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Original article
peer-reviewed

The Clinical Evaluation of Alcohol Intoxication Is Inaccurate in Trauma Patients



Abstract

Background: Discharging patients from emergency centers based on the clinical features of intoxication alone may be dangerous, as these may poorly correlate with ethanol measurements.

Objective: We determined the feasibility of utilizing a hand-held breath alcohol analyzer to aid in the disposition of intoxicated trauma patients by comparing serial breathalyzer (Intoximeter, Alco-Sensor FST, St. Louis, Missouri, USA] data with clinical assessments in determining the readiness of trauma patients for discharge.

Methods: A total of 20 legally intoxicated (LI) patients (blood alcohol concentration (BAC) >80 mg/dL) brought to our trauma center were prospectively investigated. Serial breath samples were obtained using a breathalyzer as a surrogate measure of repeated BAC. A clinical exam (nystagmus, one-leg balance, heel-toe walk) was performed prior to each breath sampling.

Results: The enrollees were 85% male, age 30±10 (range 19-51), with a body mass index (BMI) of 29±7. The average initial body alcohol level (BAL) was 245±61 (range 162-370) mg/dL. Based on breath samples, the alcohol elimination rates varied from 21.5 mg/dL/hr to 45.7 mg/dL/hr (mean 28.5 mg/dL/hr). There were no significant differences in alcohol elimination rates by gender, age, or BMI. The clinical exam also varied widely among patients; only seven of 16 (44%) LI patients demonstrated horizontal nystagmus (suggesting sobriety when actually LI) and the majority of the LI patients (66%) were able to complete the balance tasks (suggesting sobriety).

Conclusion: Intoxicated trauma patients have an unreliable clinical sobriety exam and a wide range of alcohol elimination rates. The portable alcohol breath analyzer represents a potential option to easily and inexpensively establish legal sobriety in this population.



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Original article
peer-reviewed

The Clinical Evaluation of Alcohol Intoxication Is Inaccurate in Trauma Patients


Author Information

Ashwini Kumar

Surgery, University of Texas Health Science Center at San Ant

Travis Holloway

Surgery, University of Texas Health Science Center at San Antonio

Stephen M. Cohn Corresponding Author

Surgery, Staten Island University Hospital

Gregory Goodwiler

Surgery, University of Texas Health Science Center at San Antonio

John R. Admire

Surgery, University of Texas Health Science Center at San Antonio


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. Institutional Review Board of University of Texas Health Science Center, San Antonio issued approval HSC20110163H. Dear Principal Investigator,
Your request to conduct this minimal risk research was approved by Expedited Review on January 13, 2011, under the
following regulation(s):
45 CFR 46.110(b)(1) Category 4: Collection of data through non invasive procedures routinely employed in clinical practice, excluding procedures involving x-rays or microwaves.
45 CFR 46.110(b)(1) Category 5: Research involving materials (data, documents, records or specimens) that have been collected, or will be collected solely for non-research purposes (such as medical treatment or diagnosis).
A waiver of requirement to obtain a valid authorization to use or disclose PHI was also approved. The IRB has determined that the following criteria as required by 45CFR164.512(i) were satisfied:
 -The PHI use or disclosure involves no more than minimal risk to the privacy of individuals based on at least the presence of (1) an adequate plan presented to the Privacy Board to protect PHI identifiers from improper use and disclosure; (2) an adequate plan to destroy those identifiers at the earliest opportunity, consistent with the research, absent a health or research justification for retaining the identifiers or if retention is otherwise required by law; and (3) adequate written assurances that the PHI will not be reused or disclosed to any other person or entity except (a) as required by law, (b) for authorized oversight of the research study, or (c) for other research for which the use or disclosure of the PHI is permitted by the Privacy Rule.
 -The research could not practicably be conducted without the requested waiver or alteration.
 -The research could not practicably be conducted without access to and use of the PHI.
A waiver of documentation of consent is approved based on meeting the requirements specified by 45 CFR 46.117 (c). Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.


Original article
peer-reviewed

The Clinical Evaluation of Alcohol Intoxication Is Inaccurate in Trauma Patients


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Original article
peer-reviewed

The Clinical Evaluation of Alcohol Intoxication Is Inaccurate in Trauma Patients

  • Author Information
    Ashwini Kumar

    Surgery, University of Texas Health Science Center at San Ant

    Travis Holloway

    Surgery, University of Texas Health Science Center at San Antonio

    Stephen M. Cohn Corresponding Author

    Surgery, Staten Island University Hospital

    Gregory Goodwiler

    Surgery, University of Texas Health Science Center at San Antonio

    John R. Admire

    Surgery, University of Texas Health Science Center at San Antonio


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. Institutional Review Board of University of Texas Health Science Center, San Antonio issued approval HSC20110163H. Dear Principal Investigator,
    Your request to conduct this minimal risk research was approved by Expedited Review on January 13, 2011, under the
    following regulation(s):
    45 CFR 46.110(b)(1) Category 4: Collection of data through non invasive procedures routinely employed in clinical practice, excluding procedures involving x-rays or microwaves.
    45 CFR 46.110(b)(1) Category 5: Research involving materials (data, documents, records or specimens) that have been collected, or will be collected solely for non-research purposes (such as medical treatment or diagnosis).
    A waiver of requirement to obtain a valid authorization to use or disclose PHI was also approved. The IRB has determined that the following criteria as required by 45CFR164.512(i) were satisfied:
     -The PHI use or disclosure involves no more than minimal risk to the privacy of individuals based on at least the presence of (1) an adequate plan presented to the Privacy Board to protect PHI identifiers from improper use and disclosure; (2) an adequate plan to destroy those identifiers at the earliest opportunity, consistent with the research, absent a health or research justification for retaining the identifiers or if retention is otherwise required by law; and (3) adequate written assurances that the PHI will not be reused or disclosed to any other person or entity except (a) as required by law, (b) for authorized oversight of the research study, or (c) for other research for which the use or disclosure of the PHI is permitted by the Privacy Rule.
     -The research could not practicably be conducted without the requested waiver or alteration.
     -The research could not practicably be conducted without access to and use of the PHI.
    A waiver of documentation of consent is approved based on meeting the requirements specified by 45 CFR 46.117 (c). Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

    Acknowledgements


    Article Information

    Published: February 14, 2018

    DOI

    10.7759/cureus.2190

    Cite this article as:

    Kumar A, Holloway T, Cohn S M, et al. (February 14, 2018) The Clinical Evaluation of Alcohol Intoxication Is Inaccurate in Trauma Patients. Cureus 10(2): e2190. doi:10.7759/cureus.2190

    Publication history

    Received by Cureus: January 08, 2018
    Peer review began: January 25, 2018
    Peer review concluded: February 09, 2018
    Published: February 14, 2018

    Copyright

    © Copyright 2018
    Kumar et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Background: Discharging patients from emergency centers based on the clinical features of intoxication alone may be dangerous, as these may poorly correlate with ethanol measurements.

Objective: We determined the feasibility of utilizing a hand-held breath alcohol analyzer to aid in the disposition of intoxicated trauma patients by comparing serial breathalyzer (Intoximeter, Alco-Sensor FST, St. Louis, Missouri, USA] data with clinical assessments in determining the readiness of trauma patients for discharge.

Methods: A total of 20 legally intoxicated (LI) patients (blood alcohol concentration (BAC) >80 mg/dL) brought to our trauma center were prospectively investigated. Serial breath samples were obtained using a breathalyzer as a surrogate measure of repeated BAC. A clinical exam (nystagmus, one-leg balance, heel-toe walk) was performed prior to each breath sampling.

Results: The enrollees were 85% male, age 30±10 (range 19-51), with a body mass index (BMI) of 29±7. The average initial body alcohol level (BAL) was 245±61 (range 162-370) mg/dL. Based on breath samples, the alcohol elimination rates varied from 21.5 mg/dL/hr to 45.7 mg/dL/hr (mean 28.5 mg/dL/hr). There were no significant differences in alcohol elimination rates by gender, age, or BMI. The clinical exam also varied widely among patients; only seven of 16 (44%) LI patients demonstrated horizontal nystagmus (suggesting sobriety when actually LI) and the majority of the LI patients (66%) were able to complete the balance tasks (suggesting sobriety).

Conclusion: Intoxicated trauma patients have an unreliable clinical sobriety exam and a wide range of alcohol elimination rates. The portable alcohol breath analyzer represents a potential option to easily and inexpensively establish legal sobriety in this population.



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