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

Background: Trauma patients with acute alcohol intoxication or chronic alco hol dependence are at greater risk for morbidity and mortality. We hypothes ized that relying on clinical suspicion to detect acute alcohol intoxicatio n and chronic alcohol dependence in trauma patients is inaccurate, influenc ed by injury factors, and biased by race, gender, age, and socioeconomic st atus. Methods: Trauma patients were screened with a blood alcohol concentration a nd with the Short Michigan Alcohol Screening Test and CAGE questionnaire. B efore screening, physicians and emergency department nurses were asked whet her 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 wit h blood alcohol concentration, Short Michigan Alcohol Screening Test, and C AGE questionnaire results, stratified by injury and demographic factors. Results: Clinical evaluations were obtained on 462 patients. Overall, 23% o f acutely intoxicated patients were not identified by physicians. The miss rate increased to one third in severely injured, chemically paralyzed, or i ntubated patients. Specificity was also poor. Patients with a negative bloo d alcohol concentration were more likely to be falsely suspected of intoxic ation 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 ident ified 26% of patients as alcoholic, Conclusions: Formal alcohol screening should be routine because clinical de tection of acute alcohol intoxication and dependence is inaccurate. Screeni ng should also be routine to avoid discriminatory bias attributable to pati ent characteristics.