Alcohol and drug use in adults younger than 60 years with hip fracture - A comparison of validated instruments and the clinical eye: A prospective multicenter cohort study of 218 patients.

Background: It is a common preconception that young individuals sustaining hip fractures have alcohol and/or drug use disorder. It is important to evaluate the actual use to avoid complications and plan the rehabilitation.
Aim: The primary objective was to assess alcohol and drug consumption in hip fracture patients <60 years using the validated Alcohol Use Disorders Identification Test (AUDIT) and Drug Use Disorders Identification Test (DUDIT) scores. We secondarily investigated the agreement between the instruments and the physicians' clinical evaluation of usage.
Material and Methods: This is a sub-study of 91 women and 127 men from a multicenter cohort study of patients with an acute hip fracture treated at four hospitals in Denmark and Sweden. AUDIT and DUDIT forms were completed by the patients. In addition, the researchers made an evaluation of the patients' alcohol/drug use based on direct patient contact and information on previous alcohol/drug use from medical charts. AUDIT ranges 0-40 with 6 (women) and 8 (men) as the cut-off for hazardous use. DUDIT ranges 0-44 with cut-offs of 2 and 6 indicating drug-related problems.
Results: According to the AUDIT, 29 % of the patients had a hazardous alcohol use (25 % women, 31 % men), whilst the clinical evaluation identified 26 % (24 % women, 28 % men). However, there was a low agreement between "the clinical eye" and AUDIT, as the clinical evaluation only correctly identified 35 of 56 individuals with AUDIT-scores indicating hazardous alcohol use. DUDIT equaled drug related problems in 8 % (5 % women, 10 % men), the clinical evaluation depicted 8 % with drug related problems (4 % women, 10 % men). The agreement was low between "the clinical eye" and DUDIT; only 7 of 15 with DUDIT-scores indicating drug related problems were correctly identified.
Conclusion: Hazardous alcohol consumption is more common in non-elderly hip fracture patients than in the general population. Considering both self-reported alcohol use and clinical evaluation, women have almost as high rate as men. DUDIT indicated drug related problems to be slightly more common than in the population. Still, a majority did not exhibit troublesome use of neither alcohol nor drugs. The two screening methods do not identify the same individuals, and further investigation in clinical practice is needed.
Competing Interests: Declaration of competing interest The authors report disclosures as below. We consider the mentioned activities not to be related to the scope of the current paper. Rogmark - Speakers bureau for Link and Swemac, Magnusson - none, Svanholm - none, Viberg - none, Kristensen - none, Palm - none, Overgaard - Speakers bureau for Johnson & Johnson (personal payment) and Hereus (payment to institution), Rönnquist – none. ICMJE's COI forms are available for all authors.
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