Screening instruments to detect problematic alcohol use among adults in hospitals and their diagnostic test accuracy: A systematic review.

Issues: Alcohol consumption can cause physical, psychological and social problems that can result in hospitalisations. Screening in hospitals helps to determine which patients should be given interventions. In this review, we aimed to summarise the diagnostic test accuracy (DTA) of screening instruments for problematic alcohol use among adults in hospitals.

Approach: We searched three databases for studies that assessed validated screening instruments for problematic alcohol use among hospitalised adults. We used the Quality Assessment of Diagnostic Accuracy Studies 2 tool to evaluate the risk of bias.

Key findings: We included 20 studies in the review. In 11 studies performed in the emergency departments, 5 instruments had a high DTA: the AUDIT, the AUDIT-C, the RAPS4-QF, the 2-question screener and HOLD 5. In the eight studies with inpatients, three instruments had a high DTA: the AUDIT, CAGE-C and CAGE +10 items. Finally, only one of the included studies evaluated outpatients; the authors reported a high DTA for the AUDIT-C.

Implication and conclusions: The results indicate that the AUDIT is an appropriate screening instrument for both inpatients and patients in the emergency department. Moreover, for patients in the emergency department, the AUDIT-C and the RAPS4-QF can be used. More research is needed on outpatients, and several screening instruments have only been validated with one study (i.e., the 2-question screener, DSM-IV-2, HOLD 5, CAGE-C and CAGE +10 questions).