Screening Tools May Detect Youth Alcohol and Cannabis Misuse

Laurie Barclay, MD

June 09, 2011

June 9, 2011 — Emergency department clinicians should use a 2-question instrument to detect youth alcohol misuse and a 1-question instrument to detect cannabis misuse, according to the results of a systematic review reported online June 6 in Pediatrics.

"Alcohol and other drug (AOD) misuse by youth is a significant public health concern," write Amanda S. Newton, PhD, RN, from the Department of Pediatrics, Faculty of Medicine and Dentistry at the University of Alberta in Edmonton, Canada, and colleagues. "Unanticipated treatment for AOD-related morbidities is often sought in hospital emergency departments (EDs). Screening instruments that rapidly identify patients who require further diagnostic evaluation and/or brief intervention are critically important."

The goal of the study was to summarize evidence on screening tools that may help emergency care clinicians to detect alcohol and other drug misuse in pediatric patients, using a search of 14 electronic databases including MEDLINE, EMBASE, and PsycINFO, as well as reference screening. Inclusion criteria for the review were psychometric and prospective diagnostic studies of instruments to identify alcohol and other drug misuse in patients 21 years or younger who were seen in the emergency department.

Two reviewers independently evaluated methodologic quality and extracted pertinent data, including validity and reliability data for psychometric studies. Sensitivity, specificity, and positive and negative likelihood ratios were used to measure instrument performance. Because of clinical and measurement heterogeneity, meta-analysis could not be conducted.

Of 1545 articles initially identified, only 6 studies, which assessed 11 instruments for universal or targeted screening of alcohol misuse, met inclusion criteria. For detection of alcohol abuse and dependence, instruments based on diagnostic criteria for alcohol and other drug disorders had an 88% sensitivity, 90% specificity, and a positive likelihood ratio of 8.80. For detection of cannabis use disorder, the sensitivity was 96%, specificity was 86%, and positive likelihood ratio was 6.83.

Limitations of this study include heterogeneity in instrument evaluation across the studies, failure of psychometric studies to examine interrater reliability, lack of blinding during data interpretation in diagnostic studies, and an unclear independence between the reference standard and the instrument being evaluated.

"On the basis of the current evidence, we recommend that emergency care clinicians use a 2-question instrument for detecting youth alcohol misuse and a 1-question instrument for detecting cannabis misuse," the study authors write. "Additional research is required to definitively answer whether these tools should be used as targeted or universal screening approaches in the ED."

Funding for this project was provided by a Knowledge Synthesis grant awarded from the Canadian Institutes of Health Research (CIHR). Dr. Newton holds a CIHR Career Development Award from the Canadian Child Health Clinician Scientist Program in partnership with the Sick-Kids Foundation, Child & Family Research Institute (British Columbia), Women & Children's Health Research Institute (Alberta), Manitoba Institute of Child Health. Another study author (T. Cameron Wild, PhD) is a Health Scholar with Alberta Innovates-Health Solutions. The remaining study authors have disclosed no relevant financial relationships.

Pediatrics. Published online June 6, 2011. Abstract

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