Screening as a first step to intervention

CHERPITEL, C.; CREMONTE, M.; BORGES, G.

Lisboa, Portugal

Simposio; Reunión Anual del International Network for brief intervention (INEBRIA); 2006

INEBRIA International Network on Brief Interventions for Alcohol Problems

Screening as a First Step to Intervention: Comparison of Performance of Screening Instruments Among Emergency Department Patients in Argentina, Mexico and the U.S. Authors: Cherpitel, Cheryl J.; Cremonte, Mariana; Borges, Guilherme. ARGENTINA, MEXICO AND USA The association of alcohol consumption with both injury and non-injury problems presenting to the emergency department (ED) has been well-documented, and the ED has been identified as an important site for screening and brief intervention for those with alcohol-related problems.  Screening is a first step to intervention, but little is known about the performance of screening instruments for identifying alcohol use disorders in this setting, or the comparative performance of instruments across cultures.  The performance of a number of standard screening instruments (CAGE, brief MAST, AUDIT, TWEAK, RAPS4) for alcohol dependence (based on ICD-10 and DSM-IV criteria) was compared across emergency department samples in Argentina (n=643), Mexico (n=541) and the U.S. (California) (n=856).  The AUDIT and RAPS4 were both found to have highest sensitivity (.88 or above) at a reasonable level of specificity (above .80) across all three countries.  Performance of the CAGE was also good in the U.S., while performance of the TWEAK was good in Mexico and the U.S.  Performance of the brief MAST was uniformly poor across all countries.  None of the screening instruments performed as well for females as for the total sample.  Performance of the RAPS4 was better than other instruments for females across all three countries, followed by the TWEAK.  These data suggest that screening instruments may perform better in U.S. ED populations than in other countries, and that the RAPS4 may provide the best choice for consistently good performance for both males and females across countries and cultures.