Instruments to Detect Alcohol and Other Drug Misuse in the Emergency Department: A Systematic Review
Abstract
CONTEXT: 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.
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The assessment battery included validated measures: the Alcohol Use Disorders Identification Test (AUDIT), the Diagnostic Inventory for Screening Children (DISC), a subset of the Reckless Behavior Questionnaire, the physical activity section of the Youth Risk Behavior Surveillance System (YRBSS), a Drug Use Questionnaire (DUQ), a 3-question screening tool proposed by Newton et al., the CRAFFT, the
“The assessment battery included the following validated measures: the Alcohol Use Disorders Identification Test (AUDIT), the Diagnostic Inventory for Screening Children (DISC), a subset of the Reckless Behavior Questionnaire, the physical activity section of the Youth Risk Behavior Surveillance System (YRBSS), a Drug Use Questionnaire (DUQ), a 3-question screening tool proposed by Newton et al,17”
From Association of Physical Activity, Sports, and Screen Time With Adolescent Behaviors in Youth Who Visit the Pediatric Emergency Department (2022) · cites this paper as [17]
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- Authors
- Newton, A. S., Gokiert, R., Mabood, N., Ata, N., Dong, K., Ali, S., Vandermeer, B., Tjosvold, L., Hartling, L., & Wild, T. C.
- Affiliations
- Women and Children’s Health Research Institute (CA)
- University of Alberta (CA)
- Departments of Pediatrics,
- Alberta Health Services (CA)
- ORCID
- Venue
- Pediatrics
- Publisher
- American Academy of Pediatrics (AAP)
- Published
- 2011-07-01
- Volume
- 128
- Issue
- 1
- Pages
- e180-e192
- ISSN
- 0031-4005 (ISSN-L)
- 1098-4275
- OpenAlex
- W2054168748
- Cited by
- 32
- References
- 54
- Citations by year
- 2024: 1 · 2022: 1 · 2021: 2 · 2020: 5 · 2019: 4 · 2017: 3 · 2016: 3 · 2015: 1 · 2014: 4 · 2013: 4 · 2012: 4
- FWCI
- 0.45
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- PEDIATRICS (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Canadian Institutes of Health Research (200805KRS)
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Keywords
- alcohol abuse, cannabis use disorder, substance use screening, emergency department, youth, adolescents, screening tool, diagnostic accuracy, brief intervention, alcoholism, psychometric properties
- MeSH terms
- Adolescent, Alcoholism, Child, Emergency Service, Hospital, Female, Humans, Male, Reproducibility of Results, Substance Abuse Detection, Substance-Related Disorders, Young Adult
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