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
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Article info
Publication history
Published online: July 21, 2009
Accepted:
May 8,
2009
Received in revised form:
April 2,
2009
Received:
November 4,
2008
Identification
Copyright
© 2010 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
