Does the alcohol use disorders identification test-consumption identify the same patient population as the full 10-item alcohol use disorders identification test?

The aim of this study was to evaluate whether a computer-based 3-item version (Alcohol Use Disorders Identification Test-Consumption [AUDIT-C]) of the Alcohol Use Disorders Identification Test (AUDIT) identifies alcohol use disorder (AUD) in the same patients as the full 10-item version in 809 women and 747 men in an anesthesiology preoperative assessment clinic. According to cutoffs used ( AUDIT: 5-8 points, AUDIT-C: 4-6 points), rate of disagreement (AUDIT-positive and AUDIT-C-negative or vice versa) ranged between 4% and 31% (men) and between 4% and 19% (women). In male patients, 15% were positive for both the AUDIT (≥8 points) and the AUDIT-C (≥6 points), 7% were positive for AUDIT-C only, and 4% were positive for AUDIT only. In female patients, using cutoffs of 5 more points (AUDIT) and 4 or more points (AUDIT-C), 16% were positive for both versions, 9% were positive for AUDIT-C only, and 2% were positive for AUDIT only. The AUDIT and AUDIT-C seem to identify AUD in differing patients.

New strategies to detect alcohol use disorders in the preoperative assessment clinic of a German university hospital.

BACKGROUND: Although alcohol use disorders (AUDs) have enormous public health consequences, the rate of diagnosis of AUDs remains unsatisfactorily low. The primary aim of this study was to compare the detection of AUDs by anesthesiologists in a large preoperative assessment clinic to that by computerized self-assessment of the Alcohol Use Disorder Identification Test. Secondary outcome measures were to compare the actions taken by anesthesiologists upon a finding of an AUD. METHODS: One thousand five hundred fifty-six patients were included. Before preoperative assessment, patients were asked to complete the Alcohol Use Disorder Identification Test (positive scores: men > or = 8, women > or = 5) using a computer. The authors performed a retrospective chart analysis of the anesthesiologists' actions upon a finding of an AUD. The anesthesiologists were blinded to the results of the computer-based assessment and to the subsequent chart analysis. RESULTS: The prevalence rate of AUDs determined by the anesthesiologists was 6.9% (107 of 1,556), whereas the proportion of patients positive for an AUD using the computerised Alcohol Use Disorder Identification Test was 18.1% (282 of 1,556) (P < 0.001). The detection rate by the anesthesiologists of AUDs among men was significantly higher than among women (P < 0.001) as well as in the elderly compared with younger patients (P < 0.001). Action taken by anesthesiologists was mainly based on evaluating quantity of alcohol consumption. CONCLUSION: The computer-based self-assessment increases detection rates of AUDs in busy settings such as a preoperative assessment clinic. Prevalence rates of AUDs are underestimated. Best-practice guidelines for detection of AUDs are not implemented in the daily clinical routine. Barrier analysis is urgently required.

The usefulness of direct ethanol metabolites in assessing alcohol intake in nonintoxicated male patients in an emergency room setting.

BACKGROUND: A major part of medical pathology in internal medicine is associated with chronic alcoholism. The aim of the current study was to investigate whether screening for Alcohol Use Disorders (AUD) can be improved through determination of direct ethanol metabolites compared to traditional biological state markers, the Alcohol Use Disorders Identification Test (AUDIT) and additional self-reports beyond the detection time period of a positive blood alcohol concentration (BAC). METHODS: A total of 74 blood alcohol negative male patients who presented at the emergency room with either thoracic or gastrointestinal complaints were included. Phosphatidylethanol (PEth) was determined in whole blood, and ethyl glucuronide (EtG) in serum and urine samples. Traditional biological state markers [carbohydrate deficient transferrin (%CDT), gamma glutamyl transpeptidase (GGT), mean corpuscular volume (MCV)] were determined. The AUDIT was obtained and furthermore, all patients completed an additional self-report of alcohol consumption. Patients were divided into two (2) groups: AUDIT scores < 8 and AUDIT scores >or= 8. RESULTS: After assessment of the AUDIT, patients were allocated to one of the following groups: patients with AUDIT scores < 8 (n = 52) and with AUDIT scores >or= 8 (n = 22). Twenty-five percent of the patients with AUDIT scores below the cut-off (n = 13/52) were tested positive for both PEth and UEtG. Of the patients who declared to be sober during the past 12 months, 38.5% were tested positive for PEth and UEtG. PEth discriminated similarly as %CDT for AUDIT scores >or= 8 (AUC: 0.672; 95%CI 0.524 to 0.821). Self-reports of alcohol consumption were unreliable. CONCLUSION: Determination of direct ethanol metabolites such as PEth and UEtG provides additional evidence in screening for AUD in an ER setting. Determination of PEth might be considered complementary with or alternatively to %CDT.

The effect of stimulating versus nonstimulating catheters for continuous interscalene plexus blocks in short-term pain management.

STUDY OBJECTIVE: To investigate whether placement, and use of stimulating catheters for interscalene brachial plexus blocks improves short-term postoperative analgesia. DESIGN: Controlled, prospective, randomized, pilot study. SETTING: University hospital. PATIENTS: 60 patients undergoing shoulder surgery. INTERVENTIONS AND MAIN MEASUREMENTS: The brachial plexus was identified using a stimulating needle. In conventional catheter group 1 (CC 1), local anesthetic (LA) was injected through the needle and catheters were advanced blindly thereafter. In catheter group 2 (CC 2), catheters were blindly inserted and LA was injected through the catheter. In the stimulating catheter group (SC), LA was injected only after catheter tip location was confirmed by nerve stimulation. Time required to perform the block, pain intensity at rest, and dynamic pain (defined movement: lifting of arm; numeric rating scale, 0-10), patient satisfaction (verbal rating scale, Likert scale), and plasma concentrations of ropivacaine were measured. MAIN RESULTS: Patients in the SC group had significantly decreased pain scores. The median block performance time was 6 minutes in CC 1 (CI 25%-75%: 4-8 min), 11 minutes in CC 2 (CI 25%-75%: 7-13 min), and 12 minutes in SC (CI 25%-75%: 10-24 min). Patient satisfaction and plasma concentrations of ropivacaine did not differ among the groups. CONCLUSIONS: Stimulating catheters for interscalene plexus blocks improve postoperative analgesia at rest in patients undergoing shoulder surgery.