Screening for harmful substance use in emergency departments: a systematic review
Dublin Core
Title
Screening for harmful substance use in emergency departments: a systematic review
Subject
Substance-related disorders, Drug abuse screening, Emergency, Departments, Public health
Description
Abstract
Background Substance use-related emergency department (ED) visits have increased substantially in North Amer‐
ica. Screening for substance use in EDs is recommended; best approaches are unclear. This systematic review synthe‐
sizes evidence on diagnostic accuracy of ED screening tools to detect harmful substance use.
Methods We included derivation or validation studies, with or without comparator, that included adult (≥18 years)
ED patients and evaluated screening tools to identify general or specific substance use disorders or harmful use.
Our search strategy combined concepts Emergency Department AND Screening AND Substance Use. Trained review‐
ers assessed title/abstracts and full-text articles for inclusion, extracted data, and assessed risk of bias (QUADAS-2)
independently and in duplicate. Reviewers resolved disagreements by discussion. Primary investigators adjudicated
if necessary. Heterogeneity precluded meta-analysis. We descriptively summarized results.
Results Our search strategy yielded 2696 studies; we included 33. Twenty-one (64%) evaluated a North Ameri‐
can population. Fourteen (42%) applied screening among general ED patients. Screening tools were administered
by research staff (n=21), self-administered by patients (n=10), or non-research healthcare providers (n=1). Most
studies evaluated alcohol use screens (n=26), most commonly the Alcohol Use Disorders Identification Test (AUDIT;
n=14), Cut down/Annoyed/Guilty/Eye-opener (CAGE; n=13), and Rapid Alcohol Problems Screen (RAPS/RAPS4/
RAPS4-QF; n=12). Four studies assessing six tools and screening thresholds for alcohol abuse/dependence in North
American patients (AUDIT≥8; CAGE≥2; Diagnostic and Statistical Manual of Mental Disorders, 4th Edition [DSM-
IV-2]≥1; RAPS≥1; National Institute on Alcohol Abuse and Alcoholism [NIAAA]; Tolerance/Worry/Eye-opener/
Amnesia/K-Cut down [TWEAK]≥3) reported both sensitivities and specificities≥83%. Two studies evaluating a single
alcohol screening question (SASQ) (When was the last time you had more than X drinks in 1 day?, X=4 for women; X=5
for men) reported sensitivities 82–85% and specificities 70–77%. Five evaluated screening tools for general substance
abuse/dependence (Relax/Alone/Friends/Family/Trouble [RAFFT]≥3, Drug Abuse Screening Test [DAST]≥4, single
drug screening question, Alcohol, Smoking and Substance Involvement Screening Test [ASSIST]≥42/18), reporting
sensitivities 64%-90% and specificities 61%-100%. Studies’ risk of bias were mostly high or uncertain.
Conclusions Six screening tools demonstrated both sensitivities and specificities≥83% for detecting alcohol abuse/
dependence in EDs. Tools with the highest sensitivities (AUDIT≥8; RAPS≥1) and that prioritize simplicity and effi‐
ciency (SASQ) should be prioritized.
Keywords Substance-related disorders, Drug abuse screening, Emergency, Departments, Public health
Background Substance use-related emergency department (ED) visits have increased substantially in North Amer‐
ica. Screening for substance use in EDs is recommended; best approaches are unclear. This systematic review synthe‐
sizes evidence on diagnostic accuracy of ED screening tools to detect harmful substance use.
Methods We included derivation or validation studies, with or without comparator, that included adult (≥18 years)
ED patients and evaluated screening tools to identify general or specific substance use disorders or harmful use.
Our search strategy combined concepts Emergency Department AND Screening AND Substance Use. Trained review‐
ers assessed title/abstracts and full-text articles for inclusion, extracted data, and assessed risk of bias (QUADAS-2)
independently and in duplicate. Reviewers resolved disagreements by discussion. Primary investigators adjudicated
if necessary. Heterogeneity precluded meta-analysis. We descriptively summarized results.
Results Our search strategy yielded 2696 studies; we included 33. Twenty-one (64%) evaluated a North Ameri‐
can population. Fourteen (42%) applied screening among general ED patients. Screening tools were administered
by research staff (n=21), self-administered by patients (n=10), or non-research healthcare providers (n=1). Most
studies evaluated alcohol use screens (n=26), most commonly the Alcohol Use Disorders Identification Test (AUDIT;
n=14), Cut down/Annoyed/Guilty/Eye-opener (CAGE; n=13), and Rapid Alcohol Problems Screen (RAPS/RAPS4/
RAPS4-QF; n=12). Four studies assessing six tools and screening thresholds for alcohol abuse/dependence in North
American patients (AUDIT≥8; CAGE≥2; Diagnostic and Statistical Manual of Mental Disorders, 4th Edition [DSM-
IV-2]≥1; RAPS≥1; National Institute on Alcohol Abuse and Alcoholism [NIAAA]; Tolerance/Worry/Eye-opener/
Amnesia/K-Cut down [TWEAK]≥3) reported both sensitivities and specificities≥83%. Two studies evaluating a single
alcohol screening question (SASQ) (When was the last time you had more than X drinks in 1 day?, X=4 for women; X=5
for men) reported sensitivities 82–85% and specificities 70–77%. Five evaluated screening tools for general substance
abuse/dependence (Relax/Alone/Friends/Family/Trouble [RAFFT]≥3, Drug Abuse Screening Test [DAST]≥4, single
drug screening question, Alcohol, Smoking and Substance Involvement Screening Test [ASSIST]≥42/18), reporting
sensitivities 64%-90% and specificities 61%-100%. Studies’ risk of bias were mostly high or uncertain.
Conclusions Six screening tools demonstrated both sensitivities and specificities≥83% for detecting alcohol abuse/
dependence in EDs. Tools with the highest sensitivities (AUDIT≥8; RAPS≥1) and that prioritize simplicity and effi‐
ciency (SASQ) should be prioritized.
Keywords Substance-related disorders, Drug abuse screening, Emergency, Departments, Public health
Creator
Jessica Moe1*, Justin Koh2
, Jennifer A. Ma3
, Lulu X. Pei1
, Eleanor MacLean1
, James Keech4
, Kaitlyn Maguire1
,
Claire Ronsley1
, Mary M. Doyle‐Waters5 and Jeffrey R. Brubacher1
, Jennifer A. Ma3
, Lulu X. Pei1
, Eleanor MacLean1
, James Keech4
, Kaitlyn Maguire1
,
Claire Ronsley1
, Mary M. Doyle‐Waters5 and Jeffrey R. Brubacher1
Source
https://doi.org/10.1186/s12245-024-00616-2
Date
2024
Contributor
Peri Irawan
Format
pdf
Language
english
Type
text
Files
Collection
Citation
Jessica Moe1*, Justin Koh2
, Jennifer A. Ma3
, Lulu X. Pei1
, Eleanor MacLean1
, James Keech4
, Kaitlyn Maguire1
,
Claire Ronsley1
, Mary M. Doyle‐Waters5 and Jeffrey R. Brubacher1, “Screening for harmful substance use in emergency departments: a systematic review,” Repository Horizon University Indonesia, accessed April 13, 2026, https://repository.horizon.ac.id/items/show/12315.