Detection of acute alcohol intoxication and chronic alcohol dependence by trauma center staff

Larry M. Gentilello, Andres Villaveces, Richard R. Ries, Katie S. Nason, Elizabeth Daranciang, Dennis M. Donovan, Michael Copass, Gregory Jurkovich, Frederick P. Rivara

Research output: Contribution to journalArticle

89 Citations (Scopus)

Abstract

Background: Trauma patients with acute alcohol intoxication or chronic alcohol dependence are at greater risk for morbidity and mortality. We hypothesized that relying on clinical suspicion to detect acute alcohol intoxication and chronic alcohol dependence in trauma patients is inaccurate, influenced by injury factors, and biased by race, gender, age, and socioeconomic status. Methods: Trauma patients were screened with a blood alcohol concentration and with the Short Michigan Alcohol Screening Test and CAGE questionnaire. Before screening, physicians and emergency department nurses were asked whether the patient was acutely intoxicated (blood alcohol concentration > 100 mg/dL) or had a chronic alcohol problem. Sensitivity, specificity, positive, and negative predictive values were determined by comparing responses with blood alcohol concentration, Short Michigan Alcohol Screening Test, and CAGE questionnaire results, stratified by injury and demographic factors. Results: Clinical evaluations were obtained on 462 patients. Overall, 23% of acutely intoxicated patients were not identified by physicians. The miss rate increased to one third in severely injured, chemically paralyzed, or intubated patients. Specificity was also poor. Patients with a negative blood alcohol concentration were more likely to be falsely suspected of intoxication if they were either young, male, perceived as disheveled, uninsured, or having a low income (p < 0.05). Staff identified < 50% of patients with a positive Short Michigan Alcohol Screening Test or CAGE, and falsely identified 26% of patients as alcoholic. Conclusions: Formal alcohol screening should be routine because clinical detection of acute alcohol intoxication and dependence is inaccurate. Screening should also be routine to avoid discriminatory bias attributable to patient characteristics.

Original languageEnglish (US)
Pages (from-to)1131-1139
Number of pages9
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume47
Issue number6
DOIs
StatePublished - Jan 1 1999
Externally publishedYes

Fingerprint

Alcoholic Intoxication
Trauma Centers
Alcoholism
Alcohols
Wounds and Injuries
Physicians
Social Class
Hospital Emergency Service
Nurses
Demography

Keywords

  • Alcohol
  • Alcoholism
  • Injuries
  • Intervention studies
  • Public health
  • Trauma centers
  • Traumatology

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Gentilello, L. M., Villaveces, A., Ries, R. R., Nason, K. S., Daranciang, E., Donovan, D. M., ... Rivara, F. P. (1999). Detection of acute alcohol intoxication and chronic alcohol dependence by trauma center staff. Journal of Trauma - Injury, Infection and Critical Care, 47(6), 1131-1139. https://doi.org/10.1097/00005373-199912000-00027

Detection of acute alcohol intoxication and chronic alcohol dependence by trauma center staff. / Gentilello, Larry M.; Villaveces, Andres; Ries, Richard R.; Nason, Katie S.; Daranciang, Elizabeth; Donovan, Dennis M.; Copass, Michael; Jurkovich, Gregory; Rivara, Frederick P.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 47, No. 6, 01.01.1999, p. 1131-1139.

Research output: Contribution to journalArticle

Gentilello, LM, Villaveces, A, Ries, RR, Nason, KS, Daranciang, E, Donovan, DM, Copass, M, Jurkovich, G & Rivara, FP 1999, 'Detection of acute alcohol intoxication and chronic alcohol dependence by trauma center staff', Journal of Trauma - Injury, Infection and Critical Care, vol. 47, no. 6, pp. 1131-1139. https://doi.org/10.1097/00005373-199912000-00027
Gentilello, Larry M. ; Villaveces, Andres ; Ries, Richard R. ; Nason, Katie S. ; Daranciang, Elizabeth ; Donovan, Dennis M. ; Copass, Michael ; Jurkovich, Gregory ; Rivara, Frederick P. / Detection of acute alcohol intoxication and chronic alcohol dependence by trauma center staff. In: Journal of Trauma - Injury, Infection and Critical Care. 1999 ; Vol. 47, No. 6. pp. 1131-1139.
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AU - Donovan, Dennis M.

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N2 - Background: Trauma patients with acute alcohol intoxication or chronic alcohol dependence are at greater risk for morbidity and mortality. We hypothesized that relying on clinical suspicion to detect acute alcohol intoxication and chronic alcohol dependence in trauma patients is inaccurate, influenced by injury factors, and biased by race, gender, age, and socioeconomic status. Methods: Trauma patients were screened with a blood alcohol concentration and with the Short Michigan Alcohol Screening Test and CAGE questionnaire. Before screening, physicians and emergency department nurses were asked whether the patient was acutely intoxicated (blood alcohol concentration > 100 mg/dL) or had a chronic alcohol problem. Sensitivity, specificity, positive, and negative predictive values were determined by comparing responses with blood alcohol concentration, Short Michigan Alcohol Screening Test, and CAGE questionnaire results, stratified by injury and demographic factors. Results: Clinical evaluations were obtained on 462 patients. Overall, 23% of acutely intoxicated patients were not identified by physicians. The miss rate increased to one third in severely injured, chemically paralyzed, or intubated patients. Specificity was also poor. Patients with a negative blood alcohol concentration were more likely to be falsely suspected of intoxication if they were either young, male, perceived as disheveled, uninsured, or having a low income (p < 0.05). Staff identified < 50% of patients with a positive Short Michigan Alcohol Screening Test or CAGE, and falsely identified 26% of patients as alcoholic. Conclusions: Formal alcohol screening should be routine because clinical detection of acute alcohol intoxication and dependence is inaccurate. Screening should also be routine to avoid discriminatory bias attributable to patient characteristics.

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