Accuracy of one or two simple questions to identify alcohol-use disorder in primary care: a meta-analysis

Abstract

BackgroundThere is much interest in ultra-short alcohol screening in primary care that may support brief alcohol interventions. Brief screening consisting of one or two questions might be used alone or in combination with longer tests as recommended by the Primary Care Service Framework. AimTo investigate whether a simple one and two question screening might prove an accurate and acceptable screening method in primary care. Design and settingA systematic literature search, critical appraisal and meta-analysis were conducted. MethodA comprehensive search identified 61 analyses of single questions to detect alcohol problems including 17 that took place in primary care, using a robust interview standard. Despite focusing alcohol-use disorder in primary care settings, heterogeneity remained high, therefore random effects and bivariate meta-analyses were used. ResultsAfter adjustments, diagnostic accuracy of a single-question approach was given by a sensitivity of 54.5% (95% CI = 43.0% to 65.5%) and a specificity of 87.3% (95% CI = 81.5% to 91.5%) using meta-analytic weighting. Two questions had a sensitivity of 87.2% (95% CI = 69.9% to 97.7%) and specificity of 79.8% (95% CI = 75.7% to 83.6%). Looking at each question individually, the most successful single question was a modification of the Single Alcohol Screening Question (SASQ) namely, 'How often do you have six or more drinks on one occasion?'. The optimal approach appears to be two questions followed by the CAGE questionnaire, which achieved an overall accuracy of 90.9% and required only 3.3 questions per attendee. ConclusionTwo brief questions can be used as an initial screen for alcohol problems but only when combined with a second-step screen. A brief alcohol intervention should be considered in those individuals who answer positively on both steps. Keywordsalcohol; diagnostic accuracy; diagnostic validity; primary care; sensitivity; specificity.

Cribaje de trastornos por uso de alcohol en pacientes psiquiátricos ambulatorios: influencia de género, edad, y diagnóstico psiquiátrico

“…En la prueba diagnóstica, el punto de corte es un tema crítico, dado que afecta la sensibilidad y especificidad de la prueba. En general, la estimación de sensibilidad y especificidad del cuestionario CAGE es de 71% y 90%, respectivamente, para las poblaciones clínicas (Dhalla y Kopec, 2007;Mitchell et al, 2014). En pacientes con esquizofrenia, el punto de corte de 1 o más muestra una sensibilidad de 91% y una especificidad de 83% (Dervaux et al, 2006), con variaciones hasta 82% y 94%, respectivamente, con un punto de corte de 2.…”

“…La literatura apoya el uso de instrumentos de cribado para aumentar la detección temprana de TUA (Barnaby, Drummond, McCloud, Burns, y Omu, 2003;Fiellin, Reid, y O'Connor, 2000). El cuestionario CAGE es breve, sencillo de aplicar, y ampliamente usado como instrumento de cribado para detectar TUA en la población general (Baltieri y de Andrade, 2008;Curran, Gawley, Casey, Gill, y Crumlish, 2009) así como en muestras clínicas (Berks y McCormick, 2008;Fiellin et al, 2000;Lejoyeux et al, 2012;Mitchell, Bird, Rizzo, Hussain, y Meader, 2014) y psiquiátricas (Castells y Furlanetto, 2005;Derks, Vink, Willemsen, van den Brink, y Boomsma, 2014;Etter y Etter, 2004;Kim, Shin, Kim, y Lee, 2016;Lejoyeux et al, 2014;Malet, Schwan, Boussiron, Aublet-Cuvelier, y Llorca, 2005;Oe et al, 2016;Tang et al, 2016). También se ha utilizado para valorar pacientes geriátricos (Draper et al, 2015;León-Muñoz et al, 2015) y en estudios de género (de Oliveira, Kerr-Correa, Lima, Bertolote, y Santos, 2014).…”

“…Tiene estimaciones de sensibilidad de 71% y especificidad de 90% para poblaciones clínicas (Dhalla y Kopec, 2007;Mitchell et al, 2014). Ha sido validado en varios idiomas, incluyendo castellano (Rodríguez-Martos, 1986).…”

Tradução, adaptação cultural e validação da questão-chave para rastreamento do uso de risco de álcool para o português

“…A Single-Question (SQ) devido a sua praticidade de uso, ao baixo custo, à adequação para aplicabilidade a toda população, tem sido apontada atualmente Considerações sobre os instrumentos validados no Brasil... 38 como uma boa estratégia para rastreio ao uso de risco/nocivo de álcool nos serviços de APS (Mitchell et al, 2014).…”

“…Desse modo, em todo o mundo, estima-se que dentre todos os atendimentos feitos nos serviços de APS cerca de 7% a 20 % dos pacientes são de bebedores de uso de risco ou nocivo (Mitchell et al, 2014).…”