Cj. Cherpitel, ANALYSIS OF CUT POINTS FOR SCREENING INSTRUMENTS FOR ALCOHOL-PROBLEMSIN THE EMERGENCY ROOM, Journal of studies on alcohol, 56(6), 1995, pp. 695-700
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.