Screening for harmful substance use in emergency departments: a systematic review
Abstract Background Substance use-related emergency department (ED) visits have increased substantially in North America. Screening for substance use in EDs is recommended; best approaches are unclear. This systematic review synthesizes evidence on diagnostic accuracy of ED screening tools to detect...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2024-04-01
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| Series: | International Journal of Emergency Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12245-024-00616-2 |
| _version_ | 1797209587223363584 |
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| author | Jessica Moe Justin Koh Jennifer A. Ma Lulu X. Pei Eleanor MacLean James Keech Kaitlyn Maguire Claire Ronsley Mary M. Doyle-Waters Jeffrey R. Brubacher |
| author_facet | Jessica Moe Justin Koh Jennifer A. Ma Lulu X. Pei Eleanor MacLean James Keech Kaitlyn Maguire Claire Ronsley Mary M. Doyle-Waters Jeffrey R. Brubacher |
| author_sort | Jessica Moe |
| collection | DOAJ |
| description | Abstract Background Substance use-related emergency department (ED) visits have increased substantially in North America. Screening for substance use in EDs is recommended; best approaches are unclear. This systematic review synthesizes evidence on diagnostic accuracy of ED screening tools to detect harmful substance use. Methods We included derivation or validation studies, with or without comparator, that included adult (≥ 18 years) ED patients and evaluated screening tools to identify general or specific substance use disorders or harmful use. Our search strategy combined concepts Emergency Department AND Screening AND Substance Use. Trained reviewers assessed title/abstracts and full-text articles for inclusion, extracted data, and assessed risk of bias (QUADAS-2) independently and in duplicate. Reviewers resolved disagreements by discussion. Primary investigators adjudicated if necessary. Heterogeneity precluded meta-analysis. We descriptively summarized results. Results Our search strategy yielded 2696 studies; we included 33. Twenty-one (64%) evaluated a North American population. Fourteen (42%) applied screening among general ED patients. Screening tools were administered by research staff (n = 21), self-administered by patients (n = 10), or non-research healthcare providers (n = 1). Most studies evaluated alcohol use screens (n = 26), most commonly the Alcohol Use Disorders Identification Test (AUDIT; n = 14), Cut down/Annoyed/Guilty/Eye-opener (CAGE; n = 13), and Rapid Alcohol Problems Screen (RAPS/RAPS4/RAPS4-QF; n = 12). Four studies assessing six tools and screening thresholds for alcohol abuse/dependence in North American patients (AUDIT ≥ 8; CAGE ≥ 2; Diagnostic and Statistical Manual of Mental Disorders, 4th Edition [DSM-IV-2] ≥ 1; RAPS ≥ 1; National Institute on Alcohol Abuse and Alcoholism [NIAAA]; Tolerance/Worry/Eye-opener/Amnesia/K-Cut down [TWEAK] ≥ 3) reported both sensitivities and specificities ≥ 83%. Two studies evaluating a single alcohol screening question (SASQ) (When was the last time you had more than X drinks in 1 day?, X = 4 for women; X = 5 for men) reported sensitivities 82–85% and specificities 70–77%. Five evaluated screening tools for general substance abuse/dependence (Relax/Alone/Friends/Family/Trouble [RAFFT] ≥ 3, Drug Abuse Screening Test [DAST] ≥ 4, single drug screening question, Alcohol, Smoking and Substance Involvement Screening Test [ASSIST] ≥ 42/18), reporting sensitivities 64%-90% and specificities 61%-100%. Studies’ risk of bias were mostly high or uncertain. Conclusions Six screening tools demonstrated both sensitivities and specificities ≥ 83% for detecting alcohol abuse/dependence in EDs. Tools with the highest sensitivities (AUDIT ≥ 8; RAPS ≥ 1) and that prioritize simplicity and efficiency (SASQ) should be prioritized. |
| first_indexed | 2024-04-24T09:57:04Z |
| format | Article |
| id | doaj.art-dcc9dc97878c4d55a46476aef81f9d61 |
| institution | Directory Open Access Journal |
| issn | 1865-1380 |
| language | English |
| last_indexed | 2024-04-24T09:57:04Z |
| publishDate | 2024-04-01 |
| publisher | BMC |
| record_format | Article |
| series | International Journal of Emergency Medicine |
| spelling | doaj.art-dcc9dc97878c4d55a46476aef81f9d612024-04-14T11:07:05ZengBMCInternational Journal of Emergency Medicine1865-13802024-04-0117112810.1186/s12245-024-00616-2Screening for harmful substance use in emergency departments: a systematic reviewJessica Moe0Justin Koh1Jennifer A. Ma2Lulu X. Pei3Eleanor MacLean4James Keech5Kaitlyn Maguire6Claire Ronsley7Mary M. Doyle-Waters8Jeffrey R. Brubacher9Department of Emergency Medicine, University of British ColumbiaDepartment of Emergency Medicine, Queen’s UniversityDepartment of Emergency Medicine, University of ManitobaDepartment of Emergency Medicine, University of British ColumbiaDepartment of Emergency Medicine, University of British ColumbiaSchool of Medicine, Queen’s UniversityDepartment of Emergency Medicine, University of British ColumbiaDepartment of Emergency Medicine, University of British ColumbiaCentre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research InstituteDepartment of Emergency Medicine, University of British ColumbiaAbstract Background Substance use-related emergency department (ED) visits have increased substantially in North America. Screening for substance use in EDs is recommended; best approaches are unclear. This systematic review synthesizes evidence on diagnostic accuracy of ED screening tools to detect harmful substance use. Methods We included derivation or validation studies, with or without comparator, that included adult (≥ 18 years) ED patients and evaluated screening tools to identify general or specific substance use disorders or harmful use. Our search strategy combined concepts Emergency Department AND Screening AND Substance Use. Trained reviewers assessed title/abstracts and full-text articles for inclusion, extracted data, and assessed risk of bias (QUADAS-2) independently and in duplicate. Reviewers resolved disagreements by discussion. Primary investigators adjudicated if necessary. Heterogeneity precluded meta-analysis. We descriptively summarized results. Results Our search strategy yielded 2696 studies; we included 33. Twenty-one (64%) evaluated a North American population. Fourteen (42%) applied screening among general ED patients. Screening tools were administered by research staff (n = 21), self-administered by patients (n = 10), or non-research healthcare providers (n = 1). Most studies evaluated alcohol use screens (n = 26), most commonly the Alcohol Use Disorders Identification Test (AUDIT; n = 14), Cut down/Annoyed/Guilty/Eye-opener (CAGE; n = 13), and Rapid Alcohol Problems Screen (RAPS/RAPS4/RAPS4-QF; n = 12). Four studies assessing six tools and screening thresholds for alcohol abuse/dependence in North American patients (AUDIT ≥ 8; CAGE ≥ 2; Diagnostic and Statistical Manual of Mental Disorders, 4th Edition [DSM-IV-2] ≥ 1; RAPS ≥ 1; National Institute on Alcohol Abuse and Alcoholism [NIAAA]; Tolerance/Worry/Eye-opener/Amnesia/K-Cut down [TWEAK] ≥ 3) reported both sensitivities and specificities ≥ 83%. Two studies evaluating a single alcohol screening question (SASQ) (When was the last time you had more than X drinks in 1 day?, X = 4 for women; X = 5 for men) reported sensitivities 82–85% and specificities 70–77%. Five evaluated screening tools for general substance abuse/dependence (Relax/Alone/Friends/Family/Trouble [RAFFT] ≥ 3, Drug Abuse Screening Test [DAST] ≥ 4, single drug screening question, Alcohol, Smoking and Substance Involvement Screening Test [ASSIST] ≥ 42/18), reporting sensitivities 64%-90% and specificities 61%-100%. Studies’ risk of bias were mostly high or uncertain. Conclusions Six screening tools demonstrated both sensitivities and specificities ≥ 83% for detecting alcohol abuse/dependence in EDs. Tools with the highest sensitivities (AUDIT ≥ 8; RAPS ≥ 1) and that prioritize simplicity and efficiency (SASQ) should be prioritized.https://doi.org/10.1186/s12245-024-00616-2Substance-related disordersDrug abuse screeningEmergencyDepartmentsPublic health |
| spellingShingle | Jessica Moe Justin Koh Jennifer A. Ma Lulu X. Pei Eleanor MacLean James Keech Kaitlyn Maguire Claire Ronsley Mary M. Doyle-Waters Jeffrey R. Brubacher Screening for harmful substance use in emergency departments: a systematic review International Journal of Emergency Medicine Substance-related disorders Drug abuse screening Emergency Departments Public health |
| title | Screening for harmful substance use in emergency departments: a systematic review |
| title_full | Screening for harmful substance use in emergency departments: a systematic review |
| title_fullStr | Screening for harmful substance use in emergency departments: a systematic review |
| title_full_unstemmed | Screening for harmful substance use in emergency departments: a systematic review |
| title_short | Screening for harmful substance use in emergency departments: a systematic review |
| title_sort | screening for harmful substance use in emergency departments a systematic review |
| topic | Substance-related disorders Drug abuse screening Emergency Departments Public health |
| url | https://doi.org/10.1186/s12245-024-00616-2 |
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