THE ACCURACY OF THE CAGE, THE BRIEF MICHIGAN ALCOHOLISM SCREENING-TEST, AND THE ALCOHOL-USE DISORDERS IDENTIFICATION TEST IN SCREENING TRAUMA CENTER PATIENTS FOR ALCOHOLISM

Objective: To evaluate the accuracy of questionnaire screening instrum ents to identify lifetime alcohol dependence among trauma center patie nts, Methods: The study was conducted at a Level I trauma center betwe en September 1994 and November 1996, Patients meeting eligibility requ irements (greater than or equal to 18 years old, admission from injury scene, greater than or equal to 2 days of hospitalization, intact cog nition) were evaluated for alcohol abuse and dependence. Screening ins truments consisted of the CAGE, the Brief Michigan Alcoholism Screenin g Test, and the Alcohol Use Disorders Identification Test, Screening r esults were compared with lifetime alcohol dependence diagnoses made u sing the in-depth Psychoactive Substance Use Disorders section of the Structured Clinical Interview. Accuracy was quantified as sensitivity, specificity, positive/negative predictive values, and receiver operat ing characteristic curves (used to calculate area under the curve), Re sults: Of the 1,118 patients studied, lifetime alcohol dependence was diagnosed by Structured Clinical Interview in 397 (35.5%), and abuse w as diagnosed in 90 (8.1%) others, The CAGE,vas the best predictor of l ifetime alcohol dependence, i.e., had the largest area under the curve (93%) and the highest sensitivity (84%), specificity (90%), positive predictive value (82%), and negative predictive value (91%), Among pat ients testing positive for alcohol, 63% had a lifetime alcohol depende nce diagnosis, Conclusion: The CAGE is an efficient screening test to detect alcohol dependence in trauma center populations, It should be u sed in combination with alcohol testing to identify patients at risk o f alcohol use problems.