Screening trauma patients with the alcohol use disorders identification test and biomarkers of alcohol use.
BACKGROUND
Alcohol screening and brief interventions have been shown to reduce alcohol-related morbidity in injured patients. Use of self-report questionnaires such as the Alcohol Use Disorder Identification Test (AUDIT) is recommended as the optimum screening method. We hypothesized that the accuracy of screening is enhanced by combined use of the AUDIT and biomarkers of alcohol use in injured patients.


METHODS
The study was conducted in the emergency department of a large, urban, university hospital. Patients were evaluated with the AUDIT, and blood sampled to determine carbohydrate-deficient transferrin, gamma-glutamyl-transferase, and mean corpuscular volume. Alcohol problems were defined as presence of ICD-10 criteria for dependence or harmful use, or high-risk drinking according to World Health Organization criteria (weekly intake >420 g in males, >280 g in females). Screening accuracy was determined using Receiver Operating Characteristic curves.


RESULTS
There were 787 males and 446 females in the study. Median age was 33 years. The accuracy of the AUDIT was good to excellent, whereas all biomarkers performed only fairly to poorly in males, and even worse in females. At a specificity >0.80, sensitivity for all biomarkers was <0.43, whereas sensitivity for the AUDIT was 0.76 for males and 0.81 for females. The addition of biomarkers added little additional discriminatory information compared to use of the AUDIT alone.


CONCLUSIONS
Screening properties of the AUDIT are superior to %CDT, MCV, and GGT for detection of alcohol problems in injured patients and are not clinically significantly enhanced by the use of biomarkers.
Neumann
Tim
T
Department of Anesthesiology and Intensive Care Medicine, Charité Universitätsmedizin Berlin, Charitéplatz 1, Berlin, Germany. tim.neumann@charite.de
Gentilello
Larry M
LM
Neuner
Bruno
B
Weiss-Gerlach
Edith
E
Schürmann
Hajo
H
Schröder
Torsten
T
Müller
Christian
C
Haas
Norbert P
NP
Spies
Claudia D
CD
D000328:Adult; D000437:Alcoholism / Q000097:blood* / Q000175:diagnosis*; D015415:Biomarkers / Q000097:blood; D004636:Emergency Service, Hospital; D004909:Erythrocyte Indices; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D012372:ROC Curve; D012680:Sensitivity and Specificity; D015813:Substance Abuse Detection / Q000379:methods*; D014168:Transferrin / Q000378:metabolism*; D014944:World Health Organization; D014947:Wounds and Injuries / Q000097:blood*; D005723:gamma-Glutamyltransferase / Q000097:blood*
D015415:Biomarkers; D014168:Transferrin; D005723:gamma-Glutamyltransferase