Abstract
IntroductionAmong adult emergency department (ED) patients, we sought to examine how estimates of substance use prevalence and the need for interventions can differ, based on the type of screening and assessment strategies employed.MethodsWe estimated the prevalence of substance use and the need for interventions using the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in a secondary analysis of data from two cross-sectional studies using random samples of English- or Spanish-speaking 18–64-year-old ED patients. In addition, the test performance characteristics of three simplified screening strategies consisting of selected questions from the ASSIST (lifetime use, past three-month use, and past three-month frequency of use) to identify patients in need of a possible intervention were compared against using the full ASSIST.ResultsOf 6,432 adult ED patients, the median age was 37 years-old, 56.6% were female, and 61.6% were white. Estimated substance use prevalence among this population differed by how it was measured (lifetime use, past three-month use, past three-month frequency of use, or need for interventions). As compared to using the full ASSIST, the predictive value and accuracy to identify patients in need of any intervention was best for a simplified strategy asking about past three-month substance use. A strategy asking about daily/near-daily use was better in identifying patients needing intensive interventions. However, some patients needing interventions were missed when using these simplified strategies.ConclusionSubstance use prevalence estimates and identification of ED patients needing interventions differ by screening strategies used. EDs should carefully select strategies to identify patients in need of substance use interventions.
Highlights
Among adult emergency department (ED) patients, we sought to examine how estimates of substance use prevalence and the need for interventions can differ, based on the type of screening and assessment strategies employed
As compared to using the full ASSIST, the predictive value and accuracy to identify patients in need of any intervention was best for a simplified strategy asking about past three-month substance use
Substance use prevalence estimates and identification of ED patients needing interventions differ by screening strategies used
Summary
An enticing way to assess ED patients substance use is to use simplified screening-question strategies involving one or two screening questions that might identify individuals in possible need of an intervention (e.g., “In the past 3 months, did you drink alcohol?”).[3,4] This strategy might be applied by ED staff at triage or incorporated into the electronic medical record (EMR), and the results could prompt or obviate the need for an intervention during the clinical care encounter Before such simplified strategies can be recommended, their yield and accuracy against relatively more comprehensive screening and assessment strategies need to be evaluated
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