In SIPS we modified the original Paddington Alcohol Test (PAT, Patton et al 2004) to fit with our research protocol. We retained the original top 10 presenting conditions, which are used to target patients, however we reduced and simplified the following 4 questions down to 2 questions.

Question 1, asked “Do you feel your attendance here is related to your drinking?” if the answer was Yes, then the patient was considered SIPS-PAT positive; if the answer was No, a further question was asked.

Question 2, asked “How often do you have X or more standard drinks on one occasion?” where X = 6 for women and 8 for men, with monthly, weekly, daily or almost daily considered a positive screen (see also appendix 3 for more details). This latter question is identical to the M-SASQ and to the first question of FAST.

The original PAT has undergone validity testing in AED settings as a targeted screening tool and has been found to be of high sensitivity and specificity (Patton et al., 2004). However, it was unclear which approach was most effective in identifying cases in the typical AED setting. Or more specifically, whether universal tools like the M-SASQ or FAST were more likely to be adopted by busy AED staff compared to PAT, which is a targeted screening tool applied in cases with presenting conditions commonly associated with alcohol misuse. Moreover, PAT has been studied exclusively at St Mary’s Hospital, London, where it is embedded in the standard clinical assessment process.

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