The Clinical Evaluation of Alcohol Intoxication Is Inaccurate in Trauma Patients

Ashwini Kumar, Travis Holloway, Stephen M Cohn, Gregory Goodwiler, John R Admire, Ashwini Kumar, Travis Holloway, Stephen M Cohn, Gregory Goodwiler, John R Admire

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.

Keywords: alcohol; alcohol metabolism; breathalyzer; elimination of ethanol; intoxication; trauma.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1. Dashed lines represent breath sample…
Figure 1. Dashed lines represent breath sample measurements, solid lines represent a standard elimination rate of 20 mg/dl/hr
Different colors represent the individuals.

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