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Increased Cut‐Point of the TACER‐3 Screen Reduces False Positives Without Losing Sensitivity in Predicting Risk Alcohol Drinking in Pregnancy
Author(s) -
Chiodo Lisa M.,
DelaneyBlack Virginia,
Sokol Robert J.,
Janisse James,
Pardo Yobany,
Hannigan John H.
Publication year - 2014
Publication title -
alcoholism: clinical and experimental research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.267
H-Index - 153
eISSN - 1530-0277
pISSN - 0145-6008
DOI - 10.1111/acer.12368
Subject(s) - pregnancy , medicine , relative risk , false positive paradox , obstetrics , risk factor , risk assessment , cohort , alcohol , cohort study , confidence interval , statistics , biology , biochemistry , computer science , genetics , mathematics , computer security
Background Detection of in‐pregnancy maternal risk alcohol drinking is an essential first step in preventing fetal alcohol spectrum disorders, and the widely used T‐ ACE screen was developed for that purpose. We recently reported that increasing the total T‐ ACE score cut‐point from 2 to 3 doubled specificity of detecting risk drinking in pregnancy and identified 4‐year‐old children with neurobehavioral effects associated with prenatal alcohol exposure. Methods In this study, the TACER ‐3 was further validated in another prospectively identified high‐risk urban cohort. Women were categorized as follows: (i) Not At‐Risk Group (negative on T‐ ACE and TACER ‐3); (ii) At‐Risk Group (positive on T‐ ACE and TACER ‐3); and (iii) Change Risk Group (positive on T‐ ACE but negative on TACER ‐3). Results The TACER ‐3 total score cut‐point of 3 yielded fewer “false positives” than the T‐ ACE cut‐point of 2. Based on relative risk scores, women in the TACER ‐3‐positive At‐Risk Group were more likely to drink alcohol during pregnancy than women in the Change Risk Group. In contrast, women in the Not At‐Risk Group were largely not different in their drinking from women in the Change Risk Group. The largest increases in relative risk of the At‐Risk Group compared to the Change Risk Group were for the amount of drinking per day across pregnancy ( RR = 11.4) and for the amount of drinking per drinking day at the first prenatal visit ( RR = 12.7). For both of these measures, the relative risk of at‐risk alcohol consumption in the At‐Risk Group was over >10 times that of the Change Risk Group. Conclusions Thus, the TACER ‐3 was more effective at selectively identifying women drinking at fetal risk levels than the original T‐ ACE . The TACER ‐3 allows for more efficient use of healthcare provider time in directing targeted clinical interventions with pregnant women identified as drinking at fetal risk levels.