Advertisement

Clinical Sobriety Assessment by Emergency Physicians in Blunt Trauma Patients with Acute Alcohol Exposure

      Abstract

      Background: Alcohol use increases injury risk and severity. However, few studies have evaluated the ability of emergency physicians (EPs) to accurately determine sobriety. Objectives: To determine the predictive value of clinical sobriety assessment by EPs in blunt trauma patients with acute alcohol use. Materials and Methods: Blunt trauma patients, aged 18–65 years with suspected acute alcohol use, were prospectively enrolled in the study. EPs assessed study subjects before sample collection for blood alcohol level (BAL) and urine drug screen measurement. Alcohol exposure was considered significant if BAL was ≥ 80 mg/dL. Sobriety (non-significant alcohol exposure) was defined as a BAL < 80 mg/dL. EP sobriety assessment was compared to measured BAL and predictive values were calculated. Agreement on significance of alcohol exposure occurred if EP-estimated BAL > 80 mg/dL agreed with measured BAL > 80 mg/dL, or estimated BAL < 80 mg/dL agreed with measured BAL < 80 mg/dL. Chi-squared analysis was used to compare the proportion of correct physician assessments among patients with sobriety and those with significant alcohol exposure. Results: Of 158 enrolled subjects, 153 completed clinical assessment. EP assessment had a predictive value of 83% (95% confidence interval [CI] 77–90%) for significant alcohol exposure and 69% (95% CI 60–78%) for sobriety. Agreement on the significance of alcohol exposure was 82% (125/153; 95% CI 76–88%). EPs identified 32% (11/34; 95% CI 17–48%) of sober patients, but identified 96% (114/119; 95% CI 92–99%) of patients with significant alcohol exposure. EP assessment was significantly less accurate in identifying sober patients (p < 0.01). Conclusions: Emergency physicians identified significant recent alcohol exposure in blunt trauma patients 96% of the time. However, clinical assessment by EPs in blunt trauma patients with recent alcohol use had only moderate predictive value for significant alcohol exposure. Sober patients were frequently misidentified as having significant alcohol exposure.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • World Health Organization
        Alcohol and injury in emergency departments: summary of the report from the WHO collaborative study on alcohol and injuries.
        World Health Organization, Geneva, Switzerland2007
        • Gentilello L.M.
        • Ebel B.E.
        • Wickizer T.M.
        • et al.
        Alcohol interventions for trauma patients treated in emergency departments and hospitals; a cost benefit analysis.
        Ann Surg. 2005; 241: 541-549
        • National Center for Injury Prevention and Control
        WISQARStm (Web-based Injury Statistics Query and Reporting System) Center for Disease Control.
        (Accessed June 1, 2008)
        • Waller P.F.
        • Hill E.M.
        • Maio R.F.
        • et al.
        Alcohol effects on motor vehicle crash injury.
        Alcohol Clin Exp Res. 2003; 27: 695-703
        • Fabbri A.
        • Marchesini G.
        • Morselli-Labate A.M.
        • et al.
        Positive blood alcohol concentration and road accidents: a prospective study in an Italian emergency department.
        Emerg Med J. 2002; 19: 210-214
        • Pulrad D.
        • Demetriades D.
        • Gruzinski G.
        • et al.
        Pedestrian injuries: the association of alcohol consumption with the type and severity of injuries and outcomes.
        J Am Coll Surg. 2006; 202: 919-927
        • Cunningham R.M.
        • Maio R.F.
        • Hill E.M.
        • Zink B.J.
        The effects of alcohol on head injury in the motor vehicle crash victim.
        Alcohol Alcohol. 2002; 37: 236-240
        • Johnston J.J.
        • McGovern S.J.
        Alcohol related falls: an interesting pattern of injuries.
        Emerg Med J. 2004; 21: 185-188
        • Shih H.C.
        • Hu S.C.
        • Yang C.C.
        • et al.
        Alcohol intoxication increases morbidity in drivers involved in motor vehicle accidents.
        Am J Emerg Med. 2003; 21: 91-94
        • Fabbri A.
        • Marchesini G.
        • Morselli-Labate A.M.
        • et al.
        Blood alcohol concentration and management of road trauma patients in the emergency department.
        J Trauma. 2001; 50: 521-528
        • Hoffman J.R.
        • Mower W.R.
        • Wolfson A.B.
        • et al.
        Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma.
        N Engl J Med. 2000; 343: 94-99
        • Haydel M.J.
        • Preston C.A.
        • Mills T.J.
        • et al.
        Indications for computed tomography in patients with minor head injury.
        N Engl J Med. 2000; 343: 100-105
        • Cherpitel C.
        • Bond J.
        • Ye Y.
        • et al.
        Clinical assessment compared with breathalyser readings in the emergency room: concordance of ICD-10 Y90 and Y91 codes.
        Emerg Med J. 2005; 22: 689-695
        • Gmel G.
        • Givel J.C.
        • Yersin B.
        • Daeppen J.B.
        Injury and repeated injury – what is the link with acute consumption, binge drinking and chronic heavy alcohol use?.
        Swiss Med Wkly. 2007; 137: 642-648
        • Watt K.
        • Purdie D.M.
        • Roche A.M.
        • et al.
        Risk of injury from acute alcohol consumption and the influence of confounders.
        Addiction. 2004; 99: 1262-1273
        • Spurling A.C.
        • Vinson D.C.
        Alcohol-related injuries: evidence for the prevention paradox.
        Ann Fam Med. 2005; 3: 47-52
        • Vinson D.C.
        • Maclure M.
        • Reidinger C.
        • et al.
        A population-based case-crossover and case-control study of alcohol and the risk of injury.
        J Stud Alcohol. 2003; 64: 358-366
        • Langdorf M.I.
        • Rudkin S.E.
        • Dellota K.
        • et al.
        Decision rule and utility of routine urine toxicology screening of trauma patients.
        Eur J Emerg Med. 2002; 9: 115-121
        • Moeller K.E.
        • Lee K.C.
        • Kissack J.C.
        Urine drug screening: practical guide for clinicians.
        Mayo Clin Proc. 2008; 83: 66-76