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Screening for Alcohol Abuse Using CAGE Scores and Likelihood Ratios

David G. Buchsbaum, MD, MHA; Robin G. Buchanan, BA; Robert M. Centor, MD; Sidney H. Schnoll, MD, PhD; and Marcia J. Lawton, PhD
[+] Article, Author, and Disclosure Information

Grant Support: By the Commonwealth Center on Drug Abuse Faculty Grant Program and The Bureau of Health Professions HRSA Grant for Residency Training in General Internal Medicine.

Requests for Reprints: David Buchsbaum, MD, MHA, Medical College of Virginia, Box 102, Richmond, VA 23298.

Current Author Addresses: Drs. Buchsbaum and Centor and Ms. Buchanan: Medical College of Virginia, Box 102, Richmond, VA 23298.

Dr. Schnoll: Medical College of Virginia, Box 109, Richmond, VA 23298.

Dr. Lawton: Virginia Commonwealth University, Box 2030, Richmond, VA 23220.

© 1991 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1991;115(10):774-777. doi:10.7326/0003-4819-115-10-774
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Objective: To assess the performance of the CAGE (acronym referring to four questions, see below) questionnaire in discriminating between medicine outpatients with and without an alcohol abuse or dependence disorder.

Design: A cross-sectional design of a sample of consecutive patients who received both the alcohol module of the diagnostic interview schedule and the CAGE (Cut down, Annoyed, Guilty, Eye-opener) screening questionnaire.

Setting: The outpatient medical practice of an urban university teaching hospital.

Patients: All patients 18 years or older who signed a consent form approved by the university's institutional review board.

Measurement: Calculation of the sensitivity, specificity, receiver operating characteristic (ROC) curve, and likelihood ratio for CAGE scores of 0 to 4.

Results: Thirty-six percent of the sample group met criteria for a history of alcohol abuse or dependence. A CAGE score of 2 or more was associated with a sensitivity and specificity of 74% and 91%. The calculated area under the ROC curve was 0.89, whereas the likelihood ratios for CAGE scores of 0 to 4 were 0.14, 1.5, 4.5, 13, and 100, respectively. These ratios were associated with posterior probabilities for an abuse or dependence disorder of 7%, 46%, 72%, 88%, and 98%, respectively.

Conclusion: Clinicians can improve their ability to estimate a patient's risk for an alcohol abuse or dependence disorder using likelihood ratios for CAGE scores.





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