title: Instruments to detect alcohol and other drug misuse in the emergency department: a systematic review.
abstract: BACKGROUND
  Alcohol and other drug (AOD) misuse by youth is a significant public health concern. Unanticipated treatment for AOD-related morbidities is often sought in hospital emergency departments (EDs). Screening instruments that rapidly identify patients who require further diagnostic evaluation and/or brief intervention are critically important.
  
  
  OBJECTIVE
  To summarize evidence on screening instruments that can assist emergency care clinicians in identifying AOD misuse in pediatric patients.
  
  
  METHODS
  Fourteen electronic databases (including Medline, Embase, and PsycINFO) and reference screening were used. Psychometric and prospective diagnostic studies were selected if the instrument focused on detecting AOD misuse in patients aged 21 years or younger in the ED. Two reviewers independently assessed quality and extracted data. Validity and reliability data were collected for psychometric studies. Instrument performance was assessed by using sensitivity, specificity, and positive (LR(+)) and negative (LR(-)) likelihood ratios. Meta-analysis was not possible because of clinical and measurement heterogeneity.
  
  
  RESULTS
  Of the 1545 references initially identified, 6 studies met inclusion criteria; these studies evaluated 11 instruments for universal or targeted screening of alcohol misuse. Instruments based on diagnostic criteria for AOD disorders were effective in detecting alcohol abuse and dependence (sensitivity: 0.88; specificity: 0.90; LR(+): 8.80) and cannabis use disorder (sensitivity: 0.96; specificity: 0.86; LR(+): 6.83).
  
  
  CONCLUSIONS
  On the basis of the current evidence, we recommend that emergency care clinicians use a 2-question instrument for detecting youth alcohol misuse and a 1-question instrument for detecting cannabis misuse. Additional research is required to definitively answer whether these tools should be used as targeted or universal screening approaches in the ED.
authors.affiliation: Department of Pediatrics, Faculty of Medicine and Dentistry, 8213 Aberhart Centre One, 11402 University Ave, Edmonton, Alberta, Canada T6G 2J3. mandi.newton@ualberta.ca
authors.forename: Amanda S
authors.initials: AS
authors.lastname: Newton
authors.forename: Rebecca
authors.initials: R
authors.lastname: Gokiert
authors.forename: Neelam
authors.initials: N
authors.lastname: Mabood
authors.forename: Nicole
authors.initials: N
authors.lastname: Ata
authors.forename: Kathryn
authors.initials: K
authors.lastname: Dong
authors.forename: Samina
authors.initials: S
authors.lastname: Ali
authors.forename: Ben
authors.initials: B
authors.lastname: Vandermeer
authors.forename: Lisa
authors.initials: L
authors.lastname: Tjosvold
authors.forename: Lisa
authors.initials: L
authors.lastname: Hartling
authors.forename: T Cameron
authors.initials: TC
authors.lastname: Wild
mesh_terms: D000293:Adolescent; D000437:Alcoholism / Q000175:diagnosis*; D002648:Child; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D015203:Reproducibility of Results; D015813:Substance Abuse Detection / Q000379:methods*; D019966:Substance-Related Disorders / Q000175:diagnosis*; D055815:Young Adult