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Three Part Question

In [Adult patients presenting to the ED due to Alcohol] is [the Paddington alcohol test better then the CAGE] at [screening for alcohol problems]?

Clinical Scenario

A patient arrives in the emergency department because of an alcohol related incident. You want to know whether they are at risk of further problems and believe the Paddington Alcohol test would be appropriate but are not sure if it is as useful as the better known CAGE questions.

Search Strategy

Using the OVID Interface:
Medline 1996-06/07:
[PAT.mp. or paddington alcohol test.mp. or CAGE.mp. or cage questions.mp or (cage adj5 alcohol).mp or (paddington adj5 alcohol).mp] and [exp Ethanol or exp Alcoholism or exp Alcohol Drinking or exp Alcoholic Intoxication] and limit to (humans and english language)
Embase 1996-2007 week 26:
[PAT.mp. or paddington alcohol test.mp. or CAGE.mp. or cage questions.mp or (cage adj5 alcohol).mp or (paddington adj5 alcohol).mp] and [exp Ethanol or exp Alcoholism or exp Alcohol Drinking or exp Alcoholic Intoxication] and limit to (humans and english language)

Search Outcome

Medline found 244 articles and Embase found 261 articles. 1 of these articles was found to be relevant.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Hodgson RJ et al 2002 Britain	Al total of 2185 patients seen by triage nurses in 4 Emergency Department unless they refused, unable to read english, severely intoxicated by drugs or alcohol or in too much pain/confusion. Each Patient was randomly administered one of three short screening tests; FAST, CAGE or PAT. All patients were administered the AUDIT questionnaire as the gold standard	Randomised Control Trial	Sensitivity of screening tools compared to AUDIT	CAGE Sensitivity 40.3% with 95% confidence interval 34.9% to 45.9%, PAT sensitivity 70.0% 95% CI 64.1% to 75.3%	Use of Audit Questionnaire as Gold standard. Use Of Paddington Alcohol Test slightly out of context it was designed for.
			Specificity of screening tools compared to AUDIT	CAGE Specificity 97.7% CI 95.8% to 98.7%, PAT Specificity 84.5% CI 80.8% to 87.6%

Comment(s)

The main aim of Hodgson's paper was to compare a different screening tool (FAST) , however the CAGE and PAT were assessed in the same way. The PAT is meant to be used on patients with certain presentations causing suspicion of alcohol misuse which was not the case in the study. It still performed comparably well with regards to the CAGE questions

Clinical Bottom Line

In the Emergency Department the Paddington Alcohol Test is a useful and reliable screening tool for alcohol misuse and should be administered to appropriate patients

References

1. Hodgson RJ Fast screening for Alcohol misuse Addictive Behaviors. 2003 Oct, 28(8):1453-63