The value of the CAGE in screening for alcohol abuse and alcohol dependence in general clinical populations: a diagnostic meta-analysis

Objective: To perform a meta-analysis to assess diagnostic characteristics of the CAGE in screening for alcohol abuse or dependence in a general clinical population and to test a new method for pooling of ROC curves. Methods: Medline search performed over the period 1/1/1974 to 31/12/2001. Measurement: Calculation of diagnostic values. Results: We identified 35 articles using the DSM criteria as the gold standard to test the diagnostic value of the CAGE. Only 10 studies could be included for the meta-analysis. With a cutoff point greater than or equal to2, the pooled sensitivity is far better in inpatients (0.87) than in primary care patients (0.71) or ambulatory patients (0.60). The pooled specificity also differs for each group. The likelihood ratios seem to be relatively constant over the populations (overall LR+:3.44;LR-:0.18). We calculated a pooled AUC of 0.87 (95% CI 0.85-0.89). At low specificity values, the sensitivity was homogenous over the studies, and at a low sensitivity, the specificity was heterogenous. Conclusion: The diagnostic value of the CAGE is of limited value using this test for screening purposes at his recommended cutpoint of greater than or equal to2. (C) 2004 Elsevier Inc. All rights reserved.