Alcohol intoxicated patients are usually brought to Emergency Departments of hospitals for treatment and stabilization and to ensure that the symptoms are due to alcohol consumption alone. As such, blood alcohol concentrations are usually determined in these patients. This recent study examined the characteristics of intoxicated patients and whether the admission BAC is taken into account before the patient is released.
Pelissier, F., Lauque, D., Charpentier, S., and Franchitto, N., “Blood Alcohol Concentrations in Intoxicated Patients Seen in the Emergency Department: Does it Influence Discharge Decisions?”, Journal of Study on Alcohol and Drugs, 75: 937-944, 2014.
Characteristics of Intoxicated Patients
Between 2013 and 2014, 907 patients were admitted to the ED of a hospital in France due to acute alcohol intoxication. This represents 1.13% of all ED visits. BACs were recorded in 98.6% of these patients and the admission BACs ranged from 0 to 0.600 g/100mL (median 0.250 g/100mL). Only 2.7% of the admission BACs were less than 0.05 g/100m. Most of the patients were admitted on Saturdays and Sundays at 2 peak hours of 9:00 p.m. and 4:00 a.m. (see Figure 1).
The patients ranged in age from 18 to 84 years (mean 37 years) and the male to female ratio was 2:1. The mean length of stay in the ED was 19 hours (range 0 to 120 hours).
The BAC at discharge of the alcohol-intoxicated patients was estimated using the time between the admission and discharge and an average rate of alcohol elimination of 0.015 g/100mL/h.
Approximately 1/3 of the patients were discharged when their BAC was in excess of the legal BAC limit for driving in France (0.050 g/100mL). Some patients were released with a BAC > 0.200 g/100mL (see Figure 4).
Not Evidence-Based Medicine?
This indicates that the decision to discharge a patient was based on clinical signs of alcohol intoxication such as slurred speech, unsteady gait and red, blood shot eyes rather than the more reliable and accurate BAC and alcohol kinetics. The authors state:
“We found that emergency physicians based the discharge decision on clinical judgment rather than on evidence-based medicine. The discharge decision may carry a risk of subsequent legal proceedings. The role of the accompanying persons must be defined and proof that the physician did everything possible to prevent the patient from driving after leaving the hospital, if estimated BAC is above the legal limit, must be recorded in the patient’s file. Allowing an unaccompanied patient to leave the hospital against medical advice is unadvisable, as the patient or a lawyer can always cast doubt on the quality of consent at the time the self-discharge form was signed.”
Negligence?
The authors also warn:
If an alcohol-intoxicated patient should cause an accident after being discharged from the ED when his or her BAC is still over the legal limit, the physician could be charged with negligence if he or she had not checked that the patient was indeed accompanied at discharge.
