Department of Pediatrics, Baylor College of Medicine and Department of Emergency Medicine, Texas Children's Hospital, Houston, Texas;
Emergency Medicine and.
Pediatrics. 2019 Aug;144(2). doi: 10.1542/peds.2018-3415. Epub 2019 Jul 24.
The utility of CRAFFT (Car, Relax, Alone, Forget, Friends, Trouble) in identifying current and future problematic substance use and substance use disorders (SUDs) in pediatric emergency department (PED) patients is unknown. We conducted a secondary analysis of a study in 16 PEDs to determine the concurrent and predictive validity of CRAFFT with respect to SUD.
At baseline, 4753 participants aged 12 to 17 years completed an assessment battery (CRAFFT and other measures of alcohol, drug use, and risk behaviors). A subsample was readministered the battery at 1-, 2-, and 3-year follow-up to investigate future SUDs.
Of 2175 participants assigned to follow-up, 1493 (68.6%) completed 1-year, 1451 (66.7%) completed 2-year, and 1265 (58.1%) completed the 3-year follow-up. A baseline CRAFFT value of ≥2 was significantly associated with problematic substance use or mild or moderate to severe SUD diagnosis on the Diagnostic Interview Schedule for Children at baseline ( < .001). The results persisted after 1, 2, and 3 years ( < .001). The best combined sensitivity and specificity was achieved with a baseline CRAFFT value of ≥1 as a cutoff for predicting problematic substance use and a diagnosis of mild SUD at 1, 2, and 3 years. The baseline CRAFFT score that best predicted a moderate to severe SUD at 1 year was ≥2; but at 2 and 3 years, the cutoff score was ≥1.
CRAFFT has good concurrent validity for problematic substance use and SUD in PED patients and is useful in predicting SUDs at up to 3 years follow-up but with limited sensitivity.
CRAFFT（汽车、放松、独处、忘记、朋友、麻烦）在儿科急诊部（PED）患者中识别当前和未来的问题性物质使用和物质使用障碍（SUD）的效用尚不清楚。我们对 16 个 PED 中的一项研究进行了二次分析，以确定 CRAFFT 在 SUD 方面的同时和预测有效性。
在基线时，年龄在 12 至 17 岁的 4753 名参与者完成了一个评估组合（CRAFFT 和其他酒精、药物使用和风险行为的测量）。一个亚组在 1、2 和 3 年的随访中重新进行了组合测试，以调查未来的 SUD。
在被分配到随访的 2175 名参与者中，1493 名（68.6%）完成了 1 年随访，1451 名（66.7%）完成了 2 年随访，1265 名（58.1%）完成了 3 年随访。基线 CRAFFT 值≥2 与基线时儿童诊断访谈表上的问题性物质使用或轻度或中度至重度 SUD 诊断显著相关（<.001）。1、2 和 3 年后结果仍然存在（<.001）。当将基线 CRAFFT 值≥1 作为预测 1、2 和 3 年问题性物质使用和轻度 SUD 诊断的截止值时，可获得最佳的敏感性和特异性的组合。预测 1 年内中度至重度 SUD 的最佳基线 CRAFFT 分数为≥2；但在 2 年和 3 年时，截止分数为≥1。
CRAFFT 在 PED 患者中具有良好的同时有效性，可用于预测物质使用障碍，且在 3 年的随访中有用，但敏感性有限。
