Objectives: Alcohol use disorders are common among patients admitted to an ICU, yet systematic screening is rarely performed. We sought to confirm the construct validity of the full Alcohol Use Disorders Identification Test and to evaluate the performance of the brief three-item Alcohol Use Disorders Identification Test-C using the full Alcohol Use Disorders Identification Test as a proxy gold standard in a population of patients with a medical critical illness.
Design: Secondary analysis.
Setting: The acute respiratory distress syndrome network, a consortium of 12 university centers (44 hospitals) dedicated to conducting multicenter clinical trials in patients with acute respiratory distress syndrome.
Subjects: Patients meeting consensus criteria for acute respiratory distress syndrome.
Interventions: None.
Measurements and main results: Of 1,133 patients enrolled in one of three acute respiratory distress syndrome network studies, 1,037 (92%) had full Alcohol Use Disorders Identification Test data available. Of the included patients, 236 (23%) scored above the screening threshold for an alcohol use disorder on the full Alcohol Use Disorders Identification Test. Construct validity analysis of the full Alcohol Use Disorders Identification Test supported a three-factor model. Compared with the full Alcohol Use Disorders Identification Test, the Alcohol Use Disorders Identification Test -C had an area under the receiver operating characteristic curve of 0.99 for men and 0.98 for women. The optimal cutoff was 4 for both genders. At this cutoff, the Alcohol Use Disorders Identification Test -C had a sensitivity of 95% (95% CI, 92-98%) and specificity of 94% (95% CI, 92-96%) for men and sensitivity of 89% (95% CI, 82-96%) and specificity of 99% (95% CI, 98-100%) for women.
Conclusions: Although a three-factor structure for the Alcohol Use Disorders Identification Test was confirmed in ICU patients with acute respiratory distress syndrome, the first three questions focusing on alcohol consumption provide information that is comparable with the full 10-item Alcohol Use Disorders Identification Test screening questionnaire. This study is limited by the lack of a true gold standard, and the performance of the Alcohol Use Disorders Identification Test -C is likely overestimated due to this limitation.