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

Reed, Donald N. Jr MD, FACS; Saxe, Andrew MD, FACS; Montanez, Marcel MA; Kotlowski, Rebecca PsyD; Brancheau, Daniel A. BA; Coffey, D Chris MD; Pollard, Mischa MD; Fitzgerald, Hiram PhD; Barber, Kimberly PhD; Wolf, Barbara PhD

The Journal of Trauma: Injury, Infection, and Critical Care: September 2005 - Volume 59 - Issue 3 - p 619-623
doi: 10.1097/01.ta.0000177673.99844.57
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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.

From the Departments of Surgery (D.N.R., A.S., D.C.C.), Family Practice (R.K., P.M., B.W.), and Psychology (M.M., H.F.), Michigan State University College of Human Medicine, East Lansing, and the Divisions of Trauma (A.S., M.M., D.A.B., H.F.), Research (K.B.), and Family Practice (B.W.), McLaren Regional Medical Center, Flint, Michigan.

Submitted for publication April 30, 2004.

Accepted for publication June 17, 2005.

Address for reprints: Donald N. Reed, Jr., MD, FACS, Department of Surgery, Michigan State University, Sparrow Professional Bldg., Suite 655, 1200 East Michigan Avenue, Lansing, MI 18912; email: donald.reed@hc.msu.edu.

© 2005 Lippincott Williams & Wilkins, Inc.