Screening for Alcohol Abuse Using CAGE Scores and Likelihood Ratios

Several recent studies have sought to elaborate upon the applicability and validity of respondent-driven sampling (RDS) to find hard-to-reach samples in general and men who have sex with men (MSM) in particular. Few published studies have elucidated the characteristics associated with initial RDS participants ("seeds") who successfully recruited others into a study. A total of 74 original seeds were analyzed from four Massachusetts studies conducted between 2006 and 2008 that used RDS to reach high-risk MSM. Seeds were considered "generative" if they recruited two or more subsequent participants and "non-generative" if they recruited zero or one participant. Overall, 34% of seeds were generative. In separate multivariable logistic regression models controlling for age, race, health insurance, HIV status, and the study for which the seed was enrolled, unprotected anal sex in the past 12 months [adjusted odds ratio (AOR)=6.68; 95% confidence interval (95% CI)=1.27-35.12; p=0.03], cocaine use during sex at least monthly during the past 12 months (AOR=8.81; 95% CI=1.68-46.27; p=0.01), and meeting sex partners at social gatherings (AOR=7.42; 95% CI= 1.58-34.76; p=0.01) and public cruising areas (AOR=4.92; 95% CI=1.27-19.01; p= 0.02) were each significantly associated with increased odds of being a generative seed. These findings have methodological and practical implications for the recruitment of MSM via RDS. Finding ways to identify RDS seeds that are consistently generative may facilitate collecting a sample that is closer to reflecting the MSM who live in all of the communities in a given location or study sample.

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“…35 Social Network Size. Participants were asked the total number of study-eligible men they had in their personal social and/or sexual network.…”

Section: Data Collection and Measuresmentioning

confidence: 99%

What Makes a Respondent-Driven Sampling “Seed” Productive? Example of Finding At-Risk Massachusetts Men Who Have Sex with Men

et al. 2010

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“…Other studies have subsequently assessed the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of CAGE as a screening tool for alcohol abuse/dependence 2,25,[26][27][28][29][30][31][32][33] . Positive predictive value is important clinically, as it gives information about those who have disease among those who are screened.…”

Section: Validitymentioning

confidence: 99%

The CAGE Questionnaire for Alcohol Misuse: A Review of Reliability and Validity Studies

Dhalla

Kopeć

2007

CIM

398

253

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Purpose: To review the reliability and validity of the CAGE questionnaire across different patient populations and discuss its role in the detection of alcohol-related problems. Methods: The Cochrane Database for Systematic Reviews, Medline, Embase, and Psychinfo were searched. No systematic reviews were found on the Cochrane Database. Search of the other databases yielded one systematic review and one meta-analysis, on different aspects of CAGE. Three articles on reliability and 16 on validity of CAGE were found and used. Studies generally yielded Level II evidence. Results: CAGE has demonstrated high test-retest reliability (0.80-0.95), and adequate correlations (0.48-0.70) with other screening instruments. The questionnaire is a valid tool for detecting alcohol abuse and dependence in medical and surgical inpatients, ambulatory medical patients, and psychiatric inpatients (average sensitivity 0.71, specificity 0.90). Its performance in primary care patients has been varied, while it has not performed well in white women, prenatal women, and college students. Furthermore, it is not an appropriate screening test for less severe forms of drinking. Conclusions: CAGE is short, feasible to use, and easily applied in clinical practice. However, users should be aware of its limitations when interpreting the results. A positive screen should be followed by a proper diagnostic evaluation using standard clinical criteria.

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“…Several tools have been used to screen different populations of patients for alcohol abuse, but the most commonly used is the CAGE questionnaire, which refers to lifetime occurrence of the following: Cutting down on drinking; Annoyance at others' concerns about drinking; feeling Guilty about drinking; and using alcohol as an Eye opener in the morning. Most authors use a CAGE cut score of 2 or more positive answers, as an indicator of alcohol dependency, which yields a sensitivity of 70 -96% and specificity of 91-99% (15,16). The predictive value will vary according to the prevalence of alcohol abuse in the population under scrutiny (higher in men and hospitalized patients) and it is therefore recommended that individual patient scores be interpreted based on their prior probability for alcohol abuse (15).…”

Section: It May Be Necessary To Perform a Liver Biopsy In Patients Wimentioning

confidence: 99%

“…Most authors use a CAGE cut score of 2 or more positive answers, as an indicator of alcohol dependency, which yields a sensitivity of 70 -96% and specificity of 91-99% (15,16). The predictive value will vary according to the prevalence of alcohol abuse in the population under scrutiny (higher in men and hospitalized patients) and it is therefore recommended that individual patient scores be interpreted based on their prior probability for alcohol abuse (15). The CAGE is easily administered by paramedical personnel or can be self-administered by the patient (17).…”

Section: It May Be Necessary To Perform a Liver Biopsy In Patients Wimentioning

confidence: 99%

Alcoholic liver disease: proposed recommendations for the American College of Gastroenterology

McCullough

1998

The American Journal of Gastroenterology

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PREAMBLEGuidelines for clinical practice are intended to suggest preferable approaches to particular medical problems as established by interpretation and collation of scientifically valid research, derived from extensive review of published literature. When data are not available that will withstand objective scrutiny, a recommendation may be made based on a consensus of experts. Guidelines are intended to apply to the clinical situation for all physicians without regard to specialty. Guidelines are intended to be flexible, not necessarily indicating the only acceptable approach, and should be distinguished from standards of care that are inflexible and rarely violated. Given the wide range of choices in any health care problem, the physician should select the course best suited to the individual patient and the clinical situation presented.These guidelines are developed under the auspices of the American College of Gastroenterology and its Practice Parameters Committee. These guidelines are also approved by the governing boards of the American Gastroenterological Association and the American Association for the Study of Liver Disease. Expert opinion is solicited from the outset for the document. Guidelines are reviewed in depth by the Committee, with participation from experienced clinicians and others in related fields. The final recommendations are based on the data available at the time of the production of the document and may be updated with pertinent scientific developments at a later time.Objective: The objective of this work was to develop practice guidelines for the management of alcoholic liver disease. Method: A computerized search using the Medline Data Base from 1966 -July 1997 was performed with the search headings; alcohol, alcoholic hepatitis, alcoholic liver disease, liver transplant, diagnosis, epidemiology, human, and English only. All randomized controlled trials, case-control studies, and meta-analyses were read in depth. A manual search was also done using references from each retrieved report, review articles, editorials, postgraduate course syllabi, and textbooks. In the subsequent review, evidence was evaluated using a hierarchical scale with randomized, controlled trials given the most importance. Abstracts presented at national meetings were included only when unique data were obtained from those studies. (Am J Gastroenterol 1998;93:2022-2036.

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Screening for Alcohol Abuse Using CAGE Scores and Likelihood Ratios

Abstract: Clinicians can improve their ability to estimate a patient's risk for an alcohol abuse or dependence disorder using likelihood ratios for CAGE scores.

Cited by 310 publications

References 27 publications

What Makes a Respondent-Driven Sampling “Seed” Productive? Example of Finding At-Risk Massachusetts Men Who Have Sex with Men

What Makes a Respondent-Driven Sampling “Seed” Productive? Example of Finding At-Risk Massachusetts Men Who Have Sex with Men

The CAGE Questionnaire for Alcohol Misuse: A Review of Reliability and Validity Studies

Alcoholic liver disease: proposed recommendations for the American College of Gastroenterology

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