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Screening Trauma Patients With the Alcohol Use Disorders Identification Test and Biomarkers of Alcohol Use

Authors

  • Tim Neumann,

    1. From the Department of Anesthesiology and Intensive Care Medicine, (TN, BN, EW, HS, TS, CDS), Campus Mitte and Virchow-Klinikum; Department of Trauma and Reconstructive Surgery (NPH), Center of Musculoskeletal Surgery, Charité Universitätsmedizin Berlin, Germany; Institute for Laboratory Medicine and Pathobiochemistry (CM); and Division of Burns, Trauma, Critical Care (LMG), University of Texas, Southwestern Medical Center, Dallas, Texas.
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  • Larry M. Gentilello,

    1. From the Department of Anesthesiology and Intensive Care Medicine, (TN, BN, EW, HS, TS, CDS), Campus Mitte and Virchow-Klinikum; Department of Trauma and Reconstructive Surgery (NPH), Center of Musculoskeletal Surgery, Charité Universitätsmedizin Berlin, Germany; Institute for Laboratory Medicine and Pathobiochemistry (CM); and Division of Burns, Trauma, Critical Care (LMG), University of Texas, Southwestern Medical Center, Dallas, Texas.
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  • Bruno Neuner,

    1. From the Department of Anesthesiology and Intensive Care Medicine, (TN, BN, EW, HS, TS, CDS), Campus Mitte and Virchow-Klinikum; Department of Trauma and Reconstructive Surgery (NPH), Center of Musculoskeletal Surgery, Charité Universitätsmedizin Berlin, Germany; Institute for Laboratory Medicine and Pathobiochemistry (CM); and Division of Burns, Trauma, Critical Care (LMG), University of Texas, Southwestern Medical Center, Dallas, Texas.
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  • Edith Weiß-Gerlach,

    1. From the Department of Anesthesiology and Intensive Care Medicine, (TN, BN, EW, HS, TS, CDS), Campus Mitte and Virchow-Klinikum; Department of Trauma and Reconstructive Surgery (NPH), Center of Musculoskeletal Surgery, Charité Universitätsmedizin Berlin, Germany; Institute for Laboratory Medicine and Pathobiochemistry (CM); and Division of Burns, Trauma, Critical Care (LMG), University of Texas, Southwestern Medical Center, Dallas, Texas.
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  • Hajo Schürmann,

    1. From the Department of Anesthesiology and Intensive Care Medicine, (TN, BN, EW, HS, TS, CDS), Campus Mitte and Virchow-Klinikum; Department of Trauma and Reconstructive Surgery (NPH), Center of Musculoskeletal Surgery, Charité Universitätsmedizin Berlin, Germany; Institute for Laboratory Medicine and Pathobiochemistry (CM); and Division of Burns, Trauma, Critical Care (LMG), University of Texas, Southwestern Medical Center, Dallas, Texas.
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  • Torsten Schröder,

    1. From the Department of Anesthesiology and Intensive Care Medicine, (TN, BN, EW, HS, TS, CDS), Campus Mitte and Virchow-Klinikum; Department of Trauma and Reconstructive Surgery (NPH), Center of Musculoskeletal Surgery, Charité Universitätsmedizin Berlin, Germany; Institute for Laboratory Medicine and Pathobiochemistry (CM); and Division of Burns, Trauma, Critical Care (LMG), University of Texas, Southwestern Medical Center, Dallas, Texas.
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  • Christian Müller,

    1. From the Department of Anesthesiology and Intensive Care Medicine, (TN, BN, EW, HS, TS, CDS), Campus Mitte and Virchow-Klinikum; Department of Trauma and Reconstructive Surgery (NPH), Center of Musculoskeletal Surgery, Charité Universitätsmedizin Berlin, Germany; Institute for Laboratory Medicine and Pathobiochemistry (CM); and Division of Burns, Trauma, Critical Care (LMG), University of Texas, Southwestern Medical Center, Dallas, Texas.
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  • Norbert P. Haas,

    1. From the Department of Anesthesiology and Intensive Care Medicine, (TN, BN, EW, HS, TS, CDS), Campus Mitte and Virchow-Klinikum; Department of Trauma and Reconstructive Surgery (NPH), Center of Musculoskeletal Surgery, Charité Universitätsmedizin Berlin, Germany; Institute for Laboratory Medicine and Pathobiochemistry (CM); and Division of Burns, Trauma, Critical Care (LMG), University of Texas, Southwestern Medical Center, Dallas, Texas.
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  • Claudia D. Spies

    1. From the Department of Anesthesiology and Intensive Care Medicine, (TN, BN, EW, HS, TS, CDS), Campus Mitte and Virchow-Klinikum; Department of Trauma and Reconstructive Surgery (NPH), Center of Musculoskeletal Surgery, Charité Universitätsmedizin Berlin, Germany; Institute for Laboratory Medicine and Pathobiochemistry (CM); and Division of Burns, Trauma, Critical Care (LMG), University of Texas, Southwestern Medical Center, Dallas, Texas.
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  • Presented in part at the 2003 combined meeting of the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism, Fort Lauderdale (USA), and at the 9th Congress of the European Society for Biomedical Research on Alcoholism 2003, Prague (Czech Republic).

  • Present address of H. Schürmann is the Department of Anesthesiology and Intensive Care Medicine, Asklepios Klinik Harburg, Hamburg, Germany.

Reprint requests: Tim Neumann, Department of Anesthesiology and Intensive Care Medicine, Charité - Universitaetsmedizin Berlin, Campus Mitte and Virchow-Klinikum, Charitéplatz 1, 10117 Berlin, Germany; Fax: +49-30-450-531-911; E-mail: tim.neumann@charite.de

Abstract

Background:  Alcohol screening and brief interventions have been shown to reduce alcohol-related morbidity in injured patients. Use of self-report questionnaires such as the Alcohol Use Disorder Identification Test (AUDIT) is recommended as the optimum screening method. We hypothesized that the accuracy of screening is enhanced by combined use of the AUDIT and biomarkers of alcohol use in injured patients.

Methods:  The study was conducted in the emergency department of a large, urban, university hospital. Patients were evaluated with the AUDIT, and blood sampled to determine carbohydrate-deficient transferrin, gamma-glutamyl-transferase, and mean corpuscular volume. Alcohol problems were defined as presence of ICD-10 criteria for dependence or harmful use, or high-risk drinking according to World Health Organization criteria (weekly intake >420 g in males, >280 g in females). Screening accuracy was determined using Receiver Operating Characteristic curves.

Results:  There were 787 males and 446 females in the study. Median age was 33 years. The accuracy of the AUDIT was good to excellent, whereas all biomarkers performed only fairly to poorly in males, and even worse in females. At a specificity >0.80, sensitivity for all biomarkers was <0.43, whereas sensitivity for the AUDIT was 0.76 for males and 0.81 for females. The addition of biomarkers added little additional discriminatory information compared to use of the AUDIT alone.

Conclusions:  Screening properties of the AUDIT are superior to %CDT, MCV, and GGT for detection of alcohol problems in injured patients and are not clinically significantly enhanced by the use of biomarkers.

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