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Validation of triage criteria for deciding which apparently inebriated persons require emergency department care
  1. Keith Flower1,
  2. Anneke Post1,
  3. Jeremy Sussman2,
  4. Niels Tangherlini3,
  5. John Mendelson1,
  6. Mark J Pletcher2
  1. 1Addiction and Pharmacology Research Laboratory, California Pacific Medical Center Research Institute, San Francisco, California, USA
  2. 2Departments of Epidemiology and Biostatistics, and Medicine, University of California, San Francisco, California, USA
  3. 3San Francisco Fire Department/Emergency Medical Services, City and County of San Francisco, San Francisco, California, USA
  1. Correspondence to Keith Flower, Addiction and Pharmacology Research Laboratory, St Luke's Hospital, 7th floor, 3555 Cesar Chavez Street, San Francisco, CA 94110, USA; flowerk{at}cpmcri.org

Abstract

Objectives The sensitivity and specificity of consensus triage criteria for identifying which apparently inebriated patients could be triaged to care in a sobering centre were determined. Sensitivity and specificity for modifications to these criteria were also investigated.

Methods Paramedics prospectively collected data on apparently inebriated persons en route to the emergency department (ED). 99 of these patients' ED charts were retrospectively reviewed to assess who actually required ED care.

Results Of 99 subjects with both paramedic and ED chart data available, most were male (89%), homeless (57%) and found on the street (81%). Five were admitted and 13 others appeared to require ED care. Per consensus criteria, only 40 were eligible for triage to a sobering centre, but among those were five who appeared to require ED care (sensitivity 72%, 95% CI 47% to 90%; specificity 43%, 95% CI 32% to 55%). Paramedic opinion alone was specific (80%) but not very sensitive (39%). Lowering the pulse exclusion threshold from 130 to 83 would increase sensitivity to 100%, but decrease specificity to 22%. A simple post hoc rule excluding those with age >55 or pulse >83 from non-ED care had high sensitivity (94%) and fair specificity (61%). The consensus criteria's sensitivity and specificity varied (65–83% and 44–49%, respectively) depending on which ED services were considered optional (eg, psychiatric consultation, ECG, intravenous fluids, etc.).

Conclusion Most apparently inebriated individuals in this study did not require ED care, but prospective identification of these persons is difficult. A low exclusion cut-off for tachycardia may improve sensitivity.

  • Triage
  • alcohol
  • prehospital
  • emergency department
  • ambulance
  • clinical assessment
  • emergency care systems
  • mental health
  • alcohol abuse
  • paramedics
  • research
  • cost effectiveness

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Footnotes

  • Funding Supported by NIH DA018179.

  • Ethics approval This study was conducted with the approval of the University of California, San Francisco, Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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