title: 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.
  
  
  OBJECTIVE
  To determine the predictive value of clinical sobriety assessment by EPs in blunt trauma patients with acute alcohol use.
  
  
  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.
authors.affiliation: Department of Emergency Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana 71130, USA.
authors.forename: Simon A
authors.initials: SA
authors.lastname: Mahler
authors.forename: Sanjay
authors.initials: S
authors.lastname: Pattani
authors.forename: Jesse
authors.initials: J
authors.lastname: Standifer
authors.forename: Gloria
authors.initials: G
authors.lastname: Caldito
authors.forename: Steven A
authors.initials: SA
authors.lastname: Conrad
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Arnold
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000435:Alcoholic Intoxication / Q000175:diagnosis* / Q000453:epidemiology*; D002983:Clinical Competence; D015897:Comorbidity; D003951:Diagnostic Errors; D004635:Emergency Medicine; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014949:Wounds, Nonpenetrating / Q000453:epidemiology*; D055815:Young Adult