Is there a difference between CAGE interviews and written CAGE questionnaires?

Background: The CAGE questionnaire is a frequently studied and used instrum ent for screening of alcohol problems. It was developed and tested as a wri tten questionnaire, but, clinically, it is often used as an oral interview. No comparisons have been made between the results of a written and an oral CAGE. This study attempted to (1) compare the results of a written CAGE qu estionnaire and a CAGE interview, and (2) compare the efficiency of using a simple open-ended question about drinking habits before asking the CAGE an d asking the CAGE without an introduction. Methods: All patients who attended a general internal medicine, cardiology, or hepatology clinic were classified according to the week of the consulta tion, as follows: group I (week 1), patients completed a written CAGE and w ere subsequently interviewed during a normal consultation by a physician, w ho also asked the CAGE questions; group II (week 2), a physician first inte rviewed the patients, including the CAGE, and subsequently patients complet ed a written CAGE; and group III (week 3), patients completed a CAGE interv iew after an open-ended introduction ("What do you drink during the day?"). Kappa values were used to compare the answers of the written and oral CAGE interviews (groups II and I). Nonparametric ANOVA was used to compare the results of group III and the oral interview of group II. Results: Mean age was comparable between the groups, gender ratio was compa rable between groups I and III, but there were fewer males in group II. Com parison of all written CAGEs with the oral CAGEs in the same patients resul ted in an accuracy of 0.91 and a kappa value of 0.75 (95% CI, 0.66-0.84). N o significant difference could be found between the results of the oral CAG E with or without an open-ended introduction (p = 0.46). Conclusions: We found no difference between the oral and the written versio ns of the CAGE. This is important because most research results originate f rom written questionnaires. Our results do not support the finding that a d ifferent approach to the CAGE questions results in an increasing number of patients in which alcohol problems were detected.