Journal de l'alcoolisme et de la toxicomanie
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Value of Visual Screening by Medical Doctors in Diagnosing Alcohol Abuse: A Prospective Study

P Chevalley, J Gauthey, D Pignat, M Faouzi, V Darioli and D Genné

Goal of the study: To determine the ability of physicians to identify persons suffering from alcohol abuse by a visual first-look evaluation and to assess the impact of the examiner’s clinical experience on the accurateness of the evaluation. Method: 28 Doctors working in two hospitals determine with a rapid visual contact if 157 in-patients suffer from alcohol abuse. Every patient was independently evaluated for alcohol abuse based upon the CAGE questionnaire and DSM-IV criteria, considered together as “gold standard”. Results: 1118 evaluations were performed. Alcohol abuse was diagnosed in 19.7%, using gold-standard. The specificity of a visual first-look evaluation was 90.55%, the positive predictive value 62.5% and the positive likelihood ratio 3.89. The sensitivity was 40%. There was no statistically significant difference in performance according to clinical experience. Conclusions: Sensitivity of rapid visual inspection for diagnostic of alcohol abuse is weak and thus not appropriate for screening. Specificity, however, approaches that of CAGE. Clinical experience of the examiner had no impact on performance.