Department of Health Sciences, University of York, York, YO10 5DD, England, UK; School of Psychology, Queen's University Belfast, Belfast, BT9 5BN, Northern Ireland, UK.
Department of Health Sciences, University of York, York, YO10 5DD, England, UK; Dundee Centre for Health and Related Research, School of Nursing and Health Sciences, University of Dundee, Dundee, DD1 4HJ, Scotland, UK.
Drug Alcohol Depend. 2019 Sep 1;202:39-49. doi: 10.1016/j.drugalcdep.2019.01.030. Epub 2019 Feb 28.
There is a strong rationale for clinicians to identify risky drinking among young people given the harms caused by alcohol. This systematic review evaluates the quality of evidence in the validation literature on alcohol screening and assessment measures for young people under 25.
Six electronic databases (MEDLINE; EMBASE; PsycINFO; SSCI; HMIC; ADAI) were searched in May 2016 for published and grey literature. Full-text reports published in English since 1980 were included if they aimed to validate an alcohol screening or assessment measure in comparison with a previously validated alcohol measure. Risk of bias was assessed in studies surpassing a priori quality thresholds for predictive validity, internal and test-retest reliability using COSMIN and QUADAS-2.
Thirty nine reports comprising 135 discrete validation studies were included. Summary estimates indicated that the screening instruments performed well - AUC 0.91 (95% CI: 0.88 to 0.93); sensitivity 0.98 (0.95 to 0.99); specificity 0.78 (0.74 to 0.82). Noting a paucity of validation evidence for existing assessment instruments, aggregated reliability estimates suggest a reliability of 0.81 (0.78 to 0.83) adjusted for 10 items. Risk of bias was high for both types of studies.
The volume and quality of available evidence are superior for screening measures. It is recommended that clinicians use alcohol frequency or quantity items if asking a single question. If there is an opportunity to ask more questions either the 3-item AUDIT-C or the 10-item AUDIT are recommended. There is a need to develop new instruments to assess young people's alcohol-related problems.
鉴于酒精造成的危害，临床医生有充分的理由识别年轻人的危险饮酒行为。本系统评价评估了针对 25 岁以下年轻人的酒精筛查和评估措施的验证文献中的证据质量。
2016 年 5 月，我们在六个电子数据库（MEDLINE、EMBASE、PsycINFO、SSCI、HMIC、ADAI）中搜索了已发表和灰色文献。如果全文报告以英文发表且发表时间在 1980 年以后，旨在针对先前经过验证的酒精测量方法，对酒精筛查或评估工具进行验证，则将其纳入研究。使用 COSMIN 和 QUADAS-2 评估前瞻性质量阈值内预测有效性、内部和重测可靠性的研究的偏倚风险。
纳入了 39 份报告，其中包含 135 项独立的验证研究。汇总估计表明，筛查工具表现良好——AUC 为 0.91（95%CI：0.88 至 0.93）；灵敏度为 0.98（0.95 至 0.99）；特异性为 0.78（0.74 至 0.82）。注意到现有评估工具的验证证据不足，综合可靠性估计表明，调整 10 项后，可靠性为 0.81（0.78 至 0.83）。这两种类型的研究均存在高偏倚风险。
现有证据的数量和质量都优于筛查工具。建议临床医生在询问单个问题时使用酒精频率或数量项目。如果有机会询问更多问题，建议使用 3 项 AUDIT-C 或 10 项 AUDIT。需要开发新的工具来评估年轻人的酒精相关问题。
