Detection of acute alcohol intoxication and chronic alcohol dependence by trauma center staff.
BACKGROUND
Trauma patients with acute alcohol intoxication or chronic alcohol dependence are at greater risk for morbidity and mortality. We hypothesized that relying on clinical suspicion to detect acute alcohol intoxication and chronic alcohol dependence in trauma patients is inaccurate, influenced by injury factors, and biased by race, gender, age, and socioeconomic status.


METHODS
Trauma patients were screened with a blood alcohol concentration and with the Short Michigan Alcohol Screening Test and CAGE questionnaire. Before screening, physicians and emergency department nurses were asked whether the patient was acutely intoxicated (blood alcohol concentration > 100 mg/ dL) or had a chronic alcohol problem. Sensitivity, specificity, positive, and negative predictive values were determined by comparing responses with blood alcohol concentration, Short Michigan Alcohol Screening Test, and CAGE questionnaire results, stratified by injury and demographic factors.


RESULTS
Clinical evaluations were obtained on 462 patients. Overall, 23% of acutely intoxicated patients were not identified by physicians. The miss rate increased to one third in severely injured, chemically paralyzed, or intubated patients. Specificity was also poor. Patients with a negative blood alcohol concentration were more likely to be falsely suspected of intoxication if they were either young, male, perceived as disheveled, uninsured, or having a low income (p < 0.05). Staff identified < 50% of patients with a positive Short Michigan Alcohol Screening Test or CAGE, and falsely identified 26% of patients as alcoholic.


CONCLUSIONS
Formal alcohol screening should be routine because clinical detection of acute alcohol intoxication and dependence is inaccurate. Screening should also be routine to avoid discriminatory bias attributable to patient characteristics.
Gentilello
L M
LM
University of Washington School of Medicine, Department of Surgery, Harborview Injury Prevention and Research Center, Seattle, USA. larrygen@u.washington.edu
Villaveces
A
A
Ries
R R
RR
Nason
K S
KS
Daranciang
E
E
Donovan
D M
DM
Copass
M
M
Jurkovich
G J
GJ
Rivara
F P
FP
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000435:Alcoholic Intoxication / Q000097:blood / Q000175:diagnosis*; D000437:Alcoholism / Q000097:blood / Q000175:diagnosis*; D001291:Attitude of Health Personnel; D015982:Bias; D002908:Chronic Disease; D002983:Clinical Competence / Q000592:standards*; D000431:Ethanol / Q000097:blood; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D010564:Personnel, Hospital / Q000193:education / Q000523:psychology*; D011287:Prejudice; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires / Q000592:standards*; D014193:Trauma Centers
D000431:Ethanol