Neumann T, Neuner B, Weiss-Gerlach E, Psych D, Tonnesen H, Gentilello L, et al. The effect of computerized tailored brief advice on at-risk drinking in subcritically injured trauma patients. J Trauma Inj, Infect, and Crit Care. 2006;(61):805-814.
Alcohol use disorders are prevalent in injured patients. Brief interventions conducted in the acute trauma phase have been shown to be an effective means of reducing subsequent alcohol intake, related morbidity, and the risk of recurrent injury. This longitudinal study looks at the effect of self-administered, computerized, brief intervention in adult emergency department (ED) patients.
STUDY METHODS AND RESULTS
This is a randomized prospective study that looked at a total of 1,139 subcritically injured, medically stable patients aged 18 years or older who screened positive for an alcohol use disorder. Patients were considered to screen positive if they had an alcohol use disorders identification test (AUDIT) score of greater than or equal to 5. The AUDIT is a 10-item questionnaire that quantifies drinking from at-risk to dependent behaviors. This cutoff point enabled researchers to identify patients with at-risk drinking but did not meet diagnostic criteria for harmful use or dependence. Trained research fellows in addition performed face-to-face interviews to see whether patients met International Classification of Disease, 10th Revision criteria for alcohol abuse or dependence. Five hundred sixty-three patients were randomized to receive an intervention, whereas 576 were randomized as controls that did not receive an intervention.
The intervention consisted of a computerized-generated feedback about current alcohol consumption on the basis of information obtained from the AUDIT and the readiness to change questionnaire and written information providing strategies for behavioral change. The readiness to change questionnaire measures a patient's willingness to change his alcohol consumption.
Follow-up was conducted at 6 and 12 months for both intervention and control groups. Prior to intervention, both groups had similar number of individuals who met criteria for at-risk drinking. At 6 months postintervention, 21.7% of intervention and 30.4% of control patients met criteria for at-risk drinking. At 12-months postintervention, however, the proportion of at-risk drinkers did not differ between groups. With regard to alcohol intake, at 6 months postintervention, those in the intervention group had a 35.7% decrease in alcohol intake in comparison with a 20.5% decrease in the control group. At 12 months those in the intervention group had a 22.8% decrease in alcohol intake, whereas the control group had a 10.9% decrease in alcohol intake.
GENERAL COMMENTARY
This is a particularly relevant topic overall, given the American College of Surgeons' mandate for screening patients with alcohol problems and brief interventions to be done at level I and level II trauma centers. The study supports the use of a helpful, cost-effective, and pragmatic approach for clinicians working in the ED. Strengths of the study are a robust design, sample size, known validity, and reliability of the instruments used to determine at-risk drinking and readiness to change drinking behaviors, and a thorough analysis of the defined patient population. Limitations included patients who were excluded from the study because of their injury severity/medical instability, psychological impairment, or concurrent alcohol intoxication rendering results not wholly applicable to all injured patients. Furthermore, there was a reduction in the treatment effect at 1 year that suggests that further studies be done, which support approaches that extend the duration of the treatment effect.
Overall, this study provides compelling evidence that computerized screening and brief intervention can have a significant impact on patients treated in the ED.