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Blood Ethanol Estimation: A Comparison of Three Methods

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Letters to the Editor
85
Blood Ethanol Estimation:
A
Comparison
of
Three
Methods
To
the
Editor:-Quick and accurate
determination of ethanol intoxication is
frequently needed
in
the ED. Clinical
estimation of intoxication is reportedly
However, the “criterion
standard,” laboratory blood alcohol
concentration (BAC) analysis, often lacks
the timeliness necessary for clinical use
with
emergently
ill
patients.
Various methods for point-of-care
estimation of BAC have been applied
in
the ED. Previous studies have ad-
dressed the correlation of clinical esti-
mation (CE),1-4 breath analysis
(BRE),s-’O and saliva alcohol (SAL)
analysis”,” with BAC analysis. The ac-
curacy of each of these methods is af-
fected by several patient and technician-
dependent factors.
No
previous study has compared all
of these modalities of alcohol level es-
timation (ALE)
to
one another
in
the
same clinical setting. We performed a
blinded prospective analysis of these
modalities
in
a cohort of ED patients.
Methods
Study
Design.
This was a prospec-
tive, blinded study comparing three dif-
ferent methods of point-of-care ALE
(CE, BRE, and SAL analysis)
with
lab-
oratory BAC determination.
Setting.
The study was performed
from July
5
to December
14,
1993,
at a
university-based hospital
with
an ED
annual census of approximately
55,000
visits. The ED is staffed by residents
from emergency medicine (EM) and
other training programs who are super-
vised by full-time
EM
attending physi-
cians.
PopulationlHuman Subject
Com-
mittee Review.
Any ED patient for
whom a BAC determination was
or-
dered was considered eligible for the
study. Patients were enrolled
as
a con-
venience sample as time and personnel
permitted. Verbal consent was obtained
from patients, and they were given an
information sheet regarding the study at
the time of their release from the ED.
The study was approved by
our
insti-
tution’s Committee on Research Involv-
ing Human Subjects.
Experimental Protocol.
It was the
authors’ intent to assess these measures
in
our
normal routine ED practice.
Therefore, no additional training was
provided to participating individuals re-
garding CE
or
BRE of alcohol intoxi-
cation. In
our
ED, nurses and nursing
assistants routinely perform BRE
on
our
patients as indicated. These staff mem-
bers receive one in-service training ses-
sion. Staff members were cognizant that
the study was ongoing and were asked
to make a special effort to obtain reli-
able BRE measurements. Blood sam-
ples were drawn, sent to
our
hospital
laboratory, and analyzed per preexisting
institutional protocols. The
only
depar-
ture from routine was the addition
of
SAL estimation as performed by trained
research assistants and physicians after
receiving one in-service training session.
After skin preparation with povi-
done-iodine (Betadine), a BAC sample
was sent to the hospital laboratory in
a sodium-fluoride-containing Vacu-
tainer (Bectin-Dickenson, Franklin
Lakes, NJ). Within
15
minutes
of
a blood
draw, three ALEs were performed by
separate individuals blinded to each
other’s results.
The
three procedures
were performed sequentially
in
the fol-
lowing order: an ED registered nurse
(RN) recorded a clinical estimate. A dif-
ferent RN
or
a nursing assistant per-
formed a BAC determination with an
Alcosensor I11 (Intoximeters Incorpo-
rated, St. Louis,
MO),
which was cali-
brated on a monthly basis and used per
the manufacturer’s specifications. The
SAL was determined using a QED
A350
Saliva Alcohol Test (Enzymatics Incor-
porated, Horsham, PA). This device has
a “QIA spot,” which darkens only on
contact with an adequate volume
of
sa-
liva sample, thus allowing the user to
determine the adequacy of the test. The
SAL determinations were performed by
previously trained research assistants and
physicians. Laboratory analysis of BAC
was performed by trained laboratory
technicians using the TDx Immunoassay
(Abbott Laboratories, Chicago, IL) per
routine at
our
institution.
Data Measurements
and
Anafy-
sis.
Data from ALE for each tech-
nique and the criterion standard, BAC
determination, were recorded by the re-
search assistants. Additional data in-
cluded patient demographics, clinical in-
dication for blood ethanol, and
turnaround time for BAC results. The
turnaround time was defined as the in-
terval from the time the blood was drawn
to the time the BAC was reported.
The three ALEs were compared with
BAC determination using the kappa sta-
tistic and Pearson correlation. In addi-
tion, sensitivity and specificity (and
95%
CIS) for detecting a BAC
of
100
mg/dL
were calculated for each ALE. Since the
upper
limit
of detection for alcohol for
the SAL analysis used was
350
mg/dL,
all the BACs
>
350
mgidL were ad-
justed to
350
mg/dL for the comparison
with the SAL level. Only those patients
for whom attempts were made to collect
data
for
all three ALE methods were
subjected to analysis. Patients who did
not have adequate breath and/or saliva
samples were noted but not included
in
the final analysis.
Results
Data collection was attempted for
78
patients. Six were excluded because one
or
more
of
the ALE methods were not
performed. Twenty-eight patients
(36%)
were not included
in
the final analysis
because adequate specimens could not
be obtained for either of
or
both the
BRE and SAL techniques. Of those ex-
cluded, five
(6%)
patients could not
provide sufficient specimens
for
either
method;
14
(18%)
could not provide an
adequate breath specimen only; while
nine
(12%)
patients could not provide
an adequate saliva specimen only.
Of
the remaining
44
patients in-
86
ACADEMIC EMERGENCY MEDICINE JAN 1996 VOL 3/NO 1
500
-
400
9
UI
5
300
0
-
200
100
0
1
3
5
7
9
11
13
15
17
19
21 23 25 27 29 31
33
35 37 39 41 43
Patient Number
I
FIGURE
1.
Distribution
of
blood
alcohol concentration
(BAC)
for
the study population.
cluded
in
the analysis, the mean age was
43.7
1?:
14.5 years (SD), with a range of
22-92 years. There were 36 (82%) men
and eight (12%) women. The BAC de-
terminations were ordered
in
the follow-
ing settings: evaluation
of
depressed level
of consciousness
(n
=
23), trauma/head
injury
(n
=
11). part
of
a drug screen
(n
=
3), seizure evaluation
(n
=
3),
other
(n
=
4). Clinical estimation was
done by a total
of
27 registered nurses,
with
no
nurse participating more than
four
times. The mean turnaround time
for
blood alcohol values was 90
5
47
(SD)
minutes.
The BACs ranged from
0
to 576 mg/
dL (Fig. 1). The mean BAC was 288
t
129 (SD) mg/dL. Kappa values com-
paring blood ethanol values and the three
ALE methods were 0.84 for SAL anal-
ysis, 0.69 for BRE, and 0.55 for CE.
Pearson correlation coefficients were 0.90
for SAL analysis, 0.77 for BRE, and
0.58 for CE. Lower BACs showed a bias
toward more favorable comparisons.
For
SAL analysis and CE, the sensitivity and
specificity for detecting a BAC
>
100
mg/dLwere both 1.0(95%CI0.97,1.0).
For BRE, the sensitivity was 1.0 (95%
CI 0.97,l.O) and the specificity was 0.98
(95% CI 0.94, 1.0) for detecting a BAC
>
100 mg/dL.
Discussion
In
the present study, three modali-
ties: CE, BRE, and SAL analysis were
compared with the determination
of
BAC
by
use
of
the kappa statistic (concor-
dance) and Pearson correlation.
In
both
comparisons, SAL determination out-
performed the other two modalities.
However, a significant number
of
pa-
tients were unable to perform either BRE
(n
=
14, 18%), SAL testing
(n
=
9,
12%),
or
both
(n
=
5,6.4%). Although
this is problematic in terms
of
statistical
analysis, we consider it an important re-
sult that points out a significant limita-
tion
of
BRE and SAL analysis
in
the
ED setting.
Breath analysis requires a certain
degree of ability on the part of both the
patient and the technician. Patients’
abilities to provide breath specimens are
influenced by their abilities to follow di-
rections and to accurately execute the
procedure while in the intoxicated state.
Previous studies have reported a drop
in
correlation
of
orally obtained and na-
sally obtained breath alcohol samples
between “cooperative” and “uncoop-
erative” patientss and between con-
scious and unconscious patients.”
In
1981,
McDermott and Evans reported a cor-
relation
of
0.89 and wrote, “It is nec-
essary to stress that in order to obtain
these results a considerable effort is
needed to train staff members in the use
of the machine, and to maintain and
standardize the unit.”x In the current
study, a significant number of patients
(n
=
19) could not provide adequate
specimens
for
BRE.
Saliva specimen acquisition also was
impaired by lack
of
an adequate amount
of saliva in patients with dry mucous
membranes
(n
=
14) in the current study
population. Jones et al. reported the same
difficulty using the QED Saliva Alcohol
Test, even among healthy volunteers.
l2
This difficulty becomes particularly
problematic in view
of
the pharmaco-
logic tendency of alcohol to contribute
to clinical dehydration. Therefore, al-
though SAL determination and BRE may
provide an accurate means
of
ALE under
carefully controlled conditions, we have
found the performance
of
these screen-
ing methods to be significantly variable,
and thus they are of limited clinical util-
ity
in
the ED.
The present study is limited by the
fact that data were collected on
a
con-
venience rather than a consecutive ba-
sis. It is possible that certain patients
were not included because they were too
uncooperative
or
considered too intox-
icated to provide breath and/or saliva
specimens. If this were the case, an even
larger percentage
of
patients would have
been excluded because
of
the lack
of
adequate specimens. This would further
support the limitations of BRE and/or
SAL testing
in
a clinical setting.
In
the current study, several indi-
viduals performed BRE and SAL anal-
ysis, mimicking typical day-to-day prac-
tice. All had limited training, but
differences in experience and technical
proficiency were not assessed. The study
design called for the individuals per-
forming the three different ALES
to
be
blinded to one another’s results. Any
violation in this portion
of
the protocol
would have potentially invalidated the
results reported. Since one
of
the tech-
niques tested (SAL analysis) had an up-
per limit
of
detection, all BACs
>
350
mg/dL
(n
=
13) were adjusted to
350
Letters to the Editor
87
mg/dL for the comparison with SAL
level. This artificially improved our kappa
statistic and Pearson correlation. Fi-
nally. the study was limited by the rel-
atively low number of patients sampled.
Further studies might address the ef-
fect of additional years of experience on
CE of BAC. Our own future efforts in-
clude assessment
of
the use of serum
instead of saliva in the
QED
device. This
method of sampling promises to be less
dependent on patient compliance level
and hydration status.
Conclusion
Our findings suggest that SAL es-
timation using a QED
350
is
superior to
BRE using an Alcosensor
111
and to
CE
for rapid estimation of BAC in the
ED
patient. However,
all
tests seem to dis-
criminate between patients with
BAC
levels
>
100
mg/dL equally well.
A
sig-
nificant number of patients are unable
to provide a sufficient quantity
of
saliva
to test. This is a significant factor lim-
iting the current utility of SAL estima-
tion for
ED
patients. A similar failure
to cooperate with BRE was noted.
MARK
E.
KEIM,
MD
JOEL
M.
BARTFIELD.
MD
NANCY
RACCIO-ROBAK, RN, MPH
Albany Medical College, Albany,
NY
Department of Emergency Medicine
Prior presentation: ACEP Research Forum,
San Francisco, CA, February 1995.
The authors thank John Lekas, BS, EMT-P,
and Annette Liu, BS, for their help with study
implementation. Special appreciation to the
nursing staff of the Emergency Department
of
Albany
Medical Center for their help with
data collection. The authors also
thank
Terry
L.
Peters, MS,
for
her help in data analysis.
Key words: ethanol; alcohol; blood levels;
intoxication; measurement.
REFERENCES
1.
AMA Council on Scientific Affairs. Al-
cohol
and
the driver. JAMA. 1986;
2. Rutherford WH. Diagnosis
of
alcohol
ingestion
in
mild head injuries. Lancet.
3.
Bogen EJ. Drunkeness. JAMA. 1927;
4. Maio RF,
Wu
A, Blow FC, Zink BJ.
255 522-7.
1977; 1:1021-3.
89:1508-11.
Prehospital care providers
do
not accu-
rately identify motor-vehicle crash
pa-
tients
with
positive serum alcohol con-
centrations: a brief report. Prehosp
Disaster Med. 1994; 9(suppI):S74.
5.
Gibb KA, Yee AS, Johnston
CC,
Martin
SD, Nowak
RM.
Accuracy and useful-
ness of
a
breath alcohol analyzer. Ann
Emerg Med. 1984; 13516-20.
6. Lester D. Breath tests for alcohol.
N
Engl
J
Med. 1971; 284:1269-70.
7.
Alobaidi
TAA, Hill DW, Payne JP. Sig-
nificance of variations
in
blood-breath
partition coefficient of alcohol. Br Med
8.
Evans RP, McDermott
FT.
Use of al-
cometer
in
a casualty department. Med
9. Wenzel
J,
McDermott
FT.
Accuracy
of
blood alcohol estimations obtained with
a
breath alcohol analyzer
in
a casualty
department. Med
J
Aust.
1985;
142:627-
8.
10.
Gerberich
SG,
Gerberich BK, Fife D,
Ciceno J, Lilja
P,
Van Bertcom L. Anal-
ysis of the relationship between blood
alcohol and nasal breath alcohol concen-
trations: implications
for
assessment of
trauma cabes. J Trauma. 1989; 29:338-
43.
11.
Christopher TA. Zeccardi JA. Evalua-
tion of the Q.E.D. saliva alcohol test-
a new rapid accurate device for
mea-
suring
ethanol in saliva. Ann Emerg Med.
12.
Jones AW. Evaluation of Q.E.D. saliva
alcohol test- final report. 1992, De-
partment
of
Alcohol Toxicology,
Uni-
versity Hospital, Linkoping, Sweden;
Enzymatin Incorporated, Horsham,
PA.
J. 1976; 2: 1479-81.
J
Aus~. 1981; 1:185-6.
1992; 21:120-2.
Transport
of
Assaulted
Patients Using Nonmedical
Personnel
To
the
Editor:-At first glance, the
article “Urban Trauma Transport of
As-
saulted Patients Using Nonmedical Per-
sonnel” by Branas and colleagues may
not seem applicable to many emergency
physicians or emergency medical ser-
vices (EMS) medical directors. After
all, few EMS systems interface with po-
lice officers who are willing to get ac-
tively involved with the out-of-hospital
care and transport of injured patients.
In even fewer cases
is
it true that “police
are explicitly permitted
to
transport
penetrating injuries and
often
do
[em-
phasis added]
.
. .
,”
as in Philadelphia.
In fact, I know
of
no other
EMS
system
that has a “recognized and defined role
for police transport
of
assaulted trauma
victims.” However, whether or not the
local police department transports pa-
tients, the article is relevant to
all
phy-
sicians involved in the out-of-hospital care
of the trauma victim.
The authors concluded that as-
saulted patients have generally equiva-
lent outcomes regardless of whether they
were treated and transported by fire
medics or simply transported by
police
officers. This finding goes against the
current dogma of fluid resuscitation and
other measures designed to augment
central intravascular volume and raise
the blood pressure (BP) of hypotensive
trauma victims. However, it is well in
keeping with the clinical experience of
many EMS, emergency medicine, and
trauma specialists. It also indirectly sup-
ports recent literature on out-of-hospital
care of the trauma ~ictim.~-~
The authors state that “the effec-
tiveness of out-of-hospital endotracheal
intubation, fluid resuscitation, and con-
trol
of
hemorrhage in improving the sur-
vival
of
trauma patients has been re-
ported.” However, the effectiveness of
these modalities also has been ques-
tioned. An evolving theory
of
out-of-
hospital trauma management holds that
attempts to normalize BP in the patient
with uncontrolled hemorrhage (using
preoperative fluid resuscitation and/or
with adjuncts such
as
the pneumatic an-
tishock garment) may be detrimental.
These measures
may
lead to accelera-
tion
of
hemorrhage, hydraulic clot dis-
lodgment, and/or dilution of clotting
factors. The study of Branas et
al.
pro-
vides indirect support for that evolving
paradigm. Therein lies the importance
of
this paper, at least in my mind.
However, the authors focus on the
issue of
“a
trade-off between using per-
sonnel who are less-equipped and less-
trained for emergency medical response
against the increased costs of equipment
and training
for
transport by specialized
EMS personnel.” Isn’t the issue not the
increased cost of training and equipping
these personnel, but their benefit?
Branas et al. found that fire medics
generally transported sicker patients than
did nonmedical police officers. Not sur-
... Second, the acc:,:racy of-the saliva test is reiated to the level ofcooperation ofthe individual providing the sample; saliva BAC corresponded to blood BAC less well when samples are ottained from highly intoxicated Persons (Bendtsen et al., 1999). Thir.d, even when individuals are cooPerative, some researchers have experienced difficulty co[ecting sufficient samples for analysis -from individuals rilrh d.y -.r"or'ti membranes (Keim et al', 1996). Fourth, the accuracy of test results obtained from the Q.E.D. ,{350 decreases as BAC increases past 0.10 g/dl (Keim et al.,1999). ...
Chapter
This chapter provides an overview of the methods of determining Blood Alcohol Concentration (BAC) that are useful in alcohol research. BAC refers to the amount of alcohol circulating in the bloodstream, and is the best estimate of the effects of alcohol on the brain. BAC varies as a function of dose of alcohol, time, gender, body weight, age, beverage type, and individual differences in absorption and metabolism of alcohol. BAC measurement allows for a direct comparison of intoxication levels across persons. Although direct blood alcohol measurement via gas chromatographic methods remains the standard, BAC can be estimated from other bodily fluids, including saliva, urine, and sweat, and from the breath samples. In addition, predictions can be made using mathematical models of BAC that take into account major factors affecting the absorption and metabolism of alcohol. Both advantages and disadvantages of each method of BAC determination are reviewed. Limitations relate both to the biological correspondence of the sample tested to the actual BAC and to the current instrumentation available for analysis. When choosing among BAC measurement options, the resources available, the level of accuracy required, and the nature of the inferences to be made, must be considered.
Chapter
IntroductionFailure to perform a comprehensive medical evaluationInappropriate use of blood alcohol levels during management and dispositionFailure to protect the patient, staff, and third parties from harmFailure to consider the indications for and adverse effects of chemical restraintIncomplete or dangerous physical restraint applicationFailure to assess for and recognize suicide and/or homicide riskFailure to provide brief interventions and appropriate substance abuse referrals to intoxicated patientsPrematurely releasing an intoxicated or violent patientPearls for Improving Patient Outcomes
Chapter
IntroductionOver-reliance on the “Classic” Clinical Presentations of Aortic Dissection, Rupturing Abdominal Aortic Aneurysm, Spinal Epidural Abscess, and Pulmonary EmbolismFailure to Perform a Risk Factor Assessment for Serious Etiologies Back PainFailure to Perform a Complete Neurologic ExamFailure to Recognize the Limitations of Plain Radiography in Excluding a Back Pain EmergencyInadequate Antibiotic Treatment in Patients with Infectious Etiologies of Back PainFailure to Initiate Prompt Treatment in the Patient with Spinal Cord CompressionFailure to Promptly Refer Patients with an Acute Motor RadiculopathyPearls for Improving Patient Outcomes
Chapter
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Chapter
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Chapter
IntroductionOverdiagnosis of otitis mediaFailure to differentiate a simple febrile seizure from other causes of seizuresOver-reliance on the peripheral white blood cell (WBC)count to determine whether a child needs to have a lumbar punctureMisdosing medications for childrenDiagnosing colic in an infant without ruling out other causes of cryingRelying on the physical appearance of a newborn to determine the need for a full sepsis evaluationMisdiagnosing children with vomiting with “gastroenteritis”Pearls for Improving Patient Outcomes
Chapter
IntroductionFailure to implement surrogates to crystalloid during resuscitationOver-reliance on focused abdominal sonography in traumaNot recognizing the significance of a “seat-belt sign ” and over–reliance on the CT scanFailure to recognize early shock in the geriatric trauma patientWithholding radiographic studies in the pregnant trauma patient for fear of fetal radiation exposureInappropriate use of CTs and plain radiographs of the spineFailure to appropriately apply C-spine clearance rulesFailure to obtain CT imaging of the cervical spine in patients at high risk for injuryFailure to screen for blunt carotid injury in patients at riskReliance on a dopplerable pulse to rule out vascular injuryFailure to intervene selectively on incidentally identified pneumothoracesAvoiding succinylcholine in the acutely burned or crushed patientFailure to provide pelvic compression for open book pelvic fracturesDischarging a mild head injury patient with a normal head CT and GCS score of 15 without close observationImportant Issues That Lack Formal DataFailure to remove patients from backboardsErrors in transporting patients to tertiary care facilitiesOver-Reliance on laboratory data in traumaIntubation of trauma patients with an endotracheal tube (ETT)that is too smallFailure to provide adequate analgesia to trauma patientsPearls for Improving Patient Outcomes
Chapter
IntroductionMisdiagnosis of cardiac ischemia as intra-abdominal pathology (and vice versa)Over-reliance on laboratory values and ancillary testing in suspected mesenteric ischemiaFailure to consider heterotopic pregnancy in women receiving reproductive assistanceOver-reliance on “classic” presentations and laboratory results in populations at high risk for atypical presentations of appendicitisFailure to appreciate atypical signs and symptoms in the elderlyPearls for Improving Patient Outcomes
Chapter
IntroductionFailure to properly prepare a wound prior to closureFailure to detect the presence of a foreign body in a woundFailure to recognize the morbidity associated with plantar puncture woundsIndiscriminate use of prophylactic antibiotics for bite woundsFailure to provide appropriate wound after care instructionsPearls for Improving Patient Outcomes
Chapter
IntroductionFailure to identify “red flag” features of headachesWaiting for results before treating suspected bacterial meningitisFailing to recognize the limitations of a non-contrast head CTTrusting the laboratory evaluation of xanthochromiaNeglecting those sources of headache that lie outside the skullNeglecting a few odd sources of headache that dwell inside the skullFailure to pursue immediate neurosurgical interventionNot responding fully to the medical management of intracerebral hemorrhage while arranging for neurosurgical evaluationAttributing headache to elevated blood pressureFailure to consider a broad armamentarium in the treatment of headachePearls for Improving Patient Outcomes
Article
Scientific investigations have produced 50 years of accumulated evidence showing a direct relationship between increasing blood alcohol concentration (BAC) in drivers and increasing risk of a motor vehicle crash. There is scientific consensus that alcohol causes deterioration of driving skills beginning at 0.05% BAC or even lower, and progressively serious impairment at higher BACs. Drivers aged 16 to 24 years have the highest representation of all age groups in alcohol-related road crashes; young drivers involved in alcohol-related fatal crashes have lower average BACs than older drivers. Alcohol impairs driving skills by its effects on the central nervous system, acting like a general anesthetic. It renders slower and less efficient both information acquisition and information processing, making divided-attention tasks such as steering and braking more difficult to carry out without error. The influence of alcohol on emotions and attitudes may be a crash risk factor related to driving style in addition to driving skill. Biologic variability among humans produces substantial differences in alcohol influence and alcohol tolerance, making virtually useless any attempts to fix a “safe ” drinking level for drivers. The American Medical Association supports a policy recommending (1) public education urging drivers not to drink, (2) adoption by all states of 0.05% BAC as per se evidence of alcohol-impaired driving, (3) 21 years as the legal drinking age in all states, (4) adoption by all states of administrative driver's license suspension in driving-under-the-influence cases, and (5) encouragement for the automobile industry to develop a safety module that thwarts operation of a motor vehicle by an intoxicated person.
Article
Study objective: To evaluate the accuracy of the Q.E.D.(TM) A-150 Saliva Alcohol Test, a new device that gives a specific quantitative blood alcohol level by measuring saliva alcohol concentration in the range of 0 to 150 mg/dL. Study design: Forty-two healthy volunteers consumed 4.5 to 6 oz of alcohol in the form of beer, wine, or liquor over a 90-minute period. Blood and saliva samples were obtained for alcohol measurement at 30, 60, 90, and 120 minutes after the last drink. Blood samples were analyzed within 24 hours by gas chromatography at a commercial clinical laboratory. Saliva samples were tested immediately using the new Q.E.D.(TM) A-150 Saliva Alcohol Test. Results: Excellent correlation was observed between saliva and blood alcohol levels over the range 0 to 150 mg/dL (slope = 1.0; intercept = 2.4; r = .98). Conclusion:The Q.E.D.(TM) Test is an accurate device for specific quantitative measurement of alcohol levels using saliva.
Article
42 per cent of a consecutive series of patients with mild head injuries with concussion were found to have positive blood-alcohol tests. There were errors in the clinical diagnosis of alcohol ingestion among patients with both positive and negative blood-alcohols. Medicolegal questions have so dominated the problems of diagnosing alcohol ingestion as to prevent doctors considering its clinical importance. The value of a laboratory test giving an immediate reading is emphasised.
Article
A helium-neon laser was used to measure the alcohol content of breath from six volunteers at regular intervals over up to four hours. The corresponding blood values were calculated with a blood : breath partition coefficient of 2100. When these values were compared with those obtained by direct measurement it was obvious that substantial variations occurred from one person to another in the derived values and that even in the same person the use of the partition coefficient of 2100 led to significant differences between the direct and derived values for blood, and these differences changed with time. Thus the assertion that a constant partition coefficient of 2100 exists between alcohol in blood and that in breath is not supported by the evidence. Accordingly the use of such a partition coefficient to derive blood alcohol values for law enforcement is not justified.
Article
To evaluate the accuracy of the Q.E.D. A-150 Saliva Alcohol Test, a new device that gives a specific quantitative blood alcohol level by measuring saliva alcohol concentration in the range of 0 to 150 mg/dL. Forty-two healthy volunteers consumed 4.5 to 6 oz of alcohol in the form of beer, wine, or liquor over a 90-minute period. Blood and saliva samples were obtained for alcohol measurement at 30, 60, 90, and 120 minutes after the last drink. Blood samples were analyzed within 24 hours by gas chromatography at a commercial clinical laboratory. Saliva samples were tested immediately using the new Q.E.D. A-150 Saliva Alcohol Test. Excellent correlation was observed between saliva and blood alcohol levels over the range of 0 to 150 mg/dL (slope = 1.0; intercept = 2.4; r = .98). The Q.E.D. Test is an accurate device for specific quantitative measurement of alcohol levels using saliva.
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To prevent serious complications and facilitate efficient and effective management of patients admitted to the emergency department or intensive care settings, it is extremely important to differentiate, quickly, between elevated concentrations of alcohol in the blood and compromised neurological status due to brain injury or other pathology. This research analyzed the relationship between blood alcohol concentrations (BACs) estimated from venous blood samples and those estimated from breath samples that were obtained using the Alco-Sensor III device with an attached tube for passive nasal breath sampling. Blood and breath samples, as well as brief medical histories and demographic and environmental data, were obtained and recorded for 35 adult trauma patients admitted to two major urban emergency departments. Passively expired nasal breath provided an excellent estimate of BAC measured from venous blood (range, 0 to 0.32) as evidenced in the extremely high regression coefficient (r = 0.99; slope = 1.22; p less than 0.0001). BAC assessment and monitoring, through the application of passive nasal breath sampling, provides a means of rapidly estimating BAC, and thus can facilitate diagnosis and the initiation of appropriate management and treatment.
Article
The accuracy and reliability of a rapid blood alcohol estimation by means of a breath alcohol analyser has been evaluated under casualty department conditions in a series of 646 road-crash victims managed at the Dandenong and District Hospital. A higher correlation (r = 0.91) was found between the breath alcohol analyser readings in 633 casualties and those obtained by blood analysis in the police laboratory. In 13 unconscious casualties in whom a nasal breath test was performed, the correlation was lower (r = 0.76). In six casualties, the breath alcohol analyser readings showed lower alcohol concentrations than the legal limit of 0.05 g/100 mL (10.9 mmol/L), but blood analysis detected an illegal concentration. Further evaluation of the accuracy of the breath alcohol analyser in other casualty departments is necessary before it can be recommended as a screening device in States which have legislated for compulsory blood alcohol tests in adult road casualties.
Article
This article has no abstract; the first 100 words appear below. Above a threshold level of 0.05 per cent of ethyl alcohol in the blood, the risk of collision involvement is a positively related monotonic function of blood ethanol level. State statutes recognize blood alcohol levels of 0.08 per cent (Utah), 0.10 per cent (22 states) and 0.15 per cent (27 states) or more as prima facie evidence of "driving under the influence"; the amount of alcohol in about 225 ml of whiskey circulating in the blood of a 70-kg person produces a concentration of 0.15 per cent. Ethanol distributes itself between the blood and gas phase of the lungs according . . . David Lester, Ph.D.
Article
We evaluated the accuracy of a hand-held breath alcohol analyzer in the rapid determination of blood alcohol levels in the emergency patient with suspected ethanol intoxication. The Alco -Sensor III breath alcohol analyzer was used to measure alcohol levels in orally and nasally obtained end-expiratory breath samples in 55 patients. These levels were compared to directly measured blood alcohol levels. The patients were categorized into cooperative and uncooperative groups. The mean oral breath alcohol level obtained was 0.187 +/- 0.100 g/dL (range, 0.000 to 0.419) while the mean serum level was 0.217 +/- 0.113 g/dL (range, 0.00 to 400). The overall correlation between these two methods of measuring blood alcohol level was strong (r = .879, P less than .001). In cooperative patients the correlation was even stronger (r = .963, P less than .001), while in uncooperative patients the correlation was less but still significant (r = .723, P = .001). Nasally obtained samples correlated well with blood levels in cooperative patients (r = .874, P less than .001), but the correlation was less strong in uncooperative persons (r = .694, P = .003). Our study indicates that the Alco -Sensor III breath alcohol analyzer is sufficiently accurate to be of use in rapidly assessing blood alcohol levels, even when a patient is unable to cooperate fully.