New York University School of Medicine, Department of Medicine, United States; Center for Drug Use and HIV Research, New York University College of Nursing, United States; New York University School of Medicine, Department of Population Health, United States.
New York University School of Medicine, Department of Medicine, United States; Center for Drug Use and HIV Research, New York University College of Nursing, United States; New York University School of Medicine, Department of Population Health, United States.
J Subst Abuse Treat. 2017 Aug;79:67-74. doi: 10.1016/j.jsat.2017.05.014. Epub 2017 May 31.
Hospitalized patients have high rates of unhealthy substance use, which has important impacts on health both during and after hospitalization, but is infrequently identified in the absence of screening. The Substance Use Brief Screen (SUBS) was developed as a brief, self-administered instrument to identify use of tobacco, alcohol, illicit drugs, and non-medical use of prescription drugs, and was previously validated in primary care patients. This study assessed the diagnostic accuracy of the SUBS in comparison to longer screening instruments to identify unhealthy and high-risk alcohol and drug use in hospitalized current smokers. Participants were 439 patients, aged 18 and older, who were admitted to either two urban safety-net hospitals in New York City and enrolled in a smoking cessation trial. We measured the performance of the SUBS for identifying illicit drug and non-medical use of prescription drugs in comparison to a modified Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) and its performance for identifying excessive alcohol use in comparison to the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C). At the standard cutoff (response other than 'never' indicates a positive screen), the SUBS had a sensitivity of 98% (95% CI 95-100%) and specificity of 61% (95% CI 55-67%) for unhealthy alcohol use, a sensitivity of 85% (95% CI 80-90%) and specificity of 75% (95% CI 78-87%) for illicit drug use, and a sensitivity of 73% (95% CI 61-83%) and specificity of 83% (95% CI 78-87%) for prescription drug non-medical use. For identifying high-risk use, a higher cutoff (response of '3 or more days' of use indicates a positive screen), the SUBS retained high sensitivity (77-90%), and specificity was 62-88%. The SUBS can be considered as an alternative to longer screening instruments, which may fit more easily into busy inpatient settings. Further study is needed to evaluate its validity using gold standard measures in hospitalized populations.
住院患者有较高的不良物质使用率，这对住院期间和出院后的健康都有重要影响，但如果不进行筛查，往往无法发现。《物质使用简短筛查》（SUBS）是一种简短的、自我管理的工具，用于识别烟草、酒精、非法药物和非医疗使用处方药物的使用情况，此前已在初级保健患者中得到验证。本研究评估了 SUBS 与较长的筛查工具相比，在识别住院当前吸烟者的不健康和高风险酒精和药物使用方面的诊断准确性。参与者为 439 名年龄在 18 岁及以上的患者，他们被收入纽约市两家城市安全网医院的一项戒烟试验。我们测量了 SUBS 在识别非法药物和非医疗使用处方药物方面的表现，与改良的酒精、吸烟和物质使用筛查测试（ASSIST）相比，以及在识别过量饮酒方面的表现，与酒精使用障碍识别测试-消耗（AUDIT-C）相比。在标准截止值（回答“从不”表示筛查阳性）时，SUBS 对不健康的酒精使用的敏感性为 98%（95%置信区间 95-100%），特异性为 61%（95%置信区间 55-67%），对非法药物使用的敏感性为 85%（95%置信区间 80-90%），特异性为 75%（95%置信区间 78-87%），对处方药物非医疗使用的敏感性为 73%（95%置信区间 61-83%），特异性为 83%（95%置信区间 78-87%）。对于识别高风险使用，较高的截止值（回答“3 天或以上”表示筛查阳性），SUBS 保持了较高的敏感性（77-90%），特异性为 62-88%。SUBS 可以作为较长筛查工具的替代方案，它可能更适合繁忙的住院环境。需要进一步的研究来评估其在住院人群中使用金标准措施的有效性。
