Comparing the effectiveness of TWEAK and T-ACE in determining problem drinkers in pregnancy.
OBJECTIVE
The TWEAK and T-ACE screening tools are validated methods of identifying problem drinking in a pregnant population. The objective of this study was to compare the effectiveness of the TWEAK and T-ACE screening tools in identifying problem drinking using traditional cut-points (CP).


METHODS
Study participants consisted of women calling the Motherisk Alcohol Helpline for information regarding their alcohol use in pregnancy. In this cohort, concerns surrounding underreporting are not likely as women self-report their alcohol consumption. Participant's self-identification, confirmed by her amount of alcohol use, determined whether she was a problem drinker or not. The TWEAK and T-ACE tools were administered on both groups and subsequent analysis was done to determine if one tool was more effective in predicting problem drinking.


RESULTS
The study consisted of 75 problem and 100 non-problem drinkers. Using traditional CP, the TWEAK and T-ACE tools both performed similarly at identifying potential at-risk women (positive predictive value = 0.54), with very high sensitivity rates (100-99% and 100-93%, respectively) but poor specificity rates (36-43% and 19-34%, respectively). Upon comparison, there was no statistical difference in the effectiveness for one test performing better than next using either CP of 2 (P = 0.66) or CP of 3 (P = 0.38).


CONCLUSIONS
Despite the lack of difference in performance, improved specificity associated with TWEAK suggests that it may be better suited to screen at-risk populations seeking advice from a helpline.
Sarkar
M
M
Division of Clinical Pharmacology and Fetal Toxicology, Hospital for Sick Children, Toronto, Canada. tsarkar@yahoo.com
Einarson
T
T
Koren
G
G
D000437:Alcoholism / Q000150:complications / Q000175:diagnosis*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis*; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires