Newton Amanda S, Dong Kathryn, Mabood Neelam, Ata Nicole, Ali Samina, Gokiert Rebecca, Vandermeer Ben, Tjosvold Lisa, Hartling Lisa, Wild T Cameron
Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
Pediatr Emerg Care. 2013 May;29(5):673-84. doi: 10.1097/PEC.0b013e31828ed325.
Brief intervention (BI) is recommended for use with youth who use alcohol and other drugs. Emergency departments (EDs) can provide BIs at a time directly linked to harmful and hazardous use. The objective of this systematic review was to determine the effectiveness of ED-based BIs.
We searched 14 electronic databases, a clinical trial registry, conference proceedings, and study references. We included randomized controlled trials with youth 21 years or younger. Two reviewers independently selected studies and assessed methodological quality. One reviewer extracted and a second verified data. We summarized findings qualitatively.
Two trials with low risk of bias, 2 trials with unclear risk of bias, and 5 trials with high risk of bias were included. Trials evaluated targeted BIs for alcohol-positive (n = 3) and alcohol/other drug-positive youth (n = 1) and universal BIs for youth reporting recent alcohol (n = 4) or cannabis use (n = 1). Few differences were found in favor of ED-based BIs, and variation in outcome measurement and poor study quality precluded firm conclusions for many comparisons. Universal and targeted BIs did not significantly reduce alcohol use more than other care. In one targeted BI trial with high risk of bias, motivational interviewing (MI) that involved parents reduced drinking quantity per occasion and high-volume alcohol use compared with MI that was delivered to youth only. Another trial with high risk of bias reported an increase in abstinence and reduction in physical altercations when youth received peer-delivered universal MI for cannabis use. In 2 trials with unclear risk of bias, MI reduced drinking and driving and alcohol-related injuries after the ED visit. Computer-based MI delivered universally in 1 trial with low risk of bias reduced alcohol-related consequences 6 months after the ED visit.
Clear benefits of using ED-based BI to reduce alcohol and other drug use and associated injuries or high-risk behaviours remain inconclusive because of variation in assessing outcomes and poor study quality.
建议对饮酒及使用其他药物的青少年进行简短干预（BI）。急诊科（ED）可在与有害和危险使用直接相关的时间提供简短干预。本系统评价的目的是确定基于急诊科的简短干预的有效性。
我们检索了14个电子数据库、一个临床试验注册库、会议论文集和研究参考文献。我们纳入了针对21岁及以下青少年的随机对照试验。两名评价员独立选择研究并评估方法学质量。一名评价员提取数据，另一名评价员进行核实。我们对结果进行了定性总结。
纳入了2项偏倚风险低的试验、2项偏倚风险不明确的试验和5项偏倚风险高的试验。试验评估了针对酒精检测呈阳性的青少年（n = 3）和酒精/其他药物检测呈阳性的青少年（n = 1）的针对性简短干预，以及针对报告近期饮酒（n = 4）或使用大麻（n = 1）的青少年的普遍性简短干预。很少发现有利于基于急诊科的简短干预的差异，结果测量的差异和研究质量差使得许多比较无法得出确凿结论。普遍性和针对性简短干预在减少酒精使用方面并不比其他护理措施更显著。在一项偏倚风险高的针对性简短干预试验中，与仅对青少年进行的动机性访谈（MI）相比，涉及父母的动机性访谈减少了每次饮酒量和大量饮酒。另一项偏倚风险高的试验报告称，当青少年接受同伴提供的关于大麻使用的普遍性动机性访谈时，戒酒率增加，身体冲突减少。在2项偏倚风险不明确的试验中，动机性访谈减少了急诊科就诊后的酒后驾车和与酒精相关的伤害。在1项偏倚风险低的试验中，普遍性提供的基于计算机的动机性访谈在急诊科就诊6个月后减少了与酒精相关的后果。
由于评估结果的差异和研究质量差，使用基于急诊科的简短干预来减少酒精和其他药物使用以及相关伤害或高风险行为的明显益处仍不确定。
