CORK Bibliography: Trauma Scale (Screening Test)

11 citations. 1998 to present

Prepared: March 2004

Screening questionnaires in the detection of hazardous alcohol consumption in the general hospital: Direct or disguised assessment?

Rumpf HJ; Hapke U; Erfurth A; John U. Journal of Studies on Alcohol 59(6): 698-703, 1998. (36 refs.)
Objective. The aim of this study was to compare the validity of two direct screening questionnaires, the CAGE and MAST, in the detection of hazardous alcohol consumption with a disguised assessment by using the Trauma Scale in a poststratified general hospital sample. Method: Surgical and medical inpatients (N = 1,379) completed the three questionnaires. Hazardous alcohol consumption was defined by criteria derived from a World Health Organization study and assessed using self-reported quantity and frequency. Results: The sensitivity of the Trauma Scale was not significantly different compared to the CAGE and MAST, whereas the direct questionnaires were higher in specificity and overall accuracy (p < .0001). In male surgical patients the detection rate of the Trauma Scale was higher compared to the CAGE (p < .05). Thirteen percent of subjects with hazardous levels of alcohol consumption were detected by the Trauma Scale only. In female surgical patients, the Trauma Scale, when used as an additional tool, does not improve the detection of hazardous drinkers. Conclusions: Because of the low specificity, indirect assessment using a history of trauma cannot be recommended as a screening instrument in a general hospital setting. Despite a high number of false positives, the Trauma Scale may serve as an additional tool in conjunction with direct questionnaires when high sensitivity is desired.

Alcohol and drug use in orthopaedic inpatients.

Chalmers E; Blignault I; Hornby BH. Australian Drug and Alcohol Review 7(2): 141-145, 1988. (20 refs.)
A study was performed to determine the frequency of potentially harmful drinking among orthopedic patients at the Royal Darwin Hospital. During the week before they were admitted, 109 adult inpatients were interviewed about their use of alcohol and other drugs and in general about alcohol-related problems. Alcohol was the drug used by the greatest proportion of patients, 75 percent of whom reported drinking. Fifty-three percent reported use of tobacco, 28 percent of analgesics, and 15 percent of cannabis. Dangerous drinking was reported by 28 percent of the patients. The Trauma Scale identified more patients as problem drinkers (52 percent) than did the Brief MAST (7 percent). It is recommended that hospitalized trauma patients be routinely screened for problem drinking.

Body region prevalence of injury in alcohol- and non-alcohol-related traffic injuries.

Chen S-C; Lin FY; Chang KJ Journal of Trauma 47(5): 881-884, 1999 (31 refs.)
Objective: To explore the relationship between alcohol use and body region of injury in patients injured in traffic collisions. Materials and Methods: A prospective study of 381 patients involved in traffic collisions over the past 4 months. These patients were categorized as either using alcohol or not using alcohol on the day of the accident. Eighty of 381 patients (21%) had detectable blood alcohol concentrations. Age, sex, location of injury, helmet use, clinical diagnosis, Injury Severity Score, Glasgow Coma Scale score, and blood alcohol concentrations were collected for each patient. Blood alcohol concentrations were measured by the radioactive energy attenuation method. Results: The incidence of head, face, chest, abdomen, and extremity injury in patients with alcohol use was 39%, 56%, 13%, 15%, and 55%, respectively, and 26%, 32%, 15%, 12%, and 63% in those without alcohol use, respectively. The differences in the incidence of head and facial injuries were significant between these two groups (p < 0.05). Mean blood alcohol concentrations in head, face, chest, abdomen, and extremity injury were 171, 204, 215, 231, and 163 mg/dL, respectively. Conclusion: More injuries to the head and facial areas compared with other body parts were found in patients, with alcohol use. However, alcohol level did not seem to influence the region of the body injured.

Comparison of screening instruments for alcohol problems between black and white emergency room patients from two regions of the country.

Cherpitel CJ. Alcoholism: Clinical and Experimental Research 21(8): 1391-1397, 1997. (40 refs.)BR> A number of brief screening instruments to identify alcohol dependence exist, but the validity of these instruments across ethnic groups or regions of the country is not well established. The sensitivity and specificity of a number of standard screening instruments (CAGE, brief MAST, AUDIT, TWEAK, and RAPS), as well as other measures (History of Trauma Scale, breathalyzer reading, self-reported drinking before the event, and consuming five or more drinks at a sitting at least monthly) are compared against ICD-10 and DSM-IV criteria for alcohol dependence between probability samples of Black and White emergency roam patients in Santa Clara County, CA (n = 716) and in Jackson, MS (n = 1330). Variability in the sensitivity of screening instruments among current drinkers was found to be greater between samples for both Blacks and Whites, than for Blacks compared with Whites within the same sample. The AUDIT, TWEAK, and RAPS seemed to perform well by gender and injury status for both Blacks and Whites in the two samples, and no significant differences were found in the performance of these instruments across sample sites. To evaluate the influence of regional differences in alcohol dependence an differences found in the performance of screening instruments, using logistic regression with the simultaneous entry of demographic variables (age, gender, ethnicity, injury status, and site) and drinking variables (breathalyzer reading, self-reported drinking before the event, and drinking five or more drinks at a sitting at least monthly) to predict alcohol dependence in a merged sample of these patients (Jackson vs. Santa Clara) site was not found to be significant. Data suggest that, whereas region of the country may not be important in predicting alcohol dependence in emergency room populations, regional differences in the performance of screening instruments for alcohol dependence may exist, even when ethnicity is taken into account. Given distinct regional differences in drinking patterns and problems in the U.S., further research on commonly used screening instruments is needed to determine those screeners most efficient for identifying problem drinking.

Differences in performance of screening instruments for problem drinking among blacks, whites and hispanics in an emergency room population.

Cherpitel CJ. Journal of Studies on Alcohol 59(4): 420-426, 1998. (38 refs.)
Objective: The purpose of this study was to compare the performance of a number of standard screening instruments for alcohol dependence and harmful drinking/abuse by ethnicity (black, Hispanic and white) and by ethnicity and gender in an emergency room setting. Method: A probability sample of patients (N = 1,429) was breath analyzed and interviewed at the Santa Clara Valley Medical Center in San Jose, California. Sensitivity and specificity were analyzed among current drinkers (n = 857) for the CAGE, Brief MAST, AUDIT, TWEAK, RAPS and other items against combined ICD-10 or DSM-IV criteria for alcohol dependence and separately for alcohol dependence or harmful drinking or abuse. Results: Screening measures were not found to perform equally well by ethnicity or gender, with lower sensitivity found for women compared to men. Consistency in sensitivity of measures was found to vary considerably across ethnic and gender groups, with some measures (most notably the RAPS and the AUDIT) showing consistently high sensitivity across subgroups. None of the instruments performed nearly as well for identifying alcohol dependence or harmful drinking or abuse combined as for alcohol dependence alone. Conclusions: Analyses suggest that, while the RAPS may hold promise for identifying problem drinkers across ethnic and gender subgroups, it and other screening instruments currently in use require additional evaluation in a variety of settings to determine their usefulness for identifying those who could benefit from a brief intervention or referral for problem drinking.

Gender, injury status and acculturation differences in performance of screening instruments for alcohol problems among US Hispanic emergency department patients.

Cherpitel CJ. Drug and Alcohol Dependence 53(2): 147-157, 1999 (44 refs.)
The sensitivity and specificity of several screening instruments including the CAGE, brief MAST, AUDIT, TWEAK, RAPS, and Trauma Scale, were evaluated against both ICD-IO and DSM-IV criteria for alcohol dependence and for harmful drinking and abuse in a probability sample of 586 Hispanic emergency department patients. Screening instruments were not as sensitive for females as for males, for those in the low acculturation group, or for non-dependent drinkers. Acculturation was positively associated with the likelihood of being a current drinker, and among current drinkers, was positively associated with alcohol dependence and with harmful drinking or alcohol abuse.

Ethnic differences in performance of screening instruments for identifying harmful drinking and alcohol dependence in the emergency room.

Cherpitel CJ. Alcoholism: Clinical and Experimental Research 19(3): 628-634, 1995. (32 refs.)
This study examines sensitivity and specificity figures associated with screens used to predict harmful drinking and alcohol dependence among current drinkers. The study population comes from a probability sample of emergency room patients in Jackson, MS. Data are presented by gender and injury status (injured versus noninjured) for Blacks and Whites. The Composite International Diagnostic interview was used to assess ICD-10 criteria for harmful drinking and alcohol dependence, which were taken as standards. Predictors include screening instruments (CAGE AUDIT, brief MAST, TWEAK, and History of Trauma Scale), breathalyzer reading, self-reported consumption before the injury or noninjury event, quantity and frequency of drinking, and abbreviated alcohol dependence experiences measure used in general population surveys. Single items from those screening instruments were also tested as predictors. Overall, the TWEAK and the AUDIT performed best in terms of sensitivity and specificity, but variation across subgroups suggests that the search for a good screening instrument for general use must be continued.

Screening for PTSD in a substance abuse sample: Psychometric properties of a modified version of the PTSD Symptom Scale Self-Report.

Coffey SF; Dansky BS; Falsetti SA; Saladin ME; Brady KT. Journal of Traumatic Stress 11(2): 393-399, 1998
The high rate of post traumatic stress disorder (PTSD) among substance use disorder (SUD) patients has been documented in research protocols, but there is evidence that it is markedly under-diagnosed in clinical settings. To address the need for a brief self-report measure to identify SUD patients who may benefit from further assessment and/or treatment for PTSD, the psychometric properties of a modified version ofthe PTSD Symptom Scale Self-Report (PSS-SR) were examined in a treatment-seeking SUD sample (N = 118). The modified version of the PSS-SR, which measures both frequency and severity of PTSD symptoms, demonstrated good internal consistency reliability and was correlated with other self-report measures of trauma-related symptomatology. Comparisons between a structured PTSD diagnostic interview and the modified PSS-SR indicated that 89% of the PTSD positive patients were correctly classified by the modified PSS-SR. The clinical relevance of these findings was discussed.

Trauma symptoms in substance abusers with and without histories of childhood abuse.

Dunn GE; Ryan JJ; Dunn CE. Journal of Psychoactive Drugs 26(4): 357-360, 1994. (16 refs.)
This study was designed to provide a prevalence rate of childhood abuse in patients being treated for alcohol and other drug problems, and to compare the extent of trauma symptoms that were present in substance abusers with and without childhood histories of physical, sexual, and emotional abuse. One hundred male veterans completed a standard test battery that included the Trauma Symptom Checklist and the Dissociative Experiences Scale. Clinical information pertaining to history of childhood abuse was obtained from the subjects' medical charts. Results demonstrated that 34% of the sample reported a history of childhood abuse. Although this group did achieve higher mean scores on all the scales, in comparison to the nonabused group, statistical significance was absent. Implications of these findings are discussed and future research is suggested.

Screening of binge drinking among patients on an emergency surgical ward.

Forsberg L; Halldin J; Ekman S; Ronnberg S. Alcohol 27(2): 77-82, 2002, (36 refs.)
In a sample of 149 emergency surgical patients, binge drinking was assessed through interviews. Sensitivity, specificity, and positive and negative predictive values were calculated for three questionnaires-the Malmo modification of brief MAST (Mm-MAST), CAGE, and the Trauma Scale-and two biological markers-carbohydrate- deficient transferrin (CDT) and gamma-glutamyltransferase (GGT). Binge drinking was reported by 42% of male patients, aged 16-29 years; 66% of female patients, aged 16-29 years; 27% of male patients, aged 30-73 years; and 16% of female patients, aged 30-73 years. All alcohol biomarkers had low sensitivity to binge drinking among women. Mm-MAST alone and CAGE and CDT combined were sensitive to identifying binge drinking among men aged 30-73 years. The three questionnaires combined had a sensitivity of 0.82 to binge drinking among men aged 16-29 years.