Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland 20892-9304, USA.
Alcohol Clin Exp Res. 2010 Feb;34(2):364-74. doi: 10.1111/j.1530-0277.2009.01098.x. Epub 2009 Nov 24.
There is increasing interest in and physician support for the use of single-item screeners for problem drinking.
In a representative sample of U.S. adults (n = 43,093) and within selected subgroups, past-year frequency of drinking 5+/4+ drinks and maximum drinks consumed on any day were evaluated as screeners for past-year alcohol dependence, any alcohol use disorder (AUD), and any AUD or hazardous drinking, using standard measures of screening performance. AUDs were defined according to DSM-IV criteria. Hazardous drinking was defined as consuming >14 drinks/wk or 5+ drinks on any day for men and >7 drinks/wk or 4+ drinks on any day for women.
Optimal cutpoints for both screeners varied across population subgroups, and these variations should be taken into account in order to maximize screening performance. At the optimal cutpoints for the total population, the sensitivity and specificity of maximum drinks were 89% and 82% for dependence at > or =5 drinks, 90% and 79% for any AUD at > or =4 drinks, and 90% and 96% for any AUD or hazardous drinking at > or =4 drinks. Comparable values of sensitivity and specificity for 5+/4+ frequency were 90% and 83% at > or =3 times a year, 87% and 82% at > or =once a year, and 88% and 100% at > or =once a year, respectively. Specificity was lower when only past-year drinkers were considered. The 5+/4+ frequency screener yielded fairly low sensitivity in predicting alcohol problems among the elderly and among Blacks. Results supported a past-year reference period for frequency of 5+/4+ drinks and substantiated gender- and age-specific thresholds for defining risk drinking.
Both of the single-item screeners performed nearly on a par with the AUDIT-C and have potential for use in primary and emergency care settings.
人们对使用单项筛查工具来评估饮酒问题的兴趣日益浓厚，医生对此也表示支持。
在一项美国成年人（n=43093）的代表性样本中，并在选定的亚组内，评估过去一年中饮用 5+/4+杯和任何一天内饮用的最大杯数作为过去一年酒精依赖、任何酒精使用障碍（AUD）以及任何 AUD 或有害饮酒的筛查工具，使用筛查性能的标准衡量标准。AUD 根据 DSM-IV 标准定义。有害饮酒定义为每周饮用 >14 杯或每天饮用 5+杯以上的男性，每周饮用 >7 杯或每天饮用 4+杯以上的女性。
两种筛查工具的最佳切点在人群亚组之间存在差异，为了最大限度地提高筛查性能，应该考虑这些差异。在总人群的最佳切点处，最大杯数对依赖的敏感性和特异性分别为 >or=5 杯时为 89%和 82%，>or=4 杯时为任何 AUD 为 90%和 79%，>or=4 杯时为任何 AUD 或有害饮酒为 90%和 96%。类似的敏感性和特异性值在 >or=3 次/年时为 90%和 83%，在 >or=1 次/年时为 87%和 82%，在 >or=1 次/年时为 88%和 100%。当只考虑过去一年的饮酒者时，特异性较低。5+/4+频率筛查工具在预测老年人和黑人的酒精问题方面敏感性较低。结果支持过去一年作为 5+/4+杯数的参考期，并证实了定义风险饮酒的性别和年龄特异性阈值。
这两种单项筛查工具与 AUDIT-C 的表现几乎相当，有可能在初级和急诊护理环境中使用。
