Young Il Ryou, et al: Alcohol-screening Instruments in Elderly Male Drinkers Table 2. Cutoff points and performance of screening instruments for identifying at-risk drinking. % (n) Cutoff points Sensitivity Speciﬁcity PPV NPV AUDIT ≥ 6 85.2 (109/128) 73.7 (84/114) 78.4 (109/139) 81.6 (84/103) ≥ 7 77.3 (99/128) 85.1 (97/114) 85.3 (99/116) 77.0 (97/126) ≥ 8 71.1 (91/128) 88.6 (101/114) 87.5 (91/104) 73.2 (101/138) SMAST-G ≥ 1 93.0 (119/128) 27.2 (31/114) 58.9 (119/202) 77.5 (31/40) ≥ 2 82.0 (105/128) 45.6 (52/114) 62.9 (105/167) 69.3 (52/75) ≥ 3 60.9 (78/128) 64.0 (73/114) 65.5 (78/119) 59.3 (73/123) CAGE ≥ 1 87.5 (112/128) 40.4 (46/114) 62.2 (112/180) 74.2 (46/62) ≥ 2 59.4 (76/128) 68.4 (78/114) 67.9 (76/112) 60.0 (78/130) ≥ 3 35.2 (45/128) 93.0 (106/114) 84.9 (45/53) 56.1 (106/189) PPV: positive predictive value, NPV: negative predictive value, AUDIT: Alcohol Use Disorder Identiﬁcation Test, SMAST-G: Short Michigan Alcoholism Screening Test-geriatric version, CAGE: cut down, annoyed, guilty, eye-opener. for identifying at-risk drinking in elderly male drinkers aged ≥ 65 years, the AUDIT produced the greatest AUROC (0.903), followed by the SMAST-G (0.742) and CAGE (0.726). The AUROC was significantly greater for the AUDIT than for the SMAST-G (P < 0.001) and the CAGE (P < 0.001). There was no statistically significant difference in AUROC between the CAGE and the SMAST-G (Figure 1). The optimal cut-off score for the AUDIT in screening for at-risk drinking (where the sum of sensitivity and specificity values was maximal) was 7 points, with sensitivity of 77.3%, specificity of 85.1%, positive predictive value of 85.3%, and negative predictive value of 77.0%. The optimal cut-off score for the SMAST-G in screening for at-risk drinking was 2 points, with sensitivity of 82.0%, specificity of 45.6%, positive predictive value of 62.9%, and negative predictive value of 69.3%. The optimal cut-off score for the CAGE questionnaire in screening for at-risk drinking was 2 points, with sensitivity of 59.4%, specificity of 68.4%, positive predictive value of 67.9%, and negative predictive value of 60.0% (Table 2). 3. Validity of Screening Tools for Alcohol Use Disorders Regarding the AUROC values of the three tools for screening alcohol use disorders in elderly male drinkers aged ≥ 65 years, the AUDIT again showed the greatest AUROC (0.954), followed by the SMAST-G (0.815) and the CAGE (0.833). The AUROC 130 | Vol. 33, No. 3 May 2012 Figure 2. Area under the receiver operating characteristic curves (AUROCs) of screening instruments for identifying alcohol use disorder. AUDIT: Alcohol Use Disorder Identification Test, SMAST-G: Short Michigan Alcoholism Screening Test-geriatric version, CAGE: cut down, annoyed, guilty, eye-opener. *Statistical difference between AUROCs by comparison of paired receiver operating characteristic curves. was significantly greater for the AUDIT than for the SMAST-G (P < 0.001) and the CAGE (P < 0.001). Meanwhile, there was no statistically significant difference in AUROC values between the SMAST-G and the CAGE questionnaire (Figure 2). Korean J Fam Med