To assess criterion (predictive) validity, we used proportional hazards and logistical regression models predicting alcohol-related hospitalizations and alcohol-related separations from the Army, respectively. A total of 404,966 soldiers completed an HRA. No particular demographic group seems to be over- or underrepresented. Although few respondents skipped alcohol items, those who did tended to be older and of minority race. The alcohol items demonstrate a reasonable degree of reliability, with Cronbach's alpha = 0.69 and test-retest reliability associations in the 0.75-0.80 range for most items over 2- to 30-day interims between surveys. The alcohol measures showed good criterion-related validity: those consuming more than 21 drinks per week were at 6 times the risk for subsequent alcohol-related hospitalization versus those who abstained from drinking (hazard ratio, 6.36; 95% confidence interval=5.79, 6.99). Those who said their friends worried about their drinking were almost 5 times more likely to be discharged due to alcoholism (risk ratio, 4.9; 95% confidence interval=4.00, 6.04) and 6 times more likely to experience an alcohol-related hospitalization (hazard ratio, 6.24; 95% confidence interval=5.74, 6.77). The Army's HRA alcohol items seem to elicit reliable and valid responses. Because HRAs contain identifiers, alcohol use can be linked with subsequent health and occupational outcomes, making the HRA a useful epidemiological research tool. Associations between perceived peer opinions of drinking and subsequent problems deserve further exploration.
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