The best alcohol screening instrument to use in emergency departments

Restraint is used widely in inpatient mental health settings both in the UK and internationally, but is linked with multiple adverse outcomes.

Screening for alcohol misuse in the emergency department needs to be done quickly and accurately, so it makes sense to find the best instrument for this purpose.

This systematic review of diagnostic cohort studies searched a range of databases and journals and also conducted citation searching because of a lack of relevant literature found by the initial search.

In the end, the authors found 7 studies worth including in the review, which covered the following alcohol screening tools:

  • The FAST alcohol screening tool (FAST)
  • The Paddington Alcohol Test (PAT, PDF)
  • The Rapid Alcohol Problem Screen (RAPS-4)
  • The TWEAK test (where TWEAK is an acronym: tolerance, worried, eye-opener, amnesia, K (cut-down)).

The review found that:

  • The FAST tool was the most sensitive (93-94%), with a specificity of 86-88% and a positive predicted value of 86-87%, so may be best for accurately identifying alcohol misuse within emergency department patients
  • However, FAST is a universal screening tool which requires time and money to be used effectively, and these attributes are not always available in busy A&E departments
  • In contrast, the PAT has been developed to be used on a select population within the emergency department and has already been shown to be cost-effective

The limited number of studies included in this review begs a question about the inclusion criteria used by the researcher. Is the emergency department so different from other settings that the reviewers should limit their search to articles set in emergency departments?

Jones LA. Systematic review of alcohol screening tools for use in the emergency department. Emerg Med J. 2011 Mar;28(3):182-91. Epub 2010 Oct 14. [PubMed abstract]

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Andre Tomlin

André Tomlin is an Information Scientist with 20 years experience working in evidence-based healthcare. He's worked in the NHS, for Oxford University and since 2002 as Managing Director of Minervation Ltd, a consultancy company who do clever digital stuff for charities, universities and the public sector. Most recently André has been the driving force behind the Mental Elf and the National Elf Service; an innovative digital platform that helps professionals keep up to date with simple, clear and engaging summaries of evidence-based research. André is a Trustee at the Centre for Mental Health and an Honorary Research Fellow at University College London Division of Psychiatry. He lives in Bristol, surrounded by dogs, elflings and lots of woodland!

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