ImportanceThe accuracy of screening tests for alcohol use disorder (defined as a problematic pattern of alcohol use leading to clinically significant impairment or distress) requires reassessment to align with the latest definition in the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5).ObjectiveTo assess the diagnostic accuracy of screening tools in identifying individuals with alcohol use disorder as defined in the DSM-5.Data Sources and Study SelectionThe databases of MEDLINE and Embase were searched (January 2013-February 2023) for original studies on the diagnostic accuracy of brief screening tools to identify alcohol use disorder according to the DSM-5 definition. Because diagnosis of alcohol use disorder does not include excessive alcohol use as a criterion, studies of screening tools that identify excessive or high-risk drinking among younger (aged 9-18 years), older (aged ≥65 years), and pregnant persons also were retained.Data Extraction and SynthesisSensitivity, specificity, and likelihood ratios (LRs) were calculated. When appropriate, a meta-analysis was performed to calculate a summary LR.ResultsOf 4303 identified studies, 35 were retained (N = 79 633). There were 11 691 individuals with alcohol use disorder or a history of excessive drinking. Across all age categories, a score of 8 or greater on the Alcohol Use Disorders Identification Test (AUDIT) increased the likelihood of alcohol use disorder (LR, 6.5 [95% CI, 3.9-11]). A positive screening result using AUDIT identified alcohol use disorder better among females (LR, 6.9 [95% CI, 3.9-12]) than among males (LR, 3.8 [95% CI, 2.6-5.5]) (P = .003). An AUDIT score of less than 8 reduced the likelihood of alcohol use disorder similarly for both males and females (LR, 0.33 [95% CI, 0.20-0.52]). The abbreviated AUDIT-Consumption (AUDIT-C) has sex-specific cutoff scores of 4 or greater for males and 3 or greater for females, but was less useful for identifying alcohol use disorder (males: LR, 1.8 [95% CI, 1.5-2.2]; females: LR, 2.0 [95% CI, 1.8-2.3]). The AUDIT-C appeared useful for identifying measures of excessive alcohol use in younger people (aged 9-18 years) and in those older than 60 years of age. For those younger than 18 years of age, the National Institute on Alcohol Abuse and Alcoholism age-specific drinking thresholds were helpful for assessing the likelihood of alcohol use disorder at the lowest risk threshold (LR, 0.15 [95% CI, 0.11-0.21]), at the moderate risk threshold (LR, 3.4 [95% CI, 2.8-4.1]), and at the highest risk threshold (LR, 15 [95% CI, 12-19]). Among persons who were pregnant and screened within 48 hours after delivery, an AUDIT score of 4 or greater identified those more likely to have alcohol use disorder (LR, 6.4 [95% CI, 5.1-8.0]), whereas scores of less than 2 for the Tolerance, Worried, Eye-Opener, Amnesia and Cut-Down screening tool and the Tolerance, Annoyed, Cut-Down and Eye-Opener screening tool identified alcohol use disorder similarly (LR, 0.05 [95% CI, 0.01-0.20]).Conclusions and RelevanceThe AUDIT screening tool is useful to identify alcohol use disorder in adults and in individuals within 48 hours postpartum. The National Institute on Alcohol Abuse and Alcoholism youth screening tool is helpful to identify children and adolescents with alcohol use disorder. The AUDIT-C appears useful for identifying various measures of excessive alcohol use in young people and in older adults.

中文翻译：

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该患者是否患有酒精使用障碍？

重要性酒精使用障碍（定义为导致临床显着损害或痛苦的有问题的饮酒模式）筛查测试的准确性需要重新评估，以与最新定义保持一致。精神疾病诊断与统计手册（第五版） （帝斯曼-5).目的评估筛查工具在识别患有酒精使用障碍的个体时的诊断准确性。帝斯曼-5数据来源和研究选择检索了 MEDLINE 和 Embase 数据库（2013 年 1 月至 2023 年 2 月），以查找关于根据以下标准识别酒精使用障碍的简短筛查工具的诊断准确性的原始研究：帝斯曼-5定义。由于酒精使用障碍的诊断不包括过量饮酒作为标准，因此还对筛查工具进行了研究，以识别年轻人（9-18岁）、老年人（≥65岁）和孕妇的过度饮酒或高风险饮酒情况数据提取和合成计算了灵敏度、特异性和似然比（LR）。在适当的情况下，进行荟萃分析以计算总结 LR。结果在 4303 项已确定的研究中，保留了 35 项 (N = 79 633)。有 11 691 人患有酒精使用障碍或有过量饮酒史。在所有年龄组中，酒精使用障碍识别测试 (AUDIT) 得分为 8 或更高会增加酒精使用障碍的可能性 (LR, 6.5 [95% CI, 3.9-11])。使用 AUDIT 的阳性筛查结果更能识别女性酒精使用障碍（LR，6.9 [95% CI，3.9-12]）比男性（LR，3.8 [95% CI，2.6-5.5]）（磷=.003）。对于男性和女性来说，低于 8 分的 AUDIT 分数降低了酒精使用障碍的可能性（LR，0.33 [95% CI，0.20-0.52]）。缩写的审核消费 (AUDIT-C) 的性别特异性截止分数男性为 4 或更高，女性为 3 或更高，但对于识别酒精使用障碍不太有用（男性：LR，1.8 [95% CI，1.5] -2.2]；女性：LR，2.0 [95% CI，1.8-2.3]）。 AUDIT-C 似乎有助于确定年轻人（9-18 岁）和 60 岁以上人群的过度饮酒情况。对于 18 岁以下的人群，国家酒精滥用和酒精中毒研究所的特定年龄饮酒阈值有助于评估最低风险阈值下酒精使用障碍的可能性（LR，0.15 [95% CI，0.11-0.21] ）、中等风险阈值（LR，3.4 [95% CI，2.8-4.1]）和最高风险阈值（LR，15 [95% CI，12-19]）。在分娩后 48 小时内接受筛查的孕妇中，AUDIT 得分为 4 或更高的人识别出更有可能患有酒精使用障碍的人（LR，6.4 [95% CI，5.1-8.0]），而得分低于 2对于容忍、担心、大开眼界、健忘症和减少筛查工具以及容忍、烦恼、减少和大开眼界筛查工具，相似地识别出酒精使用障碍（LR，0.05 [95% CI，0.01-0.20] ).结论和相关性 AUDIT 筛查工具可用于识别成人和产后 48 小时内个人的酒精使用障碍。国家酒精滥用和酒精中毒研究所青少年筛查工具有助于识别患有酒精使用障碍的儿童和青少年。 AUDIT-C 似乎对于确定年轻人和老年人过度饮酒的各种措施很有用。