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Inebriation Estimation – Can You Guess Blood Alcohol Levels?

February 2, 2023

Written by Rebecca White

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ED clinicians are often inaccurate in their estimations of patients’ blood alcohol content (BAC). Overestimation is common, especially in patients arriving by ambulance compared to walk-ins.

Why does this matter?
Alcohol intoxication is frequently present in patients presenting to the emergency department. Are ED clinicians accurate in predicting BAC of their patients?

The results are sobering…
This prospective survey was conducted at a Level 1 trauma center and included 243 participants (physicians, nurses and medical students) taking care of patients with BAC measured. Clinicians provided an estimated BAC before results were available.

The mean difference in estimated and actual BAC was 17.4 (95%CI 4.7 to 30.1), and participants were inclined to overestimate. There was no significant difference in accuracy between attendings, residents, nurses, or medical students (ANOVA p = 0.90). Accuracy was not correlated to patient’s age, gender, ethnicity, or insurance status. There was an association with mode of arrival (p = 0.003), with walk-ins underestimated (-14.9, CI -32.8 to 3.1) and ambulance arrivals overestimated (28.3, CI 12.7 to 44.0). Among patients with BAC of 0 (N = 18), clinicians estimated non-zero values in 17%.

It’s important to recognize that BAC does not correlate with clinical sobriety. However, BAC can be a useful tool in evaluating and differentiating causes of altered mental status.

Clinician assessment of blood alcohol levels among emergency department patients. Am J Emerg Med. 2023 Jan;63:110-112. doi: 10.1016/j.ajem.2022.10.045. Epub 2022 Oct 31.

What are your thoughts?