The Adequacy of Self-reporting and Physician's Diagnoses for Assessing Alcohol Ingestion in Trauma Patients

ABSTRACT

PURPOSE: In the ED, alcohol ingestion in trauma patients is highly relevant both to the occurrence of an injury and its severity. Thus assessment of alcohol ingestion in trauma patients is very important in emergency practice. To date the most accurate diagnostic method for detecting alcohol ingestion is the blood alcohol concentration (BAC) test. However, it is impractical to administer this test to all patients in every ED. The aim of this study is to evaluate the accuracy of self-reporting and physician's diagnoses in assessing alcohol ingestion in trauma patients. METHODS: For three months, we collected self-reports and measured BAC for trauma patients 15 years of age or older who required admission. We excluded patients who were injured more than six hours previously or who drank alcohol after their injury. Patients were classified on the basis of BAC, and we recorded the patients' answers regarding alcohol ingestion and the physicians' diagnoses based on the smell of alcohol. The accuracy of the self-reports and the physicians' diagnoses were assessed in terms of their sensitivity, specificity, positive predictive value, and negative predictive value. RESULTS: Of 361 patients, 105 were BAC-positive and 256 were BAC-negative, respectively. For the assessment of alcohol ingestion, self-reporting was 89.5% sensitive and 94.4% specific, and physicians' diagnoses based on the smell of alcohol were very similarly 90.5% sensitive and 94.9% specific. CONCLUSION: Self-reporting and physician's diagnosis based on the smell of alcohol are both relatively accurate methods for assessing alcohol ingestion for patients in the ED.