title: EMS providers do not accurately note motor-vehicle crash patients with positive serum alcohol concentrations.
abstract: BACKGROUND
  Alcohol use is associated with many motor-vehicle crashes and may increase the severity of injury. Because alcohol use also may mask injury, prehospital emergency care providers (PHECPs) may make inaccurate assessments. To assess and triage crash victims accurately, PHECPs must identify recent alcohol use.
  
  
  OBJECTIVE
  This study examines the accuracy of PHECPs in identifying motor-vehicle crash victims who had positive serum alcohol concentrations.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Included in the study were motor-vehicle crash victims more than 17 years of age who were conveyed directly to a university medical center emergency department by ground ambulance (n = 372). TIME PERIOD: 15 July 1990 to 15 July 1991.
  
  
  METHODS
  Data sources included ambulance report forms and hospital records. Variables that were abstracted included the Revised Trauma Score (RTS), the PHECPs' impression of alcohol use, and serum alcohol concentrations. Sensitivity, specificity, predictive-value positive, predictive-value negative, and 0.95 confidence intervals (0.95 CI) were calculated for the PHECPs' ability to identify patients with a serum alcohol concentration > 0. The relationship between the RTS and the impressions of alcohol use was analyzed with chi-square testing: a p-value of < 0.05 was considered statistically significant.
  
  
  CONCLUSIONS
  This study suggests that PHECPs cannot accurately identify crash victims with positive serum alcohol concentrations. Selection bias and retrospective design are significant limitations of this study. Future studies should develop and evaluate methods to improve PHECPs' accuracy in assessing alcohol use in motor-vehicle crash victims.
authors.affiliation: Department of Surgery, University of Michigan, Ann Arbor 48109-0303, USA.
authors.forename: R F
authors.initials: RF
authors.lastname: Maio
authors.forename: A
authors.initials: A
authors.lastname: Wu
authors.forename: F C
authors.initials: FC
authors.lastname: Blow
authors.forename: B
authors.initials: B
authors.lastname: Zink
mesh_terms: D000063:Accidents, Traffic; D000293:Adolescent; D000328:Adult; D000428:Alcohol Drinking / Q000009:adverse effects / Q000097:blood*; D016009:Chi-Square Distribution; D002983:Clinical Competence / Q000592:standards*; D015331:Cohort Studies; D004634:Emergency Medical Technicians / Q000592:standards*; D000431:Ethanol / Q000097:blood*; D006801:Humans; D008499:Medical Records / Q000592:standards; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D015599:Trauma Severity Indices; D014218:Triage / Q000592:standards*