Gates Trina, Duffy Kristina, Moore Jeffrey, Howell William, McDonald William
Naval Aerospace Medicine Institute, Naval Air Station, Pensacola, FL, USA.
Aviat Space Environ Med. 2007 Jan;78(1):48-51.
Alcohol-related disorders are the most prevalent psychiatric conditions in the aviation population. Efforts to effectively screen aviators for these disorders are continually sought, as underdiagnosis may negatively impact aviation safety. This study evaluates screening tools that have been validated in non-aviators in terms of their utility for aviator patients.
There were 111 male aviation patients (27 +/- 7 yr) referred for psychiatric evaluation at the Naval Aerospace Medicine Institute who completed the Self-Administered Alcohol Screening Test (SAAST), the Alcohol-Use Disorders Identification Test (AUDIT), and the Common Alcohol Logistical Scale-Revised (CAL-R) prior to evaluation by a staff psychiatrist or psychologist.
There were 40 patients who were qualified psychiatrically with no diagnosis and 49 patients who were disqualified for psychiatric reasons due to a non alcohol-related diagnosis. The remaining 22 patients were disqualified for psychiatric reasons with an alcohol-related diagnosis. The optimal aviator cut-off scores were consistent with those of the general population, although the cut-off score used for the SAAST was set at the published sub-threshold level to provide greater sensitivity. The sensitivity/specificity values for the SAAST, AUDIT, and CAL-R were 59%/94%, 46%/96%, and 68%/81%, respectively.
The psychometrically sophisticated CAL-R is sensitive, specific, and has good negative predictive value, although its use requires a psychologist and its availability is limited. The SAAST and AUDIT can be administered by a flight surgeon or aviation medical examiner (AME). Given the higher sensitivity of the SAAST it may be the most beneficial if administered first. The AUDIT can be used as a follow-up diagnostic test given its higher specificity.
酒精相关障碍是航空人群中最普遍的精神疾病。由于漏诊可能会对航空安全产生负面影响，人们一直在寻求有效筛查飞行员是否患有这些障碍的方法。本研究评估了已在非飞行员群体中得到验证的筛查工具对飞行员患者的适用性。
111名男性航空患者（27±7岁）被转介到海军航空航天医学院进行精神评估，他们在接受精神病医生或心理学家评估之前完成了自我管理酒精筛查测试（SAAST）、酒精使用障碍识别测试（AUDIT）和通用酒精后勤量表修订版（CAL-R）。
40名患者在精神方面合格且未被诊断出问题，49名患者因与酒精无关的诊断而因精神原因被取消资格。其余22名患者因与酒精相关的诊断而因精神原因被取消资格。尽管SAAST的临界值设定为已公布的亚阈值水平以提供更高的敏感性，但最佳飞行员临界值与普通人群的临界值一致。SAAST、AUDIT和CAL-R的敏感性/特异性值分别为59%/94%、46%/96%和68%/81%。
心理测量复杂的CAL-R具有敏感性、特异性，且具有良好的阴性预测价值，不过其使用需要心理学家，且可用性有限。SAAST和AUDIT可由飞行外科医生或航空医学检查员（AME）进行。鉴于SAAST的敏感性较高，如果首先进行检测，它可能是最有益的。鉴于AUDIT的特异性较高，可将其用作后续诊断测试。
