Do chief complaints allow targeting of SBIRT in the Emergency Department?
© McCormack et al 2015
Published: 24 September 2015
Emergency Department (ED)-based Screening, Brief Interventions and Referral for Treatment (SBIRT) for alcohol and drug use has the potential to impact public health greatly. Time and resource constraints limit implementation . Targeted intervention may be more efficient and practical. We hypothesized that we could use chief complaints to identify patients at highest risk of positive drug or alcohol use assessments.
Material and methods
Using baseline data from NIDA CTN0047: SMART-ED , free text chief complaints of 14,972 subjects from six sites were coded using a tested algorithm . Multiple team members manually reviewed and further collapsed the chief complaint categorization to ensure agreement. We excluded subjects having missing data or complaints related to substance use and chief complaints stated by <15 subjects. Positive screens were defined as AUDIT-C ≥4 for men and ≥3 for women (alcohol) and DAST ≥3 (drugs). We ranked-ordered the chief complaints by their sensitivity (i.e. greatest to fewest positive screens per complaint) and positive predictive value (i.e. proportion positive screens when the complaint is present) to 1) minimize the number of chief complaints and 2) assess the fewest number of ED patients. Our goal was to identify 75% of ED patients having positive assessments using these strategies.
Based on this large, multicenter study, chief complaints provide little assistance in targeting SBIRT for alcohol or drug use in the ED.
NIDA CTN U10DA015833
NIDA CTN U10DA013035
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