title: Developing a standardized measurement of alcohol intoxication.
abstract: BACKGROUND
  We assessed multiple examinations and assessment tools to develop a standardized measurement of alcohol intoxication to aid medical decision making in the Emergency Department.
  
  
  METHODS
  Volunteers underwent an alcohol challenge. Pre- and post-alcohol challenge, subjects were videotaped performing three standardized clinical examinations: (1) Standardized Field Sobriety Test (SFST) examination, (2) Hack's Impairment Index (HII) examination, and (3) Cincinnati Intoxication Examination (CIE). Emergency clinicians evaluated the level of intoxication using five standardized assessment tools in a blinded and randomized fashion: (1) SFST assessment tool (range 0-18), (2) HII assessment tool (range 0-1), (3) St. Elizabeth Alcohol Intoxication Scale (STE, range 0-17), (4) a Visual Analog Scale (VAS, range 0-100), and (5) a Binary Intoxication Question (BIQ). Construct validity was assessed along with inter- and intra-rater reliability.
  
  
  RESULTS
  Median scores pre- and post-alcohol challenge were: SFST 6 (interquartile range 5) and 11 (3), respectively; HII 0 (0.05), 0.1 (0.1); STE 0 (1), 1 (2); VAS 10 (22), 33 (31). For BIQ, 59% and 91% indicated intoxication, respectively. Inter-rater reliability scores were: SFST 0.71 (95% confidence interval 0.48-0.86) to 0.93 (0.88-0.97) depending on examination component; HII 0.90 (0.82-0.95); STE 0.86 (0.75-0.93); VAS 0.92 (0.88-0.94); BIQ 0.3. Intra-rater reliability scores were: SFST 0.74 (0.64-0.82) to 0.87 (0.81-0.91); HII 0.85 (0.79-0.90); STE 0.78 (0.68-0.85); VAS 0.82 (0.74-0.87); BIQ 0.71. VAS reliability was best when paired with the HII and SFST examinations.
  
  
  CONCLUSIONS
  HII examination, paired with either a VAS or HII assessment tool, yielded valid and reliable measurements of alcohol intoxication.
authors.affiliation: University of Cincinnati College of Medicine, Department of Emergency Medicine, 231 Albert Sabin Way, PO Box 670769, Cincinnati, OH 45267-0769, USA. Electronic address: justin.benoit@uc.edu.
authors.forename: Justin L
authors.initials: JL
authors.lastname: Benoit
authors.affiliation: University of Cincinnati College of Medicine, Department of Emergency Medicine, 231 Albert Sabin Way, PO Box 670769, Cincinnati, OH 45267-0769, USA.
authors.forename: Kimberly W
authors.initials: KW
authors.lastname: Hart
authors.affiliation: University of Cincinnati College of Medicine, Department of Emergency Medicine, 231 Albert Sabin Way, PO Box 670769, Cincinnati, OH 45267-0769, USA.
authors.forename: Adam A
authors.initials: AA
authors.lastname: Soliman
authors.affiliation: University of Cincinnati College of Medicine, Department of Emergency Medicine, 231 Albert Sabin Way, PO Box 670769, Cincinnati, OH 45267-0769, USA.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Barczak
authors.affiliation: University of Cincinnati College of Medicine, Department of Emergency Medicine, 231 Albert Sabin Way, PO Box 670769, Cincinnati, OH 45267-0769, USA.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Sibilia
authors.affiliation: University of Cincinnati College of Medicine, Department of Emergency Medicine, 231 Albert Sabin Way, PO Box 670769, Cincinnati, OH 45267-0769, USA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Lindsell
authors.affiliation: University of Cincinnati College of Medicine, Department of Emergency Medicine, 231 Albert Sabin Way, PO Box 670769, Cincinnati, OH 45267-0769, USA.
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Fermann
mesh_terms: D000328:Adult; D000368:Aged; D000435:Alcoholic Intoxication / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology; D000066491:Clinical Decision-Making; D004636:Emergency Service, Hospital; D000431:Ethanol / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D064368:Healthy Volunteers; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012015:Reference Standards; D015203:Reproducibility of Results; D015813:Substance Abuse Detection / Q000379:methods; D014481:United States; D064232:Visual Analog Scale; D055815:Young Adult
chemical_list: D000431:Ethanol