Clinical assessment compared with breathalyser readings in the ER: concordance of ICD-10 Y90 and Y91 codes

Abstract

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.

Performance of the Hack's Impairment Index Score: A Novel Tool to Assess Impairment from Alcohol in Emergency Department Patients

“…Clinicians often rely on a blood alcohol assessment (or breathalyzer) as a proxy assessment of impairment. Unfortunately, the concentration of alcohol gives little information about the degree of clinical impairment . Reasons for this disconnect include patient's sex, age, frequency of ethanol intake, liver function, and other factors impacting tolerance to the clinical effects of alcohol.…”

“…Previous attempts reveal poor to moderate concordance between blood alcohol content and unstructured clinical assessment of “intoxication.” This may in large part be due to subjective clinician assumptions, but also is likely related to the familiarity of the health care provider in making such assessments, patients’ tolerance to alcohol, and cultural variation in “intoxicated” behavior …”

Alcohol: a missed opportunity. A survey of all accident and emergency departments in England

“…Such measures may be useful in the detection of hazardous or harmful levels of alcohol consumption among those patients who are either unable or unwilling to complete a verbal assessment. [12][13][14] The substantial minority of departments that do not assess blood alcohol levels further reduce their likelihood of identifying alcohol-misusing patients.…”

Exploring Structural Relationships Between Blood Alcohol Concentration and Signs and Clinical Assessment of Intoxication in Alcohol-Involved Injury Cases

“…Clearly, as summarized by Touquet (2005), 'clinical assessment is difficult'. For purposes concerned more with gross than with minor misclassification, Cherpitel et al (2005) provided reassurances finding that only a small proportion (1.1%) of those with BAC of 0.10% or above were assessed as not intoxicated and 0.5% were negative on BAC but assessed as moderately or severely intoxicated.…”