Screening for problematic opioid use in the emergency department: Comparison of two screening measures.
Screening for problematic opioid use in the emergency department: Comparison of two screening measures.
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DOI：
10.1002/emp2.13106
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发表时间：
2024-02
影响因子：
2.3
通讯作者：
Lyons, Michael S
中科院分区：
文献类型：
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作者：
Punches, Brittany E;Freiermuth, Caroline E;Sprague, Jon E;Brown, Jennifer L;Hutzel-Dunham, Elizabeth;Lambert, Joshua;Braun, Robert;Littlefield, Andrew;Frey, Jennifer A;Bachmann, Daniel J;Bischof, Jason J;Pantalon, Michael V;Ancona, Rachel M;Kisor, David F;Lyons, Michael S
对阿片类药物使用障碍 (OUD) 的早期干预可能会减少长期的健康影响。美国的急诊室 (ED) 每年用 OUD 治疗数百万人，他们可能不会在其他地方寻求治疗。我们的目标是 (1) 比较急诊科中 OUD 特征的两种筛查措施，以及 (2) 确定 OUD 筛查呈阳性的急诊科患者和支持其他药物使用的患者的比例，以指导未来的筛查计划。一项横断面研究纳入了随机选择的在美国中西部三个急诊室就诊的成年患者，排除了重复的患者。调查是通过研究助理进行的，并记录在平板设备上。人口统计数据由自我报告，并通过 DSM 5 检查表和 WHO ASSIST 3.1 评估 OUD 阳性。主要结果是两种 OUD 筛查措施之间的一致性。我们的次要结果是符合 OUD 标准和认可的同时发生的物质使用障碍 (SUD) 标准的 ED 患者比例。我们招募了 1305 名参与者；参与者的中位年龄为 46 岁（范围 18-84 岁），其中 639 名（49.0%）非西班牙裔、白人和 693 名（53.1%）女性。通过 DSM-5（两个或更多标准）或 ASSIST（分数为 4 或更高），17% 的参与者（1305 人中的 222 人）发现当前 OUD 阳性。我们发现这些测量值之间有一定的一致性（kappa = 0.56；Phi 系数 = 0.57）。在 OUD 筛查呈阳性的个体中，182 人 (82%) 认可同时发生 SUD 的标准。 OUD 在 ED 人群中非常普遍，六分之一的 ED 患者筛查呈阳性。我们发现患有 OUD 和同时发生 SUD 的人的患病率很高，并且措施之间具有中等程度的一致性。在急诊室开发和实施临床上可行的 OUD 筛查对于实现干预至关重要。
Earlier intervention for opioid use disorder (OUD) may reduce long‐term health implications. Emergency departments (EDs) in the United States treat millions with OUD annually who may not seek care elsewhere. Our objectives were (1) to compare two screening measures for OUD characterization in the ED and (2) to determine the proportion of ED patients screening positive for OUD and those who endorse other substance use to guide future screening programs. A cross‐sectional study of randomly selected adult patients presenting to three Midwestern US EDs were enrolled, with duplicate patients excluded. Surveys were administered via research assistant and documented on tablet devices. Demographics were self‐reported, and OUD positivity was assessed by the DSM 5 checklist and the WHO ASSIST 3.1. The primary outcome was the concordance between two screening measures for OUD. Our secondary outcome was the proportion of ED patients meeting OUD criteria and endorsed co‐occurring substance use disorder (SUD) criteria. We enrolled 1305 participants; median age of participants was 46 years (range 18–84), with 639 (49.0%) Non‐Hispanic, White, and 693 (53.1%) female. Current OUD positivity was identified in 17% (222 out of 1305) of the participants via either DSM‐5 (two or more criteria) or ASSIST (score of 4 or greater). We found moderate agreement between the measures (kappa = 0.56; Phi coefficient = 0.57). Of individuals screening positive for OUD, 182 (82%) endorsed criteria for co‐occurring SUD. OUD is remarkably prevalent in ED populations, with one in six ED patients screening positive. We found a high prevalence of persons identified with OUD and co‐occurring SUD, with moderate agreement between measures. Developing and implementing clinically feasible OUD screening in the ED is essential to enable intervention.