Use of a Single Question to Screen Trauma Patients for Alcohol Dependence

• Published in: The Journal of trauma, injury, infection, and critical care Vol. 59; no. 3; pp. 619 - 623
• Main Authors: Reed, Donald N., Saxe, Andrew, Montanez, Marcel, Kotlowski, Rebecca, Brancheau, Daniel A., Coffey, D Chris, Pollard, Mischa, Fitzgerald, Hiram, Barber, Kimberly, Wolf, Barbara
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins, Inc 01-09-2005; Lippincott Williams & Wilkins
• Subjects: Alcoholic Intoxication - complications; Alcoholism - prevention & control; Alcoholism and acute alcohol poisoning; Biological and medical sciences; Diseases of the osteoarticular system; Emergency Service, Hospital; Female; Humans; Injuries of the limb. Injuries of the spine; Male; Mass Screening; Medical sciences; Michigan; Predictive Value of Tests; Prospective Studies; Psychological Tests; Sensitivity and Specificity; Toxicology; Traumas. Diseases due to physical agents; Wounds and Injuries - complications; Michigan; Human; Statistical analysis; Prognosis; Questionnaire; Instruments; Alcohol abuse; Alcoholism; Mortality; Recidivism; Alcohol; Drinking; Identification; Medical screening; Epidemiology; Case history; Trauma; Blood; Audit; Risk factor; Adult; Female; Behavior; Woman; Alcohol Use Disorders Identification Test (AUDIT)
• ISSN: 0022-5282; 1529-8809
• DOI: 10.1097/01.ta.0000177673.99844.57

BACKGROUND:Alcohol-dependent trauma patients are known to be at future risk for both recidivism and mortality. Psychological tools exist to screen for alcohol-dependent disorders, and among patients with alcohol-dependent disorders, a brief intervention has been shown to modify behavior. However, the training involved and time required to administer these tools may decrease their utility. We explored the possibility that yet simpler screening tools could be used.
METHODS:A prospective consecutive study was designed whereby all adult patients admitted to the trauma service were asked to participate in the study. If consent was obtained, one trained member of the research team would apply a standard alcohol-misuse screening tool (i.e., the Alcohol Use Disorders Identification Test [AUDIT]). One hundred forty-nine patients met criteria and agreed to participate. Fully completed questionnaires were then subjected to statistical analysis.
RESULTS:Among the 149 participating patients, 36% were women and 64% were men, and 146 had blood alcohol levels (BALs) drawn. Those 146 patients form the basis of this report. Fifty-seven of the 146 (39%) patients had positive BALs and, among them, 74% of men and 54% of women recorded screening results consistent with harmful or dependent drinking. Among those with negative blood alcohol levels, 8% of women and 13% of men had scores consistent with harmful or dependent drinking by the AUDIT score. In both groups of patients, a cutoff of three or more drinks per day as a response to question 2 on the AUDIT (i.e., “On a typical day when you are drinking, how many drinks do you have?”) correlated strongly with scores on the entire screening tool (AUDIT) in identifying those at risk for alcohol misuse.
CONCLUSION:It may be reasonable to substitute a single question for the entire AUDIT screening instrument to screen for those at risk for alcohol misuse. If so, this single question could easily be incorporated into the history taken among patients admitted to a trauma service. Confirmation with a larger study is recommended.