Objectives: The purpose of this study was to analyse the validity of clinical assessment of alcohol intoxication (ICD-10 Y91) compared with estimated blood alcohol concentration (BAC) using a breath analyser (ICD-10 Y90) among patients in the emergency room (ER).
Methods: Representative samples of ER patients reporting within six hours of injury (n = 4798) from 12 countries comprising the WHO Collaborative Study on Alcohol and Injuries were breath analysed and assessed blindly for alcohol intoxication at the time of ER admission. Data were analysed using Kendall’s Tau-B to measure concordance of clinical assessment and BAC, and meta analysis to determine heterogeneity of effect size.
Results: Raw agreement between the two measures was 86% (Tau-B 0.68), but was lower among those reporting drinking in the six hours prior to injury (raw agreement 39%; Tau-B 0.32). No difference was found by gender or for timing of clinical assessment in relation to breath analysis. Patients positive for tolerance or dependence were more likely to be assessed as intoxicated at low levels of BAC. Estimates were homogeneous across countries only for females and for those negative for alcohol dependence.
Conclusions: Clinical assessment is moderately concordant with level of BAC, but in those patients who have actually been drinking within the last six hours the concordance was much less, possibly because, in part, of a tendency on the part of clinicians to assign some level of intoxication to anyone who appeared to have been drinking.
- BAC, blood alcohol concentration
- DALY, disability adjusted life years
- ER, emergency room
- IA, Interviewer Assessment
- ICD-9, International Classification of Diseases, 9th revision
- RAPS, Rapid Alcohol Problems Screen
- WHO, World Health Organization
- ICD-10 Y90
- ICD-10 Y91
- clinical assessment
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Preparation of this paper was supported in part by a grant from the US National Institute on Alcohol Abuse and Alcoholism (RO1 AA13750-02).
Competing interests: none declared
The authors alone are responsible for views expressed in this paper, which do not necessarily represent those of the other investigators participating in the WHO Collaborative Study on Alcohol and Injuries nor the views or policy of the World Health Organization.
This paper was presented at the Research Society for Alcoholism Annual Meeting, Vancouver, British Columbia, Canada, June 26 to July 1, 2004.
A research report from the WHO Collaborative Study on Alcohol and Injuries.