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Three Part Question

In [patients suspected with alcohol withdrawal] is [the fast alcohol screening test better than AUDIT] at[detecting those at risk of alcohol withdrawal syndrome]

Clinical Scenario

Patient thought to be using alcohol hazardously or showing early signs of alcohol withdrawal. You want to know the best way to assess their risk of alcohol withdrawal syndrome.

Search Strategy

Ovid interface-
Medline 1948 to June week 5 2011
([AUDIT.mp] AND [FAST.mp OR fast alcohol screening test.mp]) LIMIT to human AND English language.
Embase
([AUDIT.mp] AND [FAST.mp OR fast alcohol screening test.mp]) LIMIT to human AND English language.
CINAHL
[AUDIT] AND [FAST OR fast alcohol screening test]

Search Outcome

Medline found 109 papers, Embase found 106 papers and CINAHL found 50 papers. 2 of these papers were found to be relevent.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Meneses-Gaya C et al 2010 Brazil	999 subjects consisting of 429 university students, 40 patients from a psychosocial care centre and 530 patients attending A+E.	Comparative study	Sensitivity of FAST and AUDIT	AUDIT 0.92, FAST 0.92	The two screening tests had been translated into Brazilian Portuguese, although care had been taken to make this as valid as possible.
			Sensitivity of FAST and AUDIT	AUDIT 0.83, FAST 0.81
			Correlation Index	0.93
Hodgson RJ et.al. 2002 UK	2185 patients seen by triage nurses across four A+Es in London, Southampton, Bristol and Cardiff. Exclusion criteria- inability to read English, intoxication, or in excessive pain or confusion.	Randomised control trial.	FAST sensitivity compared to AUDIT as gold standard.	92.8% C.I. 89.2-95.2%	Use of AUDIT as gold standard
			FAST specificity compared to AUDIT as gold standard.	87.6% C.I. 84.3-90.3%
			Mean time taken to complete FAST vs. AUDIT.	12.52 seconds vs. 78 seconds
			Estimated cost per 50 000 patient for FAST vs. AUDIT.	£1669 vs. £10 400.

Comment(s)

FAST compared well with the AUDIT tool and has the added benifit of taking less time to complete, which is beneficial in the emergency setting.

Clinical Bottom Line

The Fast Alcohol Assessment Test is a useful screeing tool for those at risk of alcohol withdrawal in the emergency department.

References

1. Meneses-Gaya C.; Crippa J.A.; Zuardi A.W.; Loureiro S.R.; Hallak J.E.; Trzesniak C.; Machado de Sousa J.P.; Chagas M.H.; Souza R.M.; Martin-Santos R. The fast alcohol screening test (FAST) is as good as the AUDIT to screen alcohol use disorders. Substance use & misuse. 2010; 45 (10) (pp 1542-1557)
2. Hodgson R.J.; John B.; Abbasi T.; Hodgson R.C.; Waller S.; Thom B.; Newcombe R.G. (2003). Fast screening for alcohol misuse Fast screening for alcohol misuse. Addictive Behaviors. 2003; 28 (8) (pp 1453-1463)