Screening for alcohol misuse in the emergency department needs to be done quickly and accurately, so it makes sense to find the best instrument for this purpose.

This systematic review of diagnostic cohort studies searched a range of databases and journals and also conducted citation searching because of a lack of relevant literature found by the initial search.

In the end, the authors found 7 studies worth including in the review, which covered the following alcohol screening tools:

• The FAST alcohol screening tool (FAST)
• The Paddington Alcohol Test (PAT, PDF)
• The Rapid Alcohol Problem Screen (RAPS-4)
• The TWEAK test (where TWEAK is an acronym: tolerance, worried, eye-opener, amnesia, K (cut-down)).

The review found that:

• The FAST tool was the most sensitive (93-94%), with a specificity of 86-88% and a positive predicted value of 86-87%, so may be best for accurately identifying alcohol misuse within emergency department patients
• However, FAST is a universal screening tool which requires time and money to be used effectively, and these attributes are not always available in busy A&E departments
• In contrast, the PAT has been developed to be used on a select population within the emergency department and has already been shown to be cost-effective

The limited number of studies included in this review begs a question about the inclusion criteria used by the researcher. Is the emergency department so different from other settings that the reviewers should limit their search to articles set in emergency departments?

Jones LA. Systematic review of alcohol screening tools for use in the emergency department. Emerg Med J. 2011 Mar;28(3):182-91. Epub 2010 Oct 14. [PubMed abstract]