ANALYSIS OF CUT POINTS FOR SCREENING INSTRUMENTS FOR ALCOHOL-PROBLEMSIN THE EMERGENCY ROOM

Objective: The purpose of this study is to evaluate the performance of a number of alcohol screening instruments (CAGE, Brief MAST, AUDIT, T WEAK), in an emergency room population, against ICD-10 criteria for ha rmful drinking and for alcohol dependence from the CIDI, by gender, ra ce and injury status. Method: A probability sample of patients were in terviewed (N = 1,330) at the University of Mississippi Medical Center. Analyses were carried out on only current drinkers (n = 771; 58% of t he sample). Instruments were compared on sensitivity, specificity and area under the curve using receiver operating characteristic (ROC) ana lysis to determine optimum cut points. Results: Overall the TWEAK and AUDIT performed best (in relation to sensitivity and area under the RO C curve) at standard cut points (3 and 8, respectively) for both harmf ul drinking and alcohol dependence. These instruments did not perform equally well across all subgroups, however, particularly among women, and among whites where the CAGE, with a cut point of 1, outperformed b oth the TWEAK and AUDIT at standard cut points. The TWEAK at a cut poi nt of 2 also did as well as the CAGE at a cut point of 1 among women. Conclusion: These data suggest that standard screening instruments do not perform equally well across ethnic and gender subgroups and that c onsideration of alternative cut points may be appropriate in some popu lations.