Screening for harmful substance use in emergency departments: a systematic review

dc.contributor.authorMoe, Jessica
dc.contributor.authorKoh, Justin
dc.contributor.authorMa, Jennifer A.
dc.contributor.authorPei, Lulu X.
dc.contributor.authorMacLean, Eleanor
dc.contributor.authorKeech, James
dc.contributor.authorMaguire, Kaitlyn
dc.contributor.authorRonsley, Claire
dc.contributor.authorDoyle-Waters, Mary M.
dc.contributor.authorBrubacher, Jeffrey R.
dc.date.accessioned2024-05-08T15:18:08Z
dc.date.available2024-05-08T15:18:08Z
dc.date.issued2024-04-08
dc.date.updated2024-05-01T16:16:10Z
dc.description.abstractBackground 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.
dc.identifier.citationInternational Journal of Emergency Medicine. 2024 Apr 08;17(1):52
dc.identifier.doi10.1186/s12245-024-00616-2
dc.identifier.urihttp://hdl.handle.net/1993/38208
dc.language.isoeng
dc.language.rfc3066en
dc.publisherBMC
dc.rightsopen accessen_US
dc.rights.holderThe Author(s)
dc.subjectSubstance‑related disorders
dc.subjectDrug abuse screening
dc.subjectEmergency
dc.subjectDepartments
dc.subjectPublic health
dc.titleScreening for harmful substance use in emergency departments: a systematic review
dc.typeJournal Article
local.author.affiliationRady Faculty of Health Sciences::Max Rady College of Medicine::Department of Emergency Medicine
oaire.citation.issue52
oaire.citation.titleInternational Journal of Emergency Medicine
oaire.citation.volume17
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