Clinical signs of alcohol intoxication as markers of refusal to provide blood alcohol readings in emergency rooms: an exploratory study

Abstract

Literature on alcohol and injury – particularly traffic accidents – focuses mostly on hospital emergency rooms, since these represent a potential point of recurrent alcohol abuse or dependence, as well as a significant source for screening, brief intervention, and referral for treatment.1,2 However, some studies report that social, cultural, and environmental factors influence the validity of self‐reported data.3 In addition, enforcement of drinking and driving laws is associated with denial of drinking among those injured in a motor vehicle accident,4 and this is of particular significance in emergency rooms, where fast decisions must be taken in life‐threatening situations. When self‐reports are compared with estimates of blood alcohol concentration (BAC), the longer the time between an injury and admission to an emergency room, the less likely a person is to report previous drinking, even with a positive blood alcohol concentration.4 Cherpitel5 states that the concordance of negative self‐reports of consumption with breath‐analyzer readings remains high in emergency ROOM populations regardless of when the breath‐analyzer reading is obtained; however, it appears best to obtain the reading before interviewing the patient, since it increases the negative predictive value of the test. Although emergency room alcohol testing rates are similar, ranging from 70% to 90%,6,7 limited research has been conducted on those who refuse to be tested, and a better understanding of those who refuse might result in a more accurate estimate of alcohol prevalence among people involved in traffic injuries. Emergency room protocols for identifying a drunk driver or victim are also not standardized across countries, and BAC testing may not be available as a standard tool for screening in some emergency rooms, particularly in developing countries. Therefore, the identification of a drunk driver or accident victim may still rely on a thorough clinical examination to determine alcohol intoxication, which without continuous training, can lead to misleading results. Consequently, this study aimed to examine the association between clinical signs of alcohol intoxication and refusals to participate in a traffic accident survey among emergency rooms cases in two major trauma centers of a Brazilian state capital.